苯妥英钠——一种需要偏离甲状腺实验室检查结果解读标准方法的药物。
Phenytoin- Medication That Warrants Deviation From Standard Approach for Thyroid Lab Interpretation.
作者信息
Pattan Vishwanath, Candula Narsimha, Adhikari Ramesh, Kashyap Rahul
机构信息
Endocrinology, Wyoming Medical Center, Casper, USA.
Hospital Medicine, University of Florida Health Jacksonville, Jacksonville, USA.
出版信息
Cureus. 2020 Nov 4;12(11):e11324. doi: 10.7759/cureus.11324.
Long-term treatment with antiepileptic drugs like phenytoin has been reported to alter the thyroid hormone levels. It makes interpretation of thyroid labs hard for clinicians. We report a case of 48-year-old Caucasian female on phenytoin since year 1996 with stable seizure control, who was referred to endocrinology clinic in 2016 for evaluation of suspected central hypothyroidism due to discordant results in thyroid lab panel. Labs showed decreased free T4 level of 0.68ng/dL (reference range 0.89-1.76ng/dL) in the setting of normal thyroid stimulating hormone (TSH) 1.76 µIU/mL (reference range 0.46-4.68 µIU/mL). Clinically patient was euthyroid. Free T3 level was normal -3.82 pg/mL (reference range 2.77-5.27 pg/mL). Phenytoin was identified as the cause of the artifactual lowering of free T4 on routine assays. Therefore subsequent thyroid monitoring was done with TSH measurements. Continued follow-up of TSH remained normal over the subsequent follow-up of four years.
据报道，长期使用苯妥英钠等抗癫痫药物会改变甲状腺激素水平。这使得临床医生难以解读甲状腺检查结果。我们报告一例48岁的白人女性，自1996年起服用苯妥英钠，癫痫控制稳定，2016年因甲状腺检查结果不一致被转诊至内分泌科门诊，怀疑患有中枢性甲状腺功能减退。检查显示，在促甲状腺激素（TSH）水平正常为1.76 μIU/mL（参考范围0.46 - 4.68 μIU/mL）的情况下，游离T4水平降低至0.68ng/dL（参考范围0.89 - 1.76ng/dL）。临床上患者甲状腺功能正常。游离T3水平正常，为3.82 pg/mL（参考范围2.77 - 5.27 pg/mL）。在常规检测中，苯妥英钠被确定为导致游离T4假性降低的原因。因此，后续通过检测TSH进行甲状腺监测。在随后四年的随访中，TSH持续监测结果保持正常。
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