THYROID FUNCTION CHANGES IN PEDIATRIC EPILEPSY PATIENTS: A PROSPECTIVE COMPARATIVE STUDY OF NEW VERSUS OLD ANTIEPILEPTIC DRUGS

Abstract

Background: Epilepsy is a persistent neurological condition that requires prolonged treatment with antiepileptic drugs (AEDs). However, these medications can lead to other undesirable consequences, such as thyroid disorders.

Aim: To evaluate the impact of old versus new antiepileptic medications on thyroid function in children with epilepsy.

Methods: This prospective cohort study included epilepsy patients from the King Fahad Specialist Hospital in Dammam. Thyroid function tests (TSH, FT4, and FT3) were performed at baseline and one year after therapy. Statistical analysis included descriptive statistics, chi-square tests, independent-sample t-tests, and paired t-tests.

Results: The study included 142 pediatric epilepsy patients (age range, 1–15 years), equally divided between new (50%) and old (50%) AED treatments. After one year of treatment, patients on newer AEDs showed significantly higher changes from a baseline in TSH (9.1764 vs. 4.0474 mIU/L, p = 0.001) and FT4 (11.5453 vs. 10.6243 pmol/L, p = 0.003) levels than those on older AEDs. Regardless of medication type, all patients experienced significant changes in all three crucial thyroid function indicators from baseline to one year post-treatment (p<0.001). TSH levels increased from 2.9726 to 6.5573 mIU/L, whereas FT4 and FT3 levels decreased (FT4: 11.8985 to 11.0783 pmol/L; FT3: 4.6999 to 4.2736 pmol/L). Furthermore, the New Medication Group has a significantly higher prevalence of Subclinical Hypothyroidism (66.2%) compared to the Old Medication Group (11.3%). The most common AEDs administered at baseline were sodium valproate (31.0%), levetiracetam (25.4%), carbamazepine (14.1%), and topiramate (12.7%). The medication groups had no significant differences regarding age, weight, height, and baseline thyroid function test results.

Conclusion: New AEDs have a more significant influence on thyroid function in pediatric patients than old AEDs. Regular thyroid function monitoring is critical for all epilepsy patients undergoing long-term AED therapy, especially for those taking newer medicines. More studies are needed to understand better the underlying processes and long-term clinical consequences of medication-induced thyroid alterations.