Antenatal Carbimazole and Choanal Atresia

Wolf, Dennis; Foulds, Nicola; Daya, Hamid

doi:10.1001/archotol.132.9.1009

Cited by 43 publications

(29 citation statements)

References 17 publications

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“…2). In contrast, we would posit that choanal atresia could occur by other mechanisms, such as medial outgrowth of vertical and horizontal processes of the palatine bone, or abnormal mesodermal adhesions forming in the choanal area [Wolf et al, 2006]. If these mechanisms were operating, choanal atresia would occur later, at the 9th or 10th week after conception.…”

Section: Discussionmentioning

confidence: 99%

“…Several case reports suggested a possible relationship between prenatal exposure to MMI and choanal atresia [Greenberg, 1987;Hall, 1997;Johnsson et al, 1997;Wilson et al, 1998;Clementi et al, 1999; Gianantonio et al, 2001;Barwell et al, 2002;Ferraris et al, 2003;Barbero et al, 2004;Foulds et al, 2005;Myers and Reardon, 2005;Ozgen et al, 2006;Wolf et al, 2006]. However, two previous epidemiological studies have not found a significant association [Momotani et al, 1984;Di Gianantonio et al, 2001].…”

Section: Discussionmentioning

confidence: 99%

“…Several case reports have associated prenatal use of MMI or CMZ with choanal atresia in the offspring [Greenberg, 1987;Hall, 1997;Johnsson et al, 1997;Barbero et al, 2004;Foulds et al, 2005;Myers and Reardon, 2005;Ozgen et al, 2006;Wolf et al, 2006]. However, two epidemiological studies did not find an increase in the frequency of congenital anomalies in children prenatally exposed to MMI [Momotani et al, 1984;Di Gianantonio et al, 2001].…”

Section: Introductionmentioning

confidence: 99%

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Choanal atresia associated with maternal hyperthyroidism treated with methimazole: A case–control study

Barbero

Valdez

Rodríguez

et al. 2008

American J of Med Genetics Pt A

113

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Thyrotoxicosis affects 0.2% of pregnant women and antithyroid drugs are the treatment of choice during pregnancy. Several case reports have suggested a relationship between the prenatal use of methimazole (MMI) and choanal atresia in the offspring. However, two epidemiological studies did not find an increased teratogenic risk for MMI. This multicenter case-control study compared the frequency of maternal hyperthyroidism treated with MMI during pregnancy, in children with choanal atresia (cases) and a control group randomly selected (three matched controls according to maternal age for each case). Mothers of cases (N = 61) and controls (N = 183) were interviewed for socio-demographic questions, obstetrical and genetic history, and exposure during pregnancy to different agents; specifically detailed information regarding hyperthyroidism and MMI intake was obtained. Prenatal exposure to maternal hyperthyroidism treated with MMI was identified in 10/61 cases (16.4%) compared to 2/183 (1.1%) in the control group (OR = 17.75; CI95% = 3.49-121.40). Cases and controls did not differ in their parental degree of education, paternal occupation, twinning, maternal parity, and other exposures during pregnancy. Facial features in exposed cases showed some similarities. Our data suggest that prenatal exposure to maternal hyperthyroidism treated with MMI is associated with choanal atresia. In addition, based on our cases and a critical literature review, we propose that the mother's disease might be the causal factor and not the MMI treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Choanal atresia associated with maternal hyperthyroidism treated with methimazole: A case–control study

Barbero

Valdez

Rodríguez

et al. 2008

American J of Med Genetics Pt A

113

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“…However, these drugs may in turn have a negative impact on foetal development as they can cross the placenta. The present clinical guidelines advise to avoid the use of MMI in early pregnancy because it may increase the risk of specific malformations including choanal and oesophageal atresia and aplasia cutis congenita (Wolf et al 2006, Azizi & Amouzegar 2011, Rodriguez-Garcia et al 2011, Vissenberg et al 2012, but it remains unclear whether these abnormalities are linked to MMI or to the maternal hyperthyroidism itself (Barbero et al 2008).…”

Section: Introductionmentioning

confidence: 99%

Maternal transfer of methimazole and effects on thyroid hormone availability in embryonic tissues

Herck

Geysens²,

Bald³

et al. 2013

Journal of Endocrinology

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Methimazole (MMI) is an anti-thyroid drug used in the treatment of chronic hyperthyroidism. There is, however, some debate about its use during pregnancy as MMI is known to cross the mammalian placenta and reach the developing foetus. A similar problem occurs in birds, where MMI is deposited in the egg and taken up by the developing embryo. To investigate whether maternally derived MMI can have detrimental effects on embryonic development, we treated laying hens with MMI (0.03% in drinking water) and measured total and reduced MMI contents in the tissues of hens and embryos at different stages of development. In hens, MMI was selectively increased in the thyroid gland, while its levels in the liver and especially brain remained relatively low. Long-term MMI treatment induced a pronounced goitre with a decrease in thyroxine (T 4 ) content but an increase in thyroidal 3,5,3 0 -triiodothyronine (T 3 ) content. This resulted in normal T 3 levels in tissues except in the brain. In chicken embryos, MMI levels were similar in the liver and brain. They gradually decreased during development but always remained above those in the corresponding maternal tissues. Contrary to the situation in hens, T 4 availability was only moderately affected in embryos. Peripheral T 3 levels were reduced in 14-day-old embryos but normal in 18-day-old embryos, while brain T 3 content was decreased at all embryonic stages tested. We conclude that all embryonic tissues are exposed to relatively high doses of MMI and its oxidised metabolites. The effect of maternal MMI treatment on embryonic thyroid hormone availability is most pronounced for brain T 3 content, which is reduced throughout the embryonic development period.

