Pharmacology of Propylthiouracil (PTU) in Pregnant Hyperthyroid Women: Correlation of Maternal PTU Concentrations with Cord Serum Thyroid Function Tests*

Gardner, David F.; Cruikshank, D. P.; Hays, Patricia M.; Cooper, David S.

doi:10.1210/jcem-62-1-217

Cited by 81 publications

(31 citation statements)

References 9 publications

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“…Furthermore, cord PTU levels were found to be higher than maternal concentrations in patients treated with PTU until term [15]. There were also no identified differences in thyroid hormone and TSH concentrations in cord blood at birth between patients treated with CBZ/MMI and PTU [16], although this study was underpowered to detect modest 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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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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“…A study showed that transfer rates across the placenta were independent of the perfusate protein concentration, and this might be due to highly efficient placental extraction of the unbound drug (23). Cord PTU levels were higher than maternal concentrations in hyperthyroid pregnant patients treated with PTU until term (24). In addition, there were no differences in thyroid hormone and TSH concentrations in cord blood at birth between the MMI-and the PTU-treated newborn (25).…”

Section: Resultsmentioning

confidence: 99%

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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“…The incidence of spontaneous or inherited ACC is approximately 1:2000 births (2) and is limited in the vast majority of cases to the scalp (Table 1 ); the ACC rate after maternal MMI treatment, however, remains unknown. PTU and MMI cross the placenta similarly (9,10) . However, the theoretical risk for PTU is lower owing to higher levels of drug binding to serum proteins (11) .…”

Section: Discussionmentioning

confidence: 99%

Aplasia cutis congenita in surviving co-twin after propylthiouracil exposure in utero

Löllgen

Calza

Schwitzgebel

et al. 2011

Journal of Pediatric Endocrinology and Metabolism

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Aim: Aplasia cutis congenita (ACC) has been observed after fetal exposure to the antithyroid drug methimazole (MMI), but not reported after propylthiouracil (PTU), the current antithyroid drug of choice during pregnancy. This occurrence has implications for patient information and causal research. Case report: We describe a surviving term co-twin to a mother with hyperthyroidism exposed to PTU from conception to 34 weeks of gestation presenting with ACC at birth. Discussion: The association between PTU exposure and ACC is clinically relevant and allows speculation on the etiology. A similar mechanism to the classical MMI-induced ACC is postulated, unless a vascular etiology suggested by a vanishing twin or maternal hyperthyroidism itself is causal. Coincidence of PTU exposure and ACC seems unlikely. Conclusion: ACC in a newborn after PTU exposure during pregnancy hitherto observed only after MMI strongly encourages further reports of similar cases that may remain clinically underdiagnosed or unreported. Such confi rmation could have signifi cant implications for maternal treatment of hyperthyroidism, common in women of childbearing age.

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Pharmacology of Propylthiouracil (PTU) in Pregnant Hyperthyroid Women: Correlation of Maternal PTU Concentrations with Cord Serum Thyroid Function Tests*

Cited by 81 publications

References 9 publications

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

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

Aplasia cutis congenita in surviving co-twin after propylthiouracil exposure in utero

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