Kose Engin, Guzel Orkide, Demir Korcan, Arslan Nur
Dokuz Eylul University, Division of Pediatric Metabolism and Nutrition, Izmir.
Behçet Uz Children Hospital, Division of Pediatric Neurology, Izmir.
J Pediatr Endocrinol Metab. 2017 Apr 1;30(4):411-416. doi: 10.1515/jpem-2016-0281.
Ketogenic diet (KD), which is high in fat and low in carbohydrates, mimics the metabolic state of starvation and is used therapeutically for pharmacoresistant epilepsy. It is known that generation of triiodothyronine (T3) from thyroxine (T4) decreases during fasting periods. The aim of this study was to evaluate the thyroid function of children receiving KD for at least 1 year due to drug-resistant epilepsy.
A total of 120 patients [63 males, 52.5%; mean age 7.3±4.3 years, median interquartile range (IQR): 7.0 (4-10 years)] treated with KD for at least 1 year were enrolled. Seizure control, side effects, and compliance with the diet were recorded, and free T3, free T4, and thyroid-stimulating hormone (TSH) levels were measured at baseline and at post-treatment months 1, 3, 6, and 12. The Mann-Whitney U-test, repeated measures analysis of variance (ANOVA) with post-hoc Bonferroni correction, and logistic regression analysis were used for data analysis.
Hypothyroidism was diagnosed and L-thyroxine medication was initiated for eight, seven and five patients (20 patients in total, 16.7%) at 1, 3, and 6 months of KD therapy, respectively. Logistic regression analysis showed that baseline TSH elevation [odds ratio (OR): 26.91, 95% confidence interval (CI) 6.48-111.76, p<0.001] and female gender (OR: 3.69, 95% CI 1.05-12.97, p=0.042) were independent risk factors for development of hypothyroidism during KD treatment in epileptic children.
KD causes thyroid malfunction and L-thyroxine treatment may be required. This is the first report documenting the effect of KD treatment on thyroid function. Thyroid function should be monitored regularly in epileptic patients treated with KD.
生酮饮食（KD）脂肪含量高而碳水化合物含量低，模拟饥饿的代谢状态，用于药物难治性癫痫的治疗。已知在禁食期间，甲状腺素（T4）转化为三碘甲状腺原氨酸（T3）的过程会减少。本研究的目的是评估因耐药性癫痫接受KD治疗至少1年的儿童的甲状腺功能。
共纳入120例接受KD治疗至少1年的患者[63例男性，占52.5%；平均年龄7.3±4.3岁，四分位间距（IQR）中位数：7.0（4 - 10岁）]。记录癫痫发作控制情况、副作用及饮食依从性，并在基线以及治疗后第1、3、6和12个月测量游离T3、游离T4和促甲状腺激素（TSH）水平。数据分析采用曼 - 惠特尼U检验、进行事后邦费罗尼校正的重复测量方差分析（ANOVA）以及逻辑回归分析。
在KD治疗的第1、3和6个月，分别有8例、7例和5例患者（共20例，占16.7%）被诊断为甲状腺功能减退并开始使用左甲状腺素治疗。逻辑回归分析显示，基线TSH升高[比值比（OR）：26.91，95%置信区间（CI）6.48 - 111.76，p<0.001]和女性性别（OR：3.69，95%CI 1.05 - 12.97，p = 0.042）是癫痫儿童KD治疗期间发生甲状腺功能减退的独立危险因素。
KD会导致甲状腺功能异常，可能需要进行左甲状腺素治疗。这是首篇记录KD治疗对甲状腺功能影响的报告。接受KD治疗的癫痫患者应定期监测甲状腺功能。
