Management of hyperthyroidism during pregnancy in Asia

Azizi, Fereidoun; Amouzegar, Atieh; Mehran, Ladan; Alamdari, Shahram; Subekti, Imam; Vaidya, Bijay; Poppe, Kris; Sarvghadi, Farzaneh; Luis, Teofilo San; Akamizu, Takashi

doi:10.1507/endocrj.ej14-0145

Cited by 13 publications

(16 citation statements)

References 40 publications

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“…PTU acts as an antithyroid drug (Cooper, 2005;Burch et al, 2012;Azizi et al, 2014). It inhibits the catalytic action of TPO, thereby blocking the synthesis of the thyroid hormone (Manna et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…In clinical practice, hyperthyroidism is controlled by three well known antithyroid drugs: methimazole (MMZ), 6-n-propyl-2-thiouracil (PTU) and carbimazole (CBZ). It has been shown that TPO is inhibited by MMZ, PTU and CBZ (Davidson et al, 1978;Cooper, 2005;Burch et al, 2012;Azizi et al, 2014). There may be other ways of controlling hyperthyroidism, but inhibition of TPO seems to be one excellent approach.…”

Section: Introductionmentioning

confidence: 99%

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Mode of binding of the antithyroid drug propylthiouracil to mammalian haem peroxidases

et al. 2015

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The mammalian haem peroxidase superfamily consists of myeloperoxidase (MPO), lactoperoxidase (LPO), eosinophil peroxidase (EPO) and thyroid peroxidase (TPO). These enzymes catalyze a number of oxidative reactions of inorganic substrates such as Cl(-), Br(-), I(-) and SCN(-) as well as of various organic aromatic compounds. To date, only structures of MPO and LPO are known. The substrate-binding sites in these enzymes are located on the distal haem side. Propylthiouracil (PTU) is a potent antithyroid drug that acts by inhibiting the function of TPO. It has also been shown to inhibit the action of LPO. However, its mode of binding to mammalian haem peroxidases is not yet known. In order to determine the mode of its binding to peroxidases, the structure of the complex of LPO with PTU has been determined. It showed that PTU binds to LPO in the substrate-binding site on the distal haem side. The IC50 values for the inhibition of LPO and TPO by PTU are 47 and 30 µM, respectively. A comparision of the residues surrounding the substrate-binding site on the distal haem side in LPO with those in TPO showed that all of the residues were identical except for Ala114 (LPO numbering scheme), which is replaced by Thr205 (TPO numbering scheme) in TPO. A threonine residue in place of alanine in the substrate-binding site may affect the affinity of PTU for peroxidases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mode of binding of the antithyroid drug propylthiouracil to mammalian haem peroxidases

et al. 2015

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“…Patients with thyroid disorders are managed by both endocrinologists and general practitioners and may be more optimally managed with the guidance of specialists. Recent surveys have been published on the management of hypo- and hyperthyroidism during pregnancy, involving 321 Asian endocrinologists from 21 Asian countries, which indicated a high accordance of the management to the recent ATA guidelines, despite wide variation in management between individuals ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

Prevalent Practices of Thyroid Diseases During Pregnancy Among Endocrinologists, Internists and General Practitioners

Azizi

Mehran

Amouzegar

et al. 2015

Int J Endocrinol Metab

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Background:Maternal thyroid disease in pregnancy is associated with adverse impact on both mother and fetus. Both the American thyroid association and the endocrine society have recently published guidelines for the management of thyroid disease in pregnancy.Objectives:The objective of this survey was to assess and compare the current practices of various East-Asian physicians in the screening and management of thyroid disease in pregnancy.Materials and Methods:Completed survey questionnaires were collected from 112 physicians of six East-Asian countries. The survey was based on clinical case scenarios, asking questions about the clinical practices related to diagnosis and management of thyroid disease during pregnancy. Reponses from 76 endocrinologists and 33 internists and general practitioners (generalists) were analyzed.Results:There were minor differences in treatment preferences for Graves’ disease in pregnancy and tests to monitor antithyroid drugs between endocrinologists and generalists; the major difference being targeted free thyroxin, and also thyroxin, depicted in the upper end of normal range, by the majority of endocrinologist and within the normal range, by generalists. Compared to generalists, endocrinologists perform more targeted screening and are more familiar with its risk factors. Predominantly, endocrinologists increase levothyroxine dose in hypothyroid women, upon confirmation of pregnancy and also indicate full dose in a pregnant woman, diagnosed with overt hypothyroidism, and treat thyroid peroxidase antibody positive or negative pregnant women with thyroid stimulating hormone (2.5 - 5 mU/L), as compared to generalists.Conclusions:There is wide variation in the clinical practices of screening and management of thyroid disorders during pregnancy in East-Asia, with many clinicians, in particular general practitioners, not adhering to clinical practice guidelines, unfortunately.

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“…The ATA guideline [24] recommends patients on MMI should be switched to PTU if pregnancy is ascertained in the ﬁrst trimester. In one survey [25], 96% of responders began treatment of hyperthyroidism of pregnant women with PTU and almost 38% of them will switch to MMI after the first trimester. In our study, patients with relapsing overt or subclinical hyperthyroidism during pregnancy were instructed to use PTU throughout the term of pregnancy, and their liver function was monitored.…”

Section: Discussionmentioning

confidence: 99%

Follow-up and evaluation of the pregnancy outcome in women of reproductive age with Graves’ disease after 131Iodine treatment

Zhang

Tian

et al. 2016

Journal of Radiation Research

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The aims of the present study were to analyze the outcomes of pregnancy, after 131I treatment, in patients of reproductive age with Graves’ hyperthyroidism and to investigate the effects, if any, of the 131I treatment on the mothers and newborns. From 2009 to 2014, 257 pregnant female patients with Graves’ hyperthyroidism in the outpatients at the Department of Nuclear Medicine and 166 healthy pregnant women from the Department of Obstetrics at Sun Yat-Sen Memorial Hospital were included in our study. They were divided into a 131I therapy group (n = 130) and an anti-thyroid drug (ATD) group (n = 127) according to their therapy before conception. The neonatal gender, rate of preterm birth, body weight ratio and occurrence of low birth weight [except for higher rates of abortion (odds ratio; OR = 2.023) and cesarean delivery (OR = 1.552) in patients with Graves’ hyperthyroidism] showed no statistically significant differences from those of the healthy group (P > 0.05). The level of intrauterine growth restriction did not differ between the Graves’ hyperthyroidism group and the healthy group (8 vs 2, 3.0% vs 1.2%). The outcomes of pregnancy among the 131I therapy group, ATD group and healthy group also showed no significant differences. Of the patients treated with 131I, no significant differences were observed in the outcomes of their pregnancies, whether they received propylthiouracil (PTU), levothyroxine or no additional drug treatment during pregnancy. Women with hyperthyroidism who were treated with 131I therapy could have normal delivery if they ceased 131I treatment for at least six months prior to conception and if their thyroid function was reasonably controlled and maintained using the medication: anti-thyroid drug and levothyroxine before and during pregnancy.

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Management of hyperthyroidism during pregnancy in Asia

Cited by 13 publications

References 40 publications

Mode of binding of the antithyroid drug propylthiouracil to mammalian haem peroxidases

Mode of binding of the antithyroid drug propylthiouracil to mammalian haem peroxidases

Prevalent Practices of Thyroid Diseases During Pregnancy Among Endocrinologists, Internists and General Practitioners

Follow-up and evaluation of the pregnancy outcome in women of reproductive age with Graves’ disease after 131Iodine treatment

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