Substituting Potassium Iodide for Methimazole as the Treatment for Graves' Disease During the First Trimester May Reduce the Incidence of Congenital Anomalies: A Retrospective Study at a Single Medical Institution in Japan

Yoshihara, Ai; Noh, Jaeduk Yoshimura; Watanabe, Natsuko; Mukasa, Koji; Ohye, Hidemi; Suzuki, Miho; Matsumoto, Masako; Kunii, Yo; Suzuki, Nami; Kameda, Toshiaki; Iwaku, Kenji; Kobayashi, Sakiko; Sugino, Kiminori; Ito, Koichi

doi:10.1089/thy.2014.0581

Cited by 47 publications

(28 citation statements)

References 27 publications

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“…In Japan, iodine therapy has been successfully used to treat hyperthyroidism in pregnancy (14,56), with a significant reduction in birth defects compared with MMI therapy in a retrospective study (Fig. 5) (56). In this Japanese study, a sub-group of the women had worsening of hyperthyroidism after shift from MMI to iodine therapy, but despite this, there was no increase in pregnancy loss in the iodine-treated group (Fig.…”

Section: Alternative Therapies For Graves' Hyperthyroidism In Early Pmentioning

confidence: 83%

Section: Alternative Therapies For Graves' Hyperthyroidism In Early Pmentioning

confidence: 99%

“…Pregnancy loss was stratified according to the description of cases given in the Japanese study (56).…”

Section: Foetal Hyper-and Hypo-thyroidismmentioning

confidence: 99%

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ENDOCRINOLOGY IN PREGNANCY: Pregnancy and the incidence, diagnosing and therapy of Graves’ disease

Laurberg

Andersen

2016

European Journal of Endocrinology

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Thyroid hormones are essential developmental factors, and Graves' disease (GD) may severely complicate a pregnancy. This review describes how pregnancy changes the risk of developing GD, how early pregnancy by several mechanisms leads to considerable changes in the results of the thyroid function tests used to diagnose hyperthyroidism, and how these changes may complicate the diagnosing of GD. Standard therapy of GD in pregnancy is anti-thyroid drugs. However, new studies have shown considerable risk of birth defects if these drugs are used in specific weeks of early pregnancy, and this should be taken into consideration when planning therapy and control of women who may in the future become pregnant. Early pregnancy is a period of major focus in GD, where pregnancy should be diagnosed as soon as possible, and where important and instant change in therapy may be warranted. Such change may be an immediate stop of anti-thyroid drug therapy in patients with a low risk of rapid relapse of hyperthyroidism, or it may be an immediate shift from methimazole/carbimazole (with risk of severe birth defects) to propylthiouracil (with less risk), or maybe to other types of therapy where no risk of birth defects have been observed. In the second half of pregnancy, an important concern is that not only the mother with GD but also her foetus should have normal thyroid function.Thyroid hormones are essential developmental factors as first shown by Gudernatsch when he, in 1912, fed tadpoles thyroid tissue and observed metamorphosis (1). In mammals, thyroid hormones are especially of importance for brain development (2, 3), and even a few months with lack of thyroid hormones in infant life may lead to irreversible brain damage. This is the background for the universal screening for congenital hypothyroidism performed in many countries. However, thyroid hormones are also important for normal pregnancy, and maternal thyroid disease may severely increase the risk of pregnancy complications, including Invited author's profile Peter Laurberg was Clinical Professor of Internal Medicine and Endocrinology, Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark. His research mainly focused on thyroid disease prevention, epidemiology, diagnosing and therapy, including studies on iodine and thyroid, and pregnancy and thyroid. He had special research interest on the risk from and optimal management of autoimmune hypo-and hyperthyroidism in pregnancy and post-partum, management of Graves' disease in general, and how the burden of thyroid disease can be minimized by adjusting the population's iodine intake. He has coauthored several international guidelines on thyroid disease management, including management of thyrotoxicosis, and thyroid disease in pregnancy. Peter Laurberg died June 20, 2016.

