Frågedatum: 1995-01-30
RELIS database 1995; id.nr. 11602, DRUGLINE
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Can treatment with carbamazepine cause hypothyroidism as an adverse effect?/nA 49-year-old woman ha



Fråga: Can treatment with carbamazepine cause hypothyroidism as an adverse effect?

A 49-year-old woman has been treated for several years with Tegretol (carbamazepine) 100 mg x2 because of severe psychiatric problems with aggression with unclear ethiology. The patient has complained of tiredness, artralgias, slight oedema of the legs as well as irregular menstruations during the last years and has been treated for these with Orudis retard (ketoprofen) 200 mg every second day and with Furix (furosemide) 30 mg when needed. During the last six months, elevated levels of S-TSH (8.3, 9.0, normal values 0.4-4.0) have been seen while other blood values are normal.

Sammanfattning: Carbamazepine treatment can cause a decrease in serum T4 and T3 levels usually without concomitant elevation in TSH. Clinical hypothyroidism caused by carbamazepine treatment appears to be rare.

Svar: The effect of carbamazepine on thyroid function has been assessed earlier by the Drug Information Centre (1). No further information has been obtained in a reniewed search in the literature. Total and free thyroxine (T4) and tri-iodothyronin (T3) levels may decrease during treatment with phenytoin and carbamazepine (2,3). The main reason for the increased hepatic metabolism of the thyroid hormones is due to enzyme induction (4). The levels of thyroid-stimulating hormone (TSH) usually remain normal or are only slightly increased. The development of clinical symptoms of hypothyroidism, however, appears to be a rare event although cases of hypothyroidism have been reported (5). One case of hypothyroidism in a patient treated with carbamazepine and valproic acid has been reported to SADRAC. The case is unclassified with respect to association with the drug treatment.

In the present case, the diagnosis of hypothyroidism should be confirmed by clinical examination and laboratory tests of thyroid function. The association between the patient´s symptoms and carbamazepine treatment appears unlikely, but cannot be excluded.

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