Motherisk Rounds

Hackmon, Rinat; Blichowski, Monica; Koren, Gideon

doi:10.1016/s1701-2163(16)35438-x

Cited by 38 publications

(14 citation statements)

References 35 publications

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“…Current PTU use in children should be stopped in favor of alternate therapies [16]. PTU may be the treatment of choice during, and just before, the first trimester of pregnancy [5] because it is believed that MMI has a relative risk of choanal atresia in the first trimester of pregnancy [3]. …”

Section: Discussionmentioning

confidence: 99%

“…Previous studies showed that the effect of PTU was significantly less than that of radioiodine treatment, and also that the effect of methimazole (MMI) was the same as that of radioiodine [2]. As the relative risk of MMI-induced choanal atresia and MMI causing a specific pattern of rare teratogenic effects after first-trimester exposure were reported, it has been considered appropriate to use PTU to treat maternal hyperthyroidism during the first trimester of pregnancy [3]. On the other hand, it has been reported that PTU can induce severe hepatotoxicity [3, 4, 5, 6].…”

Section: Introductionmentioning

confidence: 99%

“…As the relative risk of MMI-induced choanal atresia and MMI causing a specific pattern of rare teratogenic effects after first-trimester exposure were reported, it has been considered appropriate to use PTU to treat maternal hyperthyroidism during the first trimester of pregnancy [3]. On the other hand, it has been reported that PTU can induce severe hepatotoxicity [3, 4, 5, 6]. We report a rare case of acute liver failure in the first trimester during pregnancy, in PTU treatment following MMI for hyperthyroidism.…”

Section: Introductionmentioning

confidence: 99%

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Acute Liver Failure Associated with Propylthiouracil in a Pregnant 26-Year-Old Woman

Miyamura

Minemura

Nakamura

et al. 2013

Case Rep Gastroenterol

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It seems appropriate to use propylthiouracil to treat maternal hyperthyroidism during the first trimester of pregnancy. We present the case of a 26-year-old woman with acute liver failure associated with propylthiouracil during the first trimester of pregnancy. She was successfully treated without liver transplantation. Attention should be paid to the possible occurrence of propylthiouracil-induced hepatotoxicity even during the first trimester of pregnancy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Liver Failure Associated with Propylthiouracil in a Pregnant 26-Year-Old Woman

Miyamura

Minemura

Nakamura

et al. 2013

Case Rep Gastroenterol

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“…Methimazole or Carbimazole in the first trimester can cause “MMI or carbimazole embryopathy” [15-18], propylthiouracil is safe in this period but can be hepatotoxic at any time [19] so the risks should be explained to the patient. Generally low initial doses of antithyroid drugs are recommended and suggested doses are PTU, 50-300 mg/day, Carbimazole 10-15 mg/day, MMI 5-15 mg/day [12].…”

Section: Pregnancymentioning

confidence: 99%

Managing thyroid dysfunction in selected special situations

Sabih

Inayatullah

2013

Thyroid Research

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Managing thyroid dysfunction is simple at first glance, the idea is to bring hormone levels in the euthyroid range, treat with antithyroid drugs, radio-iodine or surgery if toxic and replace with thyroxine or T3 if hypothyroid. Complexities arise when there are coexisting conditions that affect the thyroid or are affected by thyroid dysfunction and this review will deal with the special situations that need care when correcting thyroid hormone levels.

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“…The most common treatments for Graves' disease are antithyroid medications such as propylthiouracil (PTU) or methimazole (MMI). MMI usage is associated with aplasia cutis congenita, and PTU is rarely associated with a form of hepatic failure [18]. PTU, at lower than typical doses, became the drug of choice during early pregnancy due to the teratogenic effect of MMI in early pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Sequential Amniotic Fluid Thyroid Hormone Changes Correlate with Goiter Shrinkage following in utero Thyroxine Therapy

et al. 2015

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Several isolated reports of fetal goiter treatment have shown limited generalizability of approaches and provide no real guidance for optimal timing, dosages, and treatment strategies. Graves' disease accounts for >60% of these cases. Maternal treatments of hyperthyroidism include antithyroid medications such as methimazole and more commonly propylthiouracil (PTU). Here, our management of a patient with a fetal thyroid goiter from maternal exposure to PTU diagnosed at 23.6 weeks' gestation and the management of other cases allow us propose a general strategy for treatment. Intrauterine therapy with 200 and then 400 μg of levothyroxine (3 weeks apart) showed an 85% reduction in fetal thyroid goiter volume. We collected amniotic fluid samples at the time of treatments and assayed thyroid hormones and associated antibodies which closely reflected the changes in thyroid goiter mass volume. Our observations suggest a weekly or biweekly therapeutic intervention schedule. Utilizing both goiter size as well as a novel approach in using amniotic fluid hormone levels to monitor therapy efficacy might improve the quality of treatments. Only with a standardized approach and collection of amniotic fluid thyroid panels do we have the opportunity to develop the database required to determine the number and timing of treatments needed.

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Motherisk Rounds

Cited by 38 publications

References 35 publications

Acute Liver Failure Associated with Propylthiouracil in a Pregnant 26-Year-Old Woman

Acute Liver Failure Associated with Propylthiouracil in a Pregnant 26-Year-Old Woman

Managing thyroid dysfunction in selected special situations

Sequential Amniotic Fluid Thyroid Hormone Changes Correlate with Goiter Shrinkage following in utero Thyroxine Therapy

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