Hypothyroidism induced by phenytoin and gabapentin A Case Report
Hypothyroidism induced by phenytoin and gabapentin A Case Report
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DOI：
10.1097/md.0000000000012938
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发表时间：
2018-10-01
期刊：
影响因子：
1.6
通讯作者：
Tamaoka, Akira
中科院分区：
文献类型：
--
作者：
Miyake, Zenshi;Ishii, Kazuhiro;Tamaoka, Akira
依据：抗癫痫药物（AEDs）是引起药物性甲状腺功能减退的药物之一。在大多数情况下，AED引起的甲状腺功能减退症是亚临床的，仅由游离甲状腺素（T4）和/或促甲状腺激素（TSH）水平异常指示。严重的症状性甲状腺功能减退症后AEDs很少在literature.Patient concerns：一个75岁的男子经历了神经系统症状，包括记忆障碍，共济失调步态，感觉性多发性神经病和肌病，嗜睡，水肿的脸和下肢。8年前，他曾服用苯妥英钠和加巴喷丁治疗症状性创伤性癫痫。诊断：患者游离T4低（0.21 ng/dL），TSH高（113.2 μ IU/mL），表明甲状腺功能减退。甲状腺相关自身抗体阴性及无甲状腺肿大排除了桥本病的可能性。强烈怀疑苯妥英钠和/或加巴喷丁引起他的甲状腺功能减退症。干预：患者接受替代治疗（左旋甲状腺素25 μ g/天）。结果：他的症状明显并迅速改善，同时继续抗癫痫治疗。教训：在这种情况下，患者的甲状腺功能减退症被认为是由两种AED导致甲状腺激素减少的不同机制引起的。AED不仅可引起无症状的甲状腺激素异常，而且可引起临床上可观察到的甲状腺功能减退症。因此，临床医生应了解抗惊厥药和症状性甲状腺功能减退症之间的关系。
Rationale: Antiepileptic drugs (AEDs) are one of the causative drugs of drug-induced hypothyroidism. In most cases, AED-induced hypothyroidism is subclinical and indicated only by abnormalities of free thyroxine (T4) and/or thyroid-stimulating hormone (TSH) levels. Severe symptomatic hypothyroidism following AEDs is rarely reported in the literature.Patient concerns: A 75-year-old man experienced neurologic symptoms including memory impairment, ataxic gait, sensory polyneuropathy and myopathy, lethargy, and edema of the face and lower extremities. He had been administered phenytoin and gabapentin for the treatment of symptomatic traumatic epilepsy 8 years before.Diagnoses: The patient had low free T4 (0.21 ng/dL) and high TSH (113.2 mu IU/mL), which indicated hypothyroidism. Negative thyroid-related autoantibody tests and the lack of goiter excluded the possibility of Hashimoto disease. Phenytoin and/or gabapentin were strongly suspected as causing his hypothyroidism.Intervention: The patient was treated with replacement therapy (levothyroxine 25 mu g/day).Outcomes: His symptoms markedly and promptly improved alongside continued antiepileptic therapy.Lessons: In this case, the patient's hypothyroidism was assumed to result from different mechanisms of the 2 AEDs leading to thyroid hormone reduction. AEDs can not only cause asymptomatic thyroid hormone abnormalities but also clinically observable hypothyroidism. Therefore, clinicians should be aware of the association between anticonvulsants and symptomatic hypothyroidism.