Shih Fu-Yuan, Chuang Yao-Chung, Chuang Ming-Jung, Lu Yan-Ting, Tsai Wan-Chen, Fu Ting-Ying, Tsai Meng-Han
Departments of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Translational Research in Biomedical Sciences, Kaohsiung, Taiwan; Department of Biological Science, National Sun Yet-Sen University, Kaohsiung, Taiwan; Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Seizure. 2017 May;48:7-10. doi: 10.1016/j.seizure.2017.03.011. Epub 2017 Mar 19.
Patients with epilepsy are frequently required to take antiepileptic drugs (AEDs) for a long period of time. Many studies have shown that AEDs have a negative influence on endocrine function including the thyroid gland, however the risk factors for the development of low thyroid function in these patients are unclear. This study aimed to determine the potential risk factors of low thyroid function in patients with epilepsy.
This was a cross-sectional study including 298 patients with epilepsy. Patients with previous thyroid disease were excluded. Epidemiologic data, type of epilepsy, etiology, the age of seizure onset, duration of epilepsy, intractable epilepsy, and number and dosage of AEDs were recorded. Levels of free thyroxine (fT4) and thyroid stimulating hormone (TSH) were measured.
Fifty-two of the 298 (17.4%) patients had low fT4. Older age (P=0.004), female sex (P=0.014), longer duration of epilepsy (P=0.001), and intractable epilepsy (P=0.009) were significantly associated with low fT4. Regarding individual AEDs, carbamazepine (30.1%), topiramate (28.6%), and levetiracetam (24.3%) were significantly associated with the presence of low fT4. After stepwise logistic regression of all significant variables, female sex, older age, three or more AEDs, and carbamazepine were independent risk factors for low fT4.
Female patients with epilepsy and an older age, AED polytherapy, and carbamazepine treatment had a higher risk of low fT4. Thyroid function in these patients should be monitored closely.
癫痫患者常常需要长期服用抗癫痫药物（AEDs）。许多研究表明，AEDs对包括甲状腺在内的内分泌功能有负面影响，然而这些患者甲状腺功能减退发生的危险因素尚不清楚。本研究旨在确定癫痫患者甲状腺功能减退的潜在危险因素。
这是一项横断面研究，纳入了298例癫痫患者。排除既往有甲状腺疾病的患者。记录流行病学数据、癫痫类型、病因、癫痫发作起始年龄、癫痫病程、难治性癫痫以及AEDs的种类和剂量。检测游离甲状腺素（fT4）和促甲状腺激素（TSH）水平。
298例患者中有52例（17.4%）fT4水平较低。年龄较大（P = 0.004）、女性（P = 0.014）、癫痫病程较长（P = 0.001）和难治性癫痫（P = 0.009）与fT4水平较低显著相关。就单一AEDs而言，卡马西平（30.1%）、托吡酯（28.6%）和左乙拉西坦（24.3%）与fT4水平较低显著相关。对所有显著变量进行逐步逻辑回归后，女性、年龄较大、使用三种或更多种AEDs以及卡马西平是fT4水平较低的独立危险因素。
癫痫女性患者、年龄较大、联合使用多种AEDs以及使用卡马西平治疗时，fT4水平较低的风险较高。应对这些患者的甲状腺功能进行密切监测。
