Isojärvi J I, Pakarinen A J, Myllylä V V
Department of Neurology, University of Oulu, Finland.
Epilepsia. 1992 Jan-Feb;33(1):142-8. doi: 10.1111/j.1528-1157.1992.tb02297.x.
Serum thyroid hormone balance was assessed in 108 patients receiving chronic antiepileptic drug (AED) therapy. Forty-five patients were receiving carbamazepine (CBZ), 26 phenytoin (PHT), 16 CBZ-PHT, 11 valproate (VPA), and 10 CBZ-VPA. Serum thyroxine (T4) and free thyroxine (FT4) concentrations were low in patient groups receiving CBZ and/or PHT. Serum T4 concentrations were below the normal range in 24 (53.3%) CBZ patients, 11 (42.3%) PHT patients, 12 (75%) CBZ-PHT patients, and in all 10 patients (100%) receiving CBZ-VPA. Furthermore, serum levels of FT4 were below the normal range in 13 (28.9%) CBZ patients, 6 PHT (23.1%) patients, 5 (31.3%) CBZ-PHT patients, and 5 (50%) CBZ-VPA patients. Despite the decreased serum T4 and FT4 levels in these patients, serum basal and stimulated thyrotropin (TSH) concentrations were normal, except for the slightly increased basal TSH in the CBZ-VPA group. In the VPA group, the findings were different from those in other patients: T4 serum levels were unchanged and FT4, T3, and basal TSH levels increased, but stimulated TSH levels did not differ from those of the control group. The decrease in serum thyroid hormone levels during CBZ and/or PHT medication probably is caused by an accelerated hepatic plasma clearance of these hormones due to induction of hepatic microsomal enzyme systems by these AEDs. VPA, an AED with no liver enzyme-inducing properties, does not cause similar changes. The feedback mechanism is not activated, possibly because of a hypothalamic interference by CBZ and PHT.(ABSTRACT TRUNCATED AT 250 WORDS)
对108例接受慢性抗癫痫药物（AED）治疗的患者的血清甲状腺激素平衡进行了评估。45例患者接受卡马西平（CBZ）治疗，26例接受苯妥英（PHT）治疗，16例接受CBZ - PHT联合治疗，11例接受丙戊酸盐（VPA）治疗，10例接受CBZ - VPA联合治疗。接受CBZ和/或PHT治疗的患者组血清甲状腺素（T4）和游离甲状腺素（FT4）浓度较低。24例（53.3%）CBZ患者、11例（42.3%）PHT患者、12例（75%）CBZ - PHT患者以及所有10例（100%）接受CBZ - VPA治疗的患者血清T4浓度低于正常范围。此外，13例（28.9%）CBZ患者、6例（23.1%）PHT患者、5例（31.3%）CBZ - PHT患者以及5例（50%）CBZ - VPA患者的血清FT4水平低于正常范围。尽管这些患者血清T4和FT4水平降低，但血清基础促甲状腺激素（TSH）和刺激后的TSH浓度正常，CBZ - VPA组基础TSH略有升高除外。在VPA组，结果与其他患者不同：血清T4水平未变，FT4、T3和基础TSH水平升高，但刺激后的TSH水平与对照组无差异。CBZ和/或PHT用药期间血清甲状腺激素水平降低可能是由于这些AED诱导肝微粒体酶系统，加速了这些激素的肝脏血浆清除。VPA是一种无肝酶诱导特性的AED，不会引起类似变化。反馈机制未被激活，可能是因为CBZ和PHT对下丘脑有干扰。（摘要截选至250字）
