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Journal of Pediatric Endocrinology and Metabolism

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Ed. by Bereket, Abdullah / Darendeliler, Feyza / Dattani, Mehul / Gustafsson, Jan / Luo, Fei Hong / Mericq, Veronica / Toppari, Jorma

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Volume 30, Issue 4


Changes of thyroid hormonal status in patients receiving ketogenic diet due to intractable epilepsy

Engin Kose / Orkide Guzel / Korcan Demir / Nur Arslan
  • Corresponding author
  • Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Izmir, Turkey
  • Dokuz Eylul University, Izmir Biomedicine and Genome Center (iBG-izmir), Izmir, Turkey
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Published Online: 2017-01-11 | DOI: https://doi.org/10.1515/jpem-2016-0281



Ketogenic diet (KD), which is high in fat and low in carbohydrates, mimics the metabolic state of starvation and is used therapeutically for pharmacoresistant epilepsy. It is known that generation of triiodothyronine (T3) from thyroxine (T4) decreases during fasting periods. The aim of this study was to evaluate the thyroid function of children receiving KD for at least 1 year due to drug-resistant epilepsy.


A total of 120 patients [63 males, 52.5%; mean age 7.3±4.3 years, median interquartile range (IQR): 7.0 (4–10 years)] treated with KD for at least 1 year were enrolled. Seizure control, side effects, and compliance with the diet were recorded, and free T3, free T4, and thyroid-stimulating hormone (TSH) levels were measured at baseline and at post-treatment months 1, 3, 6, and 12. The Mann-Whitney U-test, repeated measures analysis of variance (ANOVA) with post-hoc Bonferroni correction, and logistic regression analysis were used for data analysis.


Hypothyroidism was diagnosed and L-thyroxine medication was initiated for eight, seven and five patients (20 patients in total, 16.7%) at 1, 3, and 6 months of KD therapy, respectively. Logistic regression analysis showed that baseline TSH elevation [odds ratio (OR): 26.91, 95% confidence interval (CI) 6.48–111.76, p<0.001] and female gender (OR: 3.69, 95% CI 1.05–12.97, p=0.042) were independent risk factors for development of hypothyroidism during KD treatment in epileptic children.


KD causes thyroid malfunction and L-thyroxine treatment may be required. This is the first report documenting the effect of KD treatment on thyroid function. Thyroid function should be monitored regularly in epileptic patients treated with KD.

Keywords: children; epilepsy; hypothyroidism; ketogenic diet; thyroid hormones


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About the article

Corresponding author: Nur Arslan, MD, PhD, Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Izmir, Turkey, Phone: +90 2324126107, Fax: +90 2324126005

Received: 2016-07-14

Accepted: 2016-11-03

Published Online: 2017-01-11

Published in Print: 2017-04-01

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Journal of Pediatric Endocrinology and Metabolism, Volume 30, Issue 4, Pages 411–416, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2016-0281.

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