Hegedüs L, Hansen J M, Lühdorf K, Perrild H, Feldt-Rasmussen U, Kampmann J P
Clin Endocrinol (Oxf). 1985 Oct;23(4):423-9. doi: 10.1111/j.1365-2265.1985.tb01100.x.
Thyroid function, the clinical occurrence of goitre and ultrasonically determined thyroid gland volume were investigated in 23 patients with phenytoin- and 28 patients with carbamazepine-treated convulsive disorders and compared with matched healthy controls. In the phenytoin treated group median thyroid volume was 26 ml (range 14-57 ml) compared to 17 ml (range 8-41 ml) in the controls (P less than 0.01). Ten patients and four controls had a goitre (NS). Median serum T4 and FT4I levels were reduced, serum TSH level increased and serum T3, T3RU, FT3I and thyroglobulin levels unaltered compared with the controls. In the carbamazepine treated group median thyroid volume was 25 ml (range 13-66 ml) compared to 16 ml (range 9-44 ml) in the controls (P less than 0.01). Thirteen patients and three controls had a goitre (P less than 0.02). Median serum T4, FT4I and FT3I levels were reduced, serum thyroglobulin increased and serum T3, T3RU and TSH levels unaltered compared with the controls. The increase in thyroid size is probably a compensatory mechanism due to the low free thyroid hormones in serum caused by an increased hepatic degradation of thyroid hormones by phenytoin and carbamazepine.
对23例接受苯妥英治疗和28例接受卡马西平治疗的惊厥性疾病患者的甲状腺功能、甲状腺肿的临床发生率以及超声测定的甲状腺体积进行了研究，并与匹配的健康对照者进行了比较。在苯妥英治疗组中，甲状腺体积中位数为26 ml（范围14 - 57 ml），而对照组为17 ml（范围8 - 41 ml）（P < 0.01）。10例患者和4例对照者有甲状腺肿（无显著性差异）。与对照组相比，血清T4和FT4I水平中位数降低，血清TSH水平升高，血清T3、T3RU、FT3I和甲状腺球蛋白水平未改变。在卡马西平治疗组中，甲状腺体积中位数为25 ml（范围13 - 66 ml），而对照组为16 ml（范围9 - 44 ml）（P < 0.01）。13例患者和3例对照者有甲状腺肿（P < 0.02）。与对照组相比，血清T4、FT4I和FT3I水平中位数降低，血清甲状腺球蛋白升高，血清T3、T3RU和TSH水平未改变。甲状腺大小的增加可能是一种代偿机制，这是由于苯妥英和卡马西平增加了肝脏对甲状腺激素的降解，导致血清中游离甲状腺激素水平降低所致。
