الفهرس 
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Abstract
Subclinical hypothyroidism refers to a state in which patients
may exhibit the symptoms of hypothyroidism. These patients also
have a normal amount circulating T3 and T4. The only abnormality is
an increased TSH in their blood work > 4.50 micron IU/ml. The
majority of these patient can be expected to progress to obvious
hypothyroidism especially- if -TSH level is >5 micron IU/ml.
The aim of this study is to evaluate the relation between
treatment with carbamazepine, phenytoin and valproate and risk of
developing subclinical hypothyroidism in epileptic patients.
The study included 50 epileptic patients divided into two groups
(patients on long term antiepileptic therapy and newly diagnosed
epileptic patients) and 10 subjects (control group age and sex matched
to epileptic group) who were interviewed at Neurology Outpatient
Clinic, Menoufiya University Hospital.
Patients are presented with two or more unprovoked seizure
above the age of 18 years old of both sex, without any neurological or
psychiatric disorder other than epilepsy with no past history of
radioiodine therapy nor any surgical procedure of thyroid gland.
All the patients were subjected to the following:
• Careful history taking including seizure analysis and antiepileptic
drug intake.
• Full general medical and neurological examination.
• Assessment of subclinical hypothyroidism by using the clinical score
of symptoms and signs of hypothyroidism.
• Laboratory investigations: such as assessment of thyroid functions
TSH, T3, T4, serum level of antiepileptic medication, CBC, ALT,
AST, Bl. Urea, Serum creatinine.
• Digital electroencephalogram (EEG).
The results of the study concluded that:
• There was a statistical significant increase in mean TSH level and
scoring of symptoms and signs of hypothyroidism in epileptic patients
compared to control group.
• There was a statistical significant increase in mean TSH level and
scoring of symptoms and signs of hypothyroidism in epileptic patients
on long term antiepileptic drugs (>six months) than in early diagnosed
epileptic patients on less than 6 months antiepileptic drug therapy.
• There was a statistical significant increase in mean TSH levels and
scoring of symptoms and signs of hypothyroidism in epileptic patients
receiving poly therapy than mono antiepileptic drug therapy.
• Risk of subclinical hypothyroidism had increased in epileptic
patients receiving valproate monotherapy and in epileptic patients
receiving phenytoin monotherapy than epileptic patients receiving
carbamazepine monotherapy.
• There was a statistical significant positive correlation between the
duration of treatment with antiepileptic drugs and both TSH level and
the Scoring of symptoms and signs of hypothyroidism. The longer the
duration of treatment the more increase in the level of TSH and the
Score of symptoms and signs of hypothyroidism.
So; we can state simply that our final conclusion in this study is
that “Adult epileptic patients on antiepileptic drug therapy are at risk
of subclinical hypothyroidism especially poly medicated patients on
long term antiepileptic drug therapy ”