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Section: Alternative Therapies For Graves' Hyperthyroidism In Early Pmentioning

confidence: 83%

Section: Alternative Therapies For Graves' Hyperthyroidism In Early Pmentioning

confidence: 99%

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ENDOCRINOLOGY IN PREGNANCY: Pregnancy and the incidence, diagnosing and therapy of Graves’ disease

Laurberg

Andersen

2016

European Journal of Endocrinology

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“…Antithyroid drugs may be teratogenic with the highest risk (birth defects in 1/30 exposed to methimazole (123,124), 1/40 exposed to propylthiouracil (124,125)) in weeks six to ten of pregnancy (126). Thus, women who are treated with antithyroid drugs for subclinical hyperthyroidism and who may potentially become pregnant should be instructed to test for pregnancy very early (the first week of a missing or unusually weak menstruation), to stop the medication if the test is positive, and to immediately contact the physician responsible for the therapy to plan further management (127).…”

Section: Side Effects Of Subclinical Hyperthyroidism Therapymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Subclinical thyrotoxicosis: prevalence, causes and choice of therapy

Carlé¹,

Andersen

Boelaert

et al. 2017

European Journal of Endocrinology

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Subclinical thyrotoxicosis is a condition affecting up to 10% of the population in some studies. We have reviewed literature and identified studies describing prevalences, causes and outcomes of this condition. Treatment should be considered in all subjects if this biochemical abnormality is persistent, especially in case of symptoms of thyrotoxicosis or in the presence of any complication. In particular, treatment should be offered in those subclinically thyrotoxic patients with a sustained serum TSH below 0.1 U/L. However it is important to recognise that there are no large controlled intervention studies in the field and thus there is no high quality evidence to guide treatment recommendations. In particular, there is no evidence for therapy and there is weak evidence of harm from thyrotoxicosis if serum TSH is in the 0.1-0.4 IU/L range. In this review, we describe the different causes of subclinical thyrotoxicosis, and how treatment should be tailored to the specific cause. We advocate radioactive iodine treatment to be the first-line treatment in majority of patients suffering from subclinical thyrotoxicosis due to multinodular toxic goitre and solitary toxic adenoma, but we do generally not recommend it as the first-line treatment in patients suffering from subclinical Graves' hyperthyroidism. Such patients may benefit mostly from antithyroid drug therapy. Subclinical thyrotoxicosis in early pregnancy should in general be observed, not treated. Moreover, we advocate a general restriction of therapy in cases where no specific cause for the presumed thyroid hyperactivity has been proven. Allan Carlé, MD, PhD, is a senior researcher, Aalborg University Hospital, Aalborg, Denmark. His research has focused on nosological classification of various subtypes of hypothyroidism. He has explored the field of hypoand hyper-thyroidism with special focus on the occurrence in the population, biochemical findings at diagnosis, the symptom presentation across gender and age, the magnitude of avoiding referral bias in population-based studies, and he has studied several risk factors for both hyper-and hypo-thyroidism. The research frame has been DanThyr (The Danish Investigation on Iodine Intake and Thyroid Diseases).

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“…A study conducted during the first trimester of pregnancy, which is another indication, demonstrated efficacy and safety for both mother and fetus [50].…”

Section: Does Iodide Have a Role In Medical Treatment Of "Common" Gramentioning

confidence: 99%

Treatment of adult Graves’ disease

Corvilain

Hamy

Brunaud³

et al. 2018

Annales d'Endocrinologie

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Treatment strategy in Graves' disease firstly requires recovery of euthyroid status by antithyroid therapy. Treatment modalities, precautions, advantages and side-effects are to be discussed with the patient. No particular treatment modality has demonstrated superiority. Pregnancy or pregnancy project affects choice of treatment and monitoring. Graves' orbitopathy is liable to be aggravated by iodine-131 treatment and requires pre-treatment assessment. Iodine-131 treatment aims at achieving hypothyroidism. Thyroid surgery for Graves' disease should preferably be performed by an expert team. In case of recurrence of hyperthyroidism, the various treatment options should be discussed with the patient. Empiric treatment of thyroid dermopathy uses local corticosteroids in occlusive dressing.

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Substituting Potassium Iodide for Methimazole as the Treatment for Graves' Disease During the First Trimester May Reduce the Incidence of Congenital Anomalies: A Retrospective Study at a Single Medical Institution in Japan

Abstract: Substituting KI for MMI as a means of controlling hyperthyroidism in GD patients during the first trimester may reduce the incidence of congenital anomalies, at least in iodine-sufficient regions.

Cited by 47 publications

References 27 publications

ENDOCRINOLOGY IN PREGNANCY: Pregnancy and the incidence, diagnosing and therapy of Graves’ disease

ENDOCRINOLOGY IN PREGNANCY: Pregnancy and the incidence, diagnosing and therapy of Graves’ disease

MANAGEMENT OF ENDOCRINE DISEASE: Subclinical thyrotoxicosis: prevalence, causes and choice of therapy

Treatment of adult Graves’ disease

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