Department of Neurology and Neuroscience Center, the First Hospital of Jilin University, Xinmin Street 1#, Changchun, 130021, China.
Neurol Sci. 2022 Sep;43(9):5217-5227. doi: 10.1007/s10072-022-06120-w. Epub 2022 May 30.
Anti-seizure drugs have long been known to affect thyroid hormone levels in epilepsy patients. The current study is a network meta-analysis designed to produce a systematic review and comprehensive evaluation of thyroid hormone changes to inform future research and clinical treatment.
A systematic search of databases, PubMed, EMBASE, Web of Science, and the Cochrane Library, was conducted and all observational studies reporting thyroid hormone levels in epilepsy patients receiving monotherapy and controls were included. Stata MP.14 was used for analysis.
A total of 35 studies, including 4135 participants and 8 anti-seizure drugs, were analyzed. TSH levels were elevated following use of topiramate [mean = 1.86; 95%CI: 0.83 to 2.90], levetiracetam [mean = 1.08; 95%CI: 0.07 to 2.09], and valproic acid [mean = 1.54; 95%CI: 0.58 to 2.50]. FT4 levels may be lowered by oxcarbazepine [mean = - 6.13; 95%CI: - 8.25 to - 4.02] and T4 was lowered by carbamazepine [mean = - 1.55; 95%CI: - 2.05 to - 1.05] and phenytoin [mean = - 1.33; 95%CI: - 1.80 to - 0.85]. No significant changes were reported for FT3, although use of phenobarbital resulted in a non-significant decrease [mean = - 0.31; 95%CI: - 0.99 to 0.37]. T3 levels were lowered by carbamazepine [mean = - 0.52; 95%CI: - 0.81 to - 0.24]. Lamotrigine had no significant effect on thyroid hormone levels.
Carbamazepine and phenytoin were the drugs most strongly associated with decreases in T4 and T3 levels while topiramate had the greatest elevating effect on TSH. Oxcarbazepine may lead to decreased serum FT4 and FT3, an effect relevant to central hypothyroidism. Phenobarbital appeared to significantly lower FT3. Use of levetiracetam and valproic acid may result in subclinical hypothyroidism. The anti-seizure drug with the least disruptive effect on thyroid hormone levels was found to be lamotrigine.
抗癫痫药物早已被证实会影响癫痫患者的甲状腺激素水平。本研究旨在通过网络荟萃分析，对甲状腺激素变化进行系统评价和综合评估，为未来的研究和临床治疗提供参考。
对PubMed、EMBASE、Web of Science 和 Cochrane Library 等数据库进行系统检索，纳入所有报告接受单药治疗的癫痫患者和对照组甲状腺激素水平的观察性研究。使用 Stata MP.14 进行分析。
共纳入 35 项研究，包含 4135 名参与者和 8 种抗癫痫药物。与对照组相比，托吡酯[均数=1.86；95%置信区间：0.83 至 2.90]、左乙拉西坦[均数=1.08；95%置信区间：0.07 至 2.09]和丙戊酸[均数=1.54；95%置信区间：0.58 至 2.50]可使 TSH 水平升高。卡马西平[均数=-1.55；95%置信区间：-2.05 至-1.05]和苯妥英[均数=-1.33；95%置信区间：-1.80 至-0.85]可降低 FT4 水平，而奥卡西平[均数=-6.13；95%置信区间：-8.25 至-4.02]可降低 T4 水平。FT3 水平虽有报道，但无显著变化，而苯巴比妥的使用导致 FT3 水平非显著下降[均数=-0.31；95%置信区间：-0.99 至 0.37]。卡马西平[均数=-0.52；95%置信区间：-0.81 至-0.24]可降低 T3 水平。拉莫三嗪对甲状腺激素水平无显著影响。
卡马西平和苯妥英与 T4 和 T3 水平降低的相关性最强，而托吡酯对 TSH 的升高作用最强。奥卡西平可能导致血清 FT4 和 FT3 降低，这与中枢性甲状腺功能减退症相关。苯巴比妥似乎可显著降低 FT3。左乙拉西坦和丙戊酸的使用可能导致亚临床甲状腺功能减退症。对甲状腺激素水平影响最小的抗癫痫药物是拉莫三嗪。
