İsmail APAK, Yusuf TAMAM, Muazzez SEVİM, Banu TAMAM

Antiepileptik ilaçların tiroid hormon düzeylerine etkisi

Çalışmamızı; Dicle Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı'na başvuran , epilepsi tanısıyla izlenen ve en az 1 yıldır antiepileptik ilaç kullanan 40 hasta oluşturdu. 40 kişilik hasta grubunun 20'si kadın (%50), 20'si erkekti (%50). Hastalar kullandıkları ilaçlara göre 3 gruba ayrıldı. Valproat alan 14 hastanın yaşları 15-44 (ortalama: 27,7) yaş arasında olup, İlaç kullanım süreleri 1-4 (ort 2,67) yıl İdi. Difenilhidantoin alan 11 hastanın yaşlan 18-41 (ortalama : 28,7) yıl idi. Karbamazepin alan 15 hastanın yaşları 16-43 (ortalama 28,5) yaş arasında olup, ilaç kullanım süreleri 1-3 (ortalama 2,6) yıl idi. Bu çalışma epileptik hastalarda kullanılan antiepileptik ilaçların, tiroid hormon düzeylerine etkisini araştırmak amacıyla yapıldı. T4, FT4, T3, FT3, TSH düzeyleri araştırıldı ve aşağıdaki sonuçlar elde edildi. Valproat alan hasta grubunda; T4 düzeyinde anlamlı azalma bulundu. FT4,T3,FT3,TSH düzeylerinde değişiklik saptanmadı. Difenilhidantoin alan hasta grubunda; T4, FT4 düzeylerinde anlamlı azalma bulundu, T3.FT3, TSH düzeylerinde değişiklik saptanmadı. Karbamazepin alan hasta grubunda; T3, FT3, TSH düzeylerinde değişiklik saptanmadı .T4 , FT4 düzeylerinde anlamlı azalma bulundu. T4 düzeyindeki en fazla düşüşün sırasıyla karbamazepin, valproat, difenilhidantoinde olduğu saptandı. FT4 düzeyindeki en fazla düşüşün difenilhidantoin alan grupta, en az etkilenmenin ise valproat tedavisi alan grupta olduğu saptandı. Bu çalışmanın sonuçları antiepileptik ilaçların tiroid işlevlerini çeşitli düzeylerde etkilediğini, bu nedenlerle bu hastalarda mutlaka düzenli olarak tiroid işlevlerinin değerlendirilmesi gerektiğini göstermiştir.

Anahtar Kelimeler:

Tiroksin, Valproik asit, Tirotropin, Antikonvülzanlar, Epilepsi, Hormonlar, Tiroid hormonları

The influence of antiepileptic drugs on thyroid hormon levels

Fourty epileptic patients who were followed at Neurology Department of Diyarbakır Dicle University Medical School and taking antiepileptic drugs for at least a year, were included in the study. Twenty of patients (50%) were male and 20 (50%) were female. Patients were divided into 3 groups according to drugs they were treated with. The age range of 14 patients using valproate were between 15 and 44 years (mean 27.7) and they were taking the medication for 1 to 4 years (mean 2.67 years). Ages of 11 patients taking phenytoin were between 18 and 41 years (mean 28.7). Fifteen patients taking carbamazepine were between 16 and 43 years of age (mean 28.5) and duration of their therapy were 1 to 3 years (mean 2.6). The aim of this study was to search the effects of antiepileptic drugs on thyroid hormone levels in epileptic patients. Levels of T4, FT4, T3, FT3 and TSH were analyzed and following results were obtained. In group of patients receiving valproate, T4 levels decreased significantly. No change has been detected at FT4, T3.FT3 and TSH levels. T4 and FT4 levels decreased significantly at the patients using phenytoin. No change has been observed at T3, FT3 and TSH levels. There were no significant changes at T3, FT3 and TSH levels in the group of patients taking carbamazepine, however T4 and FT4 levels decreased significantly. The decrease at T4 levels were greater at carbamazepine, valproat and phenytoin, respectively. The most prominent decrease of FT4 levels were at the group taking phenytoin while the group treated with valproate were effected the least. The results of this study has shown that antiepileptic drugs affect thyroid functions, and patients using these drugs should be regularly followed up for any possible thyroid dysfunction.

Keywords:

Thyroxine, Valproic Acid, Thyrotropin, Anticonvulsants, Epilepsy, Hormones, Thyroid Hormones,

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