Gómez J M, Cardesín R, Virgili N, Moreno I, Navarro M A, Montaña E
An Med Interna. 1989 May;6(5):235-8.
Several antiepileptic drugs change the serum levels of thyroid hormones by different mechanisms, of these diphenylhydantoin being the most known. This study was carried out on 96 patients in order to analyse the effects of long-term treatment with phenobarbital (N = 29), carbamazepine (N = 21), sodium valproate (N = 11), diphenylhydantoin (N = 6) and a combination of them all at therapeutic doses. We observed a decrease of T4 seric levels and free T4 index (in 25 and 14 patients respectively, under normal levels) free T4 normal, T3 normal, decreased rT3, and normal TSH in all groups being more noticeable in patients treated with diphenylhydantoin, carbamazepine, phenobarbital and lastly, sodium valproate. It is a different situation from a general non-thyroid disease, where there is a decrease of T3 and where the antiepileptic drugs of different chemical structure induce changes in seric levels of thyroid hormones. The basal TSH is the best measurement to reflect the euthyroidism of these patients.
几种抗癫痫药物通过不同机制改变甲状腺激素的血清水平，其中苯妥英钠最为人所知。本研究对96例患者进行，以分析苯巴比妥（N = 29）、卡马西平（N = 21）、丙戊酸钠（N = 11）、苯妥英钠（N = 6）及其治疗剂量联合使用的长期治疗效果。我们观察到所有组中T4血清水平和游离T4指数均下降（分别有25例和14例患者低于正常水平），游离T4正常，T3正常，反T3降低，TSH正常，在用苯妥英钠、卡马西平、苯巴比妥治疗的患者中更明显，最后是丙戊酸钠。这与一般非甲状腺疾病的情况不同，在非甲状腺疾病中T3降低，不同化学结构的抗癫痫药物会引起甲状腺激素血清水平的变化。基础TSH是反映这些患者甲状腺功能正常的最佳指标。
