Liewendahl K, Helenius T, Majuri H, Ebeling P, Ahlfors U G
Scand J Clin Lab Invest. 1980;40(8):767-74. doi: 10.3109/00365518009095594.
Serum iodothyronine concentrations were measured in patients on long-term therapy with one or two anticonvulsant drugs. Diphenylhydantoin (DPH) and carbamazepine (CBZ) reduced the serum levels of thyroxine (T4) free T4 index, reverse triiodothyronine (rT3) and 3,3'-diiodothyronine (3,3'-T2), whereas the depressant effect on the serum levels of triiodothyronine (T3) and free T3 index was small but statistically significant. In patients administered DPH and phenobarbital (PB) or CBZ and primidone (PD) the serum iodothyronine levels were also depressed, except for normal T3 and free T3 index. Patients receiving only PB or PD had normal serum levels of total and free thyroid hormones, but decreased concentrations of rT3 and 3,3'-T2. Only supratherapeutic concentrations of DPH and CBZ added in vitro to control sera significantly reduced the number of T4 and T3-binding sites, as reflected in increased T4 and T3 uptake test results. This indicates that the DPH and CBZ-induced decrease in thyroid hormone concentrations in vivo is not due to a displacement of thyroid hormones from their binding sites on serum proteins. The antidepressant drugs amitriptyline and mianserin had no effect on the thyroid hormone levels in serum.
对长期使用一种或两种抗惊厥药物治疗的患者测定了血清甲状腺素浓度。苯妥英（DPH）和卡马西平（CBZ）降低了血清甲状腺素（T4）、游离T4指数、反三碘甲状腺原氨酸（rT3）和3,3'-二碘甲状腺原氨酸（3,3'-T2）的水平，而对血清三碘甲状腺原氨酸（T3）和游离T3指数水平的抑制作用较小但具有统计学意义。在服用DPH和苯巴比妥（PB）或CBZ和扑米酮（PD）的患者中，血清甲状腺素水平也降低，除了T3和游离T3指数正常。仅接受PB或PD治疗的患者血清总甲状腺激素和游离甲状腺激素水平正常，但rT3和3,3'-T2浓度降低。仅在体外向对照血清中添加超治疗浓度的DPH和CBZ可显著减少T4和T3结合位点的数量，这在T4和T3摄取试验结果增加中得到反映。这表明DPH和CBZ在体内引起的甲状腺激素浓度降低并非由于甲状腺激素从血清蛋白上的结合位点被置换。抗抑郁药物阿米替林和米安色林对血清甲状腺激素水平没有影响。
