Changes of thyroid hormone levels in epileptic patients.

We measured serum T3, T4, FT3, FT4 and thyrotropin (TSH) by radioimmunoassay in 150 patients with epilepsy. Of the 150 epileptic patients, 120 cases received single antiepileptic drug, including Sod valproate (VPA), carbamazepine (CBZ), phenytoin (PHT), or MixtBrodsky (MB). Each subgroup consisted of 30 cases. The other 30 were untreated epileptics. The results suggested that there was no significant difference in serum thyroid hormone levels among healthy control group, untreated group, and hepatic non-enzyme-inducing anticonvulsant group (P < 0.05). As compared with the three groups mentioned above, the serum T3, T4, FT3, FT4 concentrations of the enzyme inducer groups were decreased, however, significant decrease was found in PHT group and CBZ group (P < 0.05, P < 0.005). All 12 patients with circulating thyroid hormone concentrations below normal reference values were given enzyme inducer. None of them revealed any clinical manifestation of hypothyroidism. There was no significant difference in serum TSH level among the above 6 groups (P < 0.05), and the serum TSH level of all patients was within normal reference limits. Our study showed that the changes of thyroid hormone in epileptics were due to the effect of some AEDs and not the disease itself. The disparity between the effect of enzyme inducer and that of non-enzyme-inducing anticonvulsants indicated that the hepatic microsomal enzyme system metabolizing thyroid hormone to be induced was the main mechanism for decreased serum thyroid hormone concentrations. Though the serum thyroid hormone levels of the enzyme inducer groups were decreased, no significant increase of the mean serum TSH concentration was found. This implies that AEDs may interfere the HPA function in some way.