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“…Serum TSH 0,1-2 mIU/L ilk trimester için uygundur. MMT'ün aplasia kutis, koanal atrezi ve öze-fagial atrezi gibi konjenital anomalilere neden olduğu rapor edilmiştir [40][41][42]. Plesantayı daha az geçmesi ve terotojenitesinin olmaması nedeniyle son yıllara kadar PTU gebelikte tek tercih edilen tedaviydi.…”

Section: Gebeli̇kte Hi̇perti̇roi̇di̇zmunclassified

Thyroid Diseases and Treatment in Pregnancy

Aktaş

Pekkolay

2016

J Clin Exp Invest

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ÖZETGebelikte tiroid fonksiyonlarının değerlendirilmesi, maternal, fetal sağlıklı gelişim için önemlidir. Tiroid fonksiyonlarının dikkatli değerlendirilip, tanının konulması ve uygun tedavinin verilmesi çok önemlidir. Normal bir gebelikte, human korionik gonadotropin seviyesinin artması ve tiroid stimülan hormon düzeyini uyarmasıyla, birinci trimesterda, tiriiyodotironin (T3) ve tiroksin (T4) düzeyinde artış, tiroid stimülan hormonda (TSH) baskılanma olur. Gebeliğin 12-14. haftalarında tiroksin bağlayıcı globulin (TBG) artışıyla, total T3 ve T4 seviyeleri artarken, serbest T4 düzeyinde de hafif azalma olur. Gebelikte en sık görülen tiroid hastalığı, hipotiroididir. Maternal hipotiroidi, fetal kayıp, preterm doğum, preeklampsi, erken plesanta rüptürü ve doğacak çocuklarda entellektüel fonksiyonlarda azalmaya neden olabilir. Hipertiroidizm, nispeten daha az görülür. Sıklığı %0,1-1'dir. Gebe olmayan kadınlarda olduğu gibi hipertiroidizm'in en sık nedeni (%85), Graves hastalığıdır. Diğer bir neden hiperemezis gravidarumdur. Bu sık görülen durumun, Graves hastalığından ayırt edilmesi önemlidir. Gebelikte hipotiroidi ve hipertiroidinin optimal tedavisi hakkında tartışmalı çok sayıda yayın ve görüş mevcuttur. Çalışmalar arasında çelişkiler olmakla beraber, ilk trimesterde tiroid fonksiyonlarının çalışılmasını destekleyen görüşler ağır basmaktadır. Bu yazıda gebelikte tiroid disfonksiyonu ile ilgili güncel bilgilere yer verilmiştir.Anahtar kelimeler: Gebelik, tiroid hastalıkları, komplikasyonlar, tedavi Thyroid Diseases and Treatment in Pregnancy ABSTRACTAssessment of thyroid disease in pregnancy is important for gestational maternal health, obstetric outcome and, subsequent development of child. Pregnancy has profound effects on the regulation of thyroid function, and on thyroidal functional disorders, that need to be recognized, carefully evaluated and correctly managed. In women with normal thyroid function there is an increase in thyroxine (T4) and triiodothyronine (T3) production and inhibition of thyroidstimulating hormone (TSH) in the first trimester of pregnancy,. In the pregnant woman, elevated thyroxine-binding globulin (TGB) and concomitant increases in total T4 and T3 levels plateau at 12-14 weeks of pregnancy, and free T4 measurements slowly decrease. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. It is associated with fetal loss, placental abruptions, preeclampsia, preterm delivery and reduced intellectual function in the offspring. Hyperthyroidism during pregnancy is relatively uncommon, with a prevalence estimated to range between 0.1% and 1%. The most common cause of hyperthyroidism is Graves disease, as this etiology accounts for 85% of clinical hyperthyroidism in pregnancy. Another cause of hyperthyroidism is hyperemesis gravidarum. This is common and requires differentiation from Graves disease. There has been much discussion and many publications on the optimal management of pregnant women who are hyperthyroid or hypothyroid. Despite the lack of consensus organizations, ...

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Antenatal Carbimazole and Choanal Atresia

Cited by 43 publications

References 17 publications

Choanal atresia associated with maternal hyperthyroidism treated with methimazole: A case–control study

Choanal atresia associated with maternal hyperthyroidism treated with methimazole: A case–control study

Maternal transfer of methimazole and effects on thyroid hormone availability in embryonic tissues

Thyroid Diseases and Treatment in Pregnancy

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