Effect of Valproate and Levetiracetam Monotherapy on Thyroid Function in Children with Epilepsy: A Retrospective Comparative Study at Tripoli University Hospital, Libya

Abstract

Antiseizure medications (ASMs) are essential for the management of childhood epilepsy, but some may be associated with alterations in thyroid function. Valproate and levetiracetam are commonly used in children with epilepsy, and their effects on thyroid function may differ. Aim: To evaluate and compare thyroid function test abnormalities among children with epilepsy receiving valproate (Depakin) or levetiracetam (Keppra) monotherapy. This retrospective comparative study included 120 children aged 1–14 years with epilepsy diagnosed more than one year before assessment. It was conducted at the outpatient clinics of Tripoli University Hospital, Libya, using medical records from January 2024 to January 2026. Participants were divided into two groups: 60 children receiving valproate monotherapy and 60 receiving levetiracetam monotherapy. Children with documented hypothyroidism before starting ASM were excluded. Thyroid function patterns were categorized according to recorded thyroid-stimulating hormone (TSH) and free thyroxine (FT4) results. In the valproate group, 41 children (68.3%) had normal thyroid function tests, whereas 19 children (31.7%) had abnormal patterns: 10 children (16.7%) had elevated TSH with low FT4, and 9 children (15.0%) had elevated TSH with normal FT4. In the levetiracetam group, 50 children (83.3%) had normal thyroid function tests and 10 children (16.7%) had abnormal results: 4 children (6.7%) had elevated TSH with low FT4, and 6 children (10.0%) had elevated TSH with normal FT4. The prevalence of abnormal thyroid function patterns was 15.0 percentage points higher in the valproate group (31.7% vs. 16.7%; Chi-square = 3.67, p = 0.055; OR 2.32, 95% CI 0.98–5.47).   In this study population, abnormal thyroid function patterns were more frequent among children receiving valproate monotherapy than among those receiving levetiracetam monotherapy. These findings support further investigation of thyroid function in children treated with ASMs. Prospective studies with standardized laboratory measurements and adjustment for potential confounding factors are needed.