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

Barbero, Pablo; Valdez, Rita; Rodríguez, Hugo; Tiscornia, Carlos; Mansilla, Enrique; Allons, Adriana; Coll, Silvia; Liascovich, Rosa

doi:10.1002/ajmg.a.32497

Cited by 114 publications

(63 citation statements)

References 30 publications

(48 reference statements)

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“…Choanal and esophageal atresia may have a higher incidence than that expected in fetuses exposed to MMI during the first trimester of gestation, OR may be as high as 18 (37)(38)(39). However, the mother's disease might be the causal factor rather than MMI treatment (40). A prospective cohort study did not show any significant difference in incidence of major anomalies or spontaneous abortions between MMI treatment and controls during pregnancy (37).…”

Section: What Are the Associated Complications With Antithyroid Drugsmentioning

confidence: 85%

Management of hyperthyroidism during pregnancy and lactation

Azizi

Amouzegar²

2011

European Journal of Endocrinology

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Introduction: Poorly treated or untreated maternal overt hyperthyroidism may affect pregnancy outcome. Fetal and neonatal hypo-or hyper-thyroidism and neonatal central hypothyroidism may complicate health issues during intrauterine and neonatal periods. Aim: To review articles related to appropriate management of hyperthyroidism during pregnancy and lactation. Methods: A literature review was performed using MEDLINE with the terms 'hyperthyroidism and pregnancy', 'antithyroid drugs and pregnancy', 'radioiodine and pregnancy', 'hyperthyroidism and lactation', and 'antithyroid drugs and lactation', both separately and in conjunction with the terms 'fetus' and 'maternal.' Results: Antithyroid drugs are the main therapy for maternal hyperthyroidism. Both methimazole (MMI) and propylthiouracil (PTU) may be used during pregnancy; however, PTU is preferred in the first trimester and should be replaced by MMI after this trimester. Choanal and esophageal atresia of fetus in MMI-treated and maternal hepatotoxicity in PTU-treated pregnancies are of utmost concern. Maintaining free thyroxine concentration in the upper one-third of each trimester-specific reference interval denotes success of therapy. MMI is the mainstay of the treatment of post partum hyperthyroidism, in particular during lactation. Conclusion: Management of hyperthyroidism during pregnancy and lactation requires special considerations and should be carefully implemented to avoid any adverse effects on the mother, fetus, and neonate.

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Section: What Are the Associated Complications With Antithyroid Drugsmentioning

confidence: 85%

Management of hyperthyroidism during pregnancy and lactation

Azizi

Amouzegar²

2011

European Journal of Endocrinology

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“…In addition to our Danish Registry study (11) to be discussed below, a total of 91 reports were read in detail, and 24 cases with ATD-associated birth defects where shifts in ATD therapy (start/stop of therapy or shifts between MMI/CMZ and PTU) had occurred during gestational weeks 1-10 were identified in 16 of the 91 publications (7,8,10,23,24,25,26,27,28,29,30,31,32,33,34,35). Published gestational week (calculated from the 1st day of the last menstrual period) when start or stop of ATD treatment had occurred was retrieved from these publications.…”

Section: Shift Between Therapies In Early Pregnancymentioning

confidence: 99%

“…2), two cases of aplasia cutis were reported after MMI treatment had been given during the first 4 weeks of gestation only (10,29). Furthermore, a neonate was reported to suffer from choanal atresia after exposure to MMI during gestational weeks 28-37 (31), and another neonate to have esophageal atresia with fistula to the trachea after maternal intake of MMI had been initiated at 14 weeks of gestation (37). All the types of birth defects seen after ATD use may also occur without ATD use.…”

Section: Therapy Shifts In the Danish Registry Studymentioning

confidence: 99%

“…Still, from the cases included in the present review, it cannot be excluded that there is some risk of aplasia cutis even after exposure to MMI/CMZ before week 5 and also after week 10. Apparently, there is little or no association between the dose, within the dose range used for therapy, of ATDs used and the risk of birth defects (10,31,32). One Japanese study published in 1984 found that only two out of six hyperthyroid mothers giving birth to children with defects had received MMI in early pregnancy, and it was proposed that hyperthyroidism and not the drug was the main cause for the increase in risk of birth defects (38).…”

Section: Therapy Shifts In the Danish Registry Studymentioning

confidence: 99%

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THERAPY OF ENDOCRINE DISEASE: Antithyroid drug use in early pregnancy and birth defects: time windows of relative safety and high risk?

Laurberg

Andersen

2014

European Journal of Endocrinology

105

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Background: Antithyroid drugs (ATDs) may have teratogenic effects when used in early pregnancy. Objective: To review the association between the time period of ATD exposure in early pregnancy and the development of birth defects. Methods: We identified publications on birth defects after early pregnancy exposure to the ATDs methimazole (MMI; and its prodrug carbimazole (CMZ)) and propylthiouracil (PTU). Cases of birth defects after ATD treatment had been initiated or terminated within the first 10 weeks of pregnancy were identified and studied in detail. Results: A total of 92 publications were read in detail. Two recent large controlled studies showed ATD-associated birth defects in 2-3% of exposed children, and MMI/CMZ-associated defects were often severe. Out of the total number of publications, 17 included cases of birth defects with early pregnancy stop/start of ATD treatment, and these cases suggested that the high risk was confined to gestational weeks 6-10, which is the major period of organogenesis. Thus, the cases reported suggest that the risk of birth defects could be minimized if pregnant women terminate ATD intake before gestational week 6. Conclusion: Both MMI and PTU use in early pregnancy may lead to birth defects in 2-3% of the exposed children. MMI-associated defects are often severe. Proposals are given on how to minimize the risk of birth defects in fertile women treated for hyperthyroidism with ATDs.

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“…Barbero and staff have concluded in a study that there is a connection between the choanal atresia and maternal hyperthyroidism treated with antythyroid medication (methimazole, cabimazole) [11].…”

Section: Discussionmentioning

confidence: 99%

Choanal Atresia – A Permanent Challenge in Rhinology Pathology

Budu

Decuseară²,

Costache³

et al. 2016

The Scientific Bulletin of Electrical Engineering Faculty

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Abstract. Choanal atresia is the most frequent nasal congenital malformation, which, depending on the unilateral or bilateral location, has a different symptomatology. The diagnosis is confirmed through the patient's medical history, nasal endoscopy and imagistic examination (computed tomography). The treatment is surgical and aims the (fibrous and bone) tissue disintegration which blocks the choana, and is performed through endoscopic surgical techniques. The blocked area is maintained functional by mounting a stent at the choanal tunnel level. The authors aim to describe their own experience regarding both the diagnoses as well as the treatment of this pathology, the results being compared to those from the quoted literature. The surgical technique differs depending on the type of choanal atresia: bone or membranous. The duration to maintain a fix position of the stent and the material used for the stent represent the variables which provide the success of the endoscopic surgical intervention of the choanal atresia. Subsequently, the patient is followed up at 2, 6, 12 months in the first year and then annually until 18 years of age. Choanal atresia is solved through endoscopic surgical techniques by mounting a silicone stent which shall be maintained in position for a minimum period of 3 months. The endoscopic approach of the unilateral choanal imperforation is the method of choice with minimum complications, increased success rate and fast recovery.

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

Cited by 114 publications

References 30 publications

Management of hyperthyroidism during pregnancy and lactation

Management of hyperthyroidism during pregnancy and lactation

THERAPY OF ENDOCRINE DISEASE: Antithyroid drug use in early pregnancy and birth defects: time windows of relative safety and high risk?

Choanal Atresia – A Permanent Challenge in Rhinology Pathology

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