Changes in thyroid function tests induced by 2 month carbamazepine treatment in L-thyroxine-substituted hypothyroid children
Abstract
In five L-thyroxine-substituted hypothyroid children with partial epilepsy serum total thyroxine (T4) and free T4 (FT4) significantly (P less than 0.01) decreased following 2 months of carbamazepine (CBZ) administration (20 mg/kg per BW per day) from mean (+/- SD) values of 12.7 +/- 1.1 micrograms/dl and 15.5 +/- 1.8 pg/ml to mean values of 7.5 +/- 2.3 and 10.1 +/- 1.7, respectively. In all but one patient important changes in both serum total and free triiodothyronine (T3, FT3) were not observed; consequently T3:T4 and FT3:FT4 ratios significantly (P less than 0.05) increased in the whole series. Three subjects had post-treatment serum TSH that rose to hypothyroid levels parallel to a T4 decrease. The negligible thyroid hormone secretion and the unmodified T3-uptake (T3U) or T4-binding globulin (TBG) exclude direct effects of CBZ on thyroid gland and on carrier serum proteins, respectively. The findings observed, instead, might be due to accelerated T4 metabolic clearance together with augmented T4 to T3 conversion rate, as previously demonstrated for diphenylhydantoin. The sharp reduction in T4 and FT3 concentrations is the peripheral display of this event, which is associated with a decompensation of the metabolic status, as indicated by serum TSH enhancement. In all cases a supplement of L-thyroxine by itself was able to restore euthyroid TSH serum concentrations, suggesting that hypothyroidism in patients with partial epilepsy to whom CBZ had been administered requires a higher L-T4 substitutive regimen.
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Longer therapy with two months of carbamazepine caused a substantial increase in TSH in three of five hypothyroid children receiving LT4.
“Longer therapy with two months of carbamazepine caused a substantial increase in TSH in three of five hypothyroid children receiving LT4 (183).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [183]
Increased inactivation of LT4 via the monodeiodinase induced by mifepristone, rifampicin, and carbamazepine can reduce the T1/2 of LT4.
“Moreover, increased inactivation of LT4 via the monodeiodinase induced by mifepristone, rifampicin, and carbamazepine can reduce the T1/2 of LT4 (86–88).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [86]
Antiepileptic drug administration in L-T4-replaced patients with either primary or central hypothyroidism requires higher L-T4 doses.
“AED administration in L-T4-replaced patients with either PH (78) or CH (32) requires higher L-T4 doses.”
From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [78]
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- Authors
- De Luca, F., Arrigo, T., Pandullo, E., Siracusano, M. F., Benvenga, S., & Trimarchi, F.
- Affiliations
- University of Messina (IT)
- Venue
- European Journal of Pediatrics
- Published
- 1986-04
- Volume
- 145
- Issue
- 1-2
- Pages
- 77-79
- ISSN
- 0340-6199 (ISSN-L)
- 1432-1076
- OpenAlex
- W2050264182
- Cited by
- 51
- References
- 18
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 1 · 2020: 4 · 2017: 1 · 2016: 1 · 2015: 2 · 2014: 1 · 2013: 1 · 2012: 1
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- European Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- carbamazepine, hypothyroidism, thyroid function tests, free thyroxine, triiodothyronine, T4 to T3 conversion, thyroid-stimulating hormone, focal epilepsy
- MeSH terms
- Carbamazepine, Child, Child, Preschool, Congenital Hypothyroidism, Epilepsies, Partial, Female, Humans, Hypothyroidism, Male, Thyroid Function Tests, Thyroid Gland, Thyrotropin, Thyroxine, Thyroxine-Binding Proteins, Time Factors, Triiodothyronine, Triiodothyronine, Reverse
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