Intellectual capacity of subjects exposed to methimazole or propylthiouracil in utero

Eisenstein, Zemach; Weiss, Mordechai; Katz, Y.; Bank, H

doi:10.1007/bf01957719

Cited by 81 publications

(21 citation statements)

References 13 publications

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“…No differences in total IQ and verbal and performance skills were found in 31 patients aged 4 to 23 years (median age 11 years) born to mothers with GD, compared with 25 controls; all patients were euthyroid at birth. 20 Similar results were found in 2 other studies. 21,22 In contrast, in 8 children with neonatal hyperthyroidism, craniosynostosis was identified in 6 and intelligence tests were below average in 4 at ages 2 years or older.…”

Section: Introductionsupporting

confidence: 88%

Management of Neonates Born to Mothers With Graves’ Disease

2016

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Neonates born to mothers with Graves’ disease are at risk for significant morbidity and mortality and need to be appropriately identified and managed. Because no consensus guidelines regarding the treatment of these newborns exist, we sought to generate a literature-based management algorithm. The suggestions include the following: (1) Base initial risk assessment on maternal thyroid stimulating hormone (TSH) receptor antibodies. If levels are negative, no specific neonatal follow-up is necessary; if unavailable or positive, regard the newborn as “at risk” for the development of hyperthyroidism. (2) Determine levels of TSH-receptor antibodies in cord blood, or as soon as possible thereafter, so that newborns with negative antibodies can be discharged from follow-up. (3) Measurement of cord TSH and fT4 levels is not indicated. (4) Perform fT4 and TSH levels at day 3 to 5 of life, repeat at day 10 to 14 of life and follow clinically until 2 to 3 months of life. (5) Use the same testing schedule in neonates born to mothers with treated or untreated Graves’ disease. (6) When warranted, use methimazole (MMI) as the treatment of choice; β-blockers can be added for sympathetic hyperactivity. In refractory cases, potassium iodide may be used in conjunction with MMI. The need for treatment of asymptomatic infants with biochemical hyperthyroidism is uncertain. (7) Assess the MMI-treated newborn on a weekly basis until stable, then every 1 to 2 weeks, with a decrease of MMI (and other medications) as tolerated. MMI treatment duration is most commonly 1 to 2 months. (8) Be cognizant that central or primary hypothyroidism can occur in these newborns.

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Section: Introductionsupporting

confidence: 88%

Management of Neonates Born to Mothers With Graves’ Disease

2016

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“…Two studies have shown no differences in thyroid function or physical and psychomotor development between children born to CBZ/MMI or PTU treated hyperthyroid mothers during pregnancy and those born to euthyroid mothers [61,62]. However, these studies were small and underpowered to detect even substantial differences.…”

Section: Resultsmentioning

confidence: 99%

Side Effects of Anti-Thyroid Drugs and Their Impact on the Choice of Treatment for Thyrotoxicosis in Pregnancy

Taylor

Vaidya

2012

Eur Thyroid J

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Introduction: Hyperthyroidism in pregnancy is a serious condition and its management is complex. Whilst carbimazole/methimazole (CBZ/MMI) and propylthiouracil (PTU) have similar efficacies in controlling hyperthyroidism, their risk of side effects such as major congenital abnormalities and hepatotoxicity are different. Methods: Various combinations of the terms ‘anti-thyroid drugs’, ‘thionamide’, ‘carbimazole’, ‘methimazole’, ‘propylthiouracil’, ‘pregnancy’, ‘side effects’, ‘agranulocytosis’, ‘birth defects’, ‘congenital malformations’, ‘embryopathy’, ‘aplasia cutis’, ‘hepatotoxicity’, ‘hepatic failure’, ‘maternal’ and ‘fetus’ were used to search MEDLINE and the Cochrane library. The references of retrieved papers were also reviewed. Results: There is increasing evidence for a CBZ/MMI embryopathy, whilst data remain lacking for major congenital abnormalities with PTU. In contrast, PTU is associated with increased risk of severe liver injury. Management strategies to reduce these risks by using PTU in the first trimester and CBZ/MMI in the later trimesters remain untested. Conclusion: More evidence is still needed in defining the relative risks between CBZ/MMI and PTU of major congenital abnormalities and severe liver injury in pregnancy. Studies are also needed to establish the suitability of recent management suggestions in switching from PTU to CBZ/MMI after the first trimester. Major adverse outcomes secondary to CBZ/MMI and PTU are rare, and inadequately treated hyperthyroidism poses a far greater risk.

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“…Effect on pediatric physical and mental growth No differences in thyroid function or physical and psychomotor development has been found between children born to MMI-or PTU-treated hyperthyroid mothers during pregnancy and those born to euthyroid mothers (43,44).…”

Section: What Are the Associated Complications With Antithyroid Drugsmentioning

confidence: 98%

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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Intellectual capacity of subjects exposed to methimazole or propylthiouracil in utero

Cited by 81 publications

References 13 publications

Management of Neonates Born to Mothers With Graves’ Disease

Management of Neonates Born to Mothers With Graves’ Disease

Side Effects of Anti-Thyroid Drugs and Their Impact on the Choice of Treatment for Thyrotoxicosis in Pregnancy

Management of hyperthyroidism during pregnancy and lactation

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