Treatment of Graves’ hyperthyroidism with thionamides: a position paper on indications and safety in pregnancy

Tonacchera, Massimo; Chiovato, Luca; Bartalena, Luigi; Cavaliere, Anna Franca; Vitti, P

doi:10.1007/s40618-019-01148-w

Cited by 21 publications

(23 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Data from large trials and recent meta-analyses have shown that shifting MMI to PTU in early pregnancy (usually in a 1: 20 ratio) was still associated with an increased risk for birth defects [ 36,11,38 ]. We agree with the authors of a recent position paper of several Italian Societies of Endocrinology and Obstetrics-Gynecology that in MMI-treated women, contraceptive methods are not routinely necessary (they may be offered until disease control is obtained), and in those with an unplanned pregnancy, therapeutic abortion is not warranted [ 35 ].…”

Section: Maternal Outcomessupporting

confidence: 80%

“…Thionamides inhibit the iodination of thyroglobulin and thyroglobulin synthesis. PTU can also inhibit the conversion of T4 to T3 [ 7,35 ]. Alternatively, surgery may be indicated in the second trimester if allergy or intolerance to treatment occurs, but the risk of miscarriage and preterm birth is increased [ 7,8 ].…”

Section: Treatment In Pregnant Women With Hyperthyroidismmentioning

confidence: 99%

“…ATD has been associated with several side effects. In pregnant and nonpregnant women, rash, urticaria, and arthralgia are more common (1-5%), while the most severe side effects are rare (0.1-1%): liver toxicity, including fulminant hepatic failure mostly developed on PTU, a lupus-like syndrome, agranulocytosis and, more recently described, a few cases of acute pancreatitis on MMI [ 8,9,10,35 ]. Both MMI and PTU can cross the placenta and, when used in early pregnancy, may have teratogenic effects in the fetus [ 10,34,36,11 ] (they are pregnancy category D drugs, i.e., they may be used if the potential benefits outweigh the potential risks for the mother and fetus).…”

Section: Treatment In Pregnant Women With Hyperthyroidismmentioning

confidence: 99%

“…Birth defects were recorded in approximately 4-9% of pregnancies with MMI exposure and in 1.9-8% of pregnancies with PTU exposure in several, but not all studies [ 34,36,11,35,37 ]. A recent meta-analysis including 6212322 pregnancies and 388976 birth defects from 7 cohort studies and 1 case-control study has calculated even lower adjusted risks of having congenital anomalies related to ATD, compared to the unexposed population [ 38 ].…”

Section: Fetal and Neonatal Outcomesmentioning

confidence: 99%

“…According to the current guidelines, the preferred ATD for those planning a pregnancy, as well as for those diagnosed de novo during early pregnancy, is PTU, due to the lower reported prevalence of birth defects [ 7,8 ]. Patients currently on MMI may shift to PTU as soon as pregnancy is diagnosed (as currently recommended) or continue with MMI [ 7,8 ] notably when the dose is low, and PTU is not easily available, as is the case in our country and others [ 35 ]. Data from large trials and recent meta-analyses have shown that shifting MMI to PTU in early pregnancy (usually in a 1: 20 ratio) was still associated with an increased risk for birth defects [ 36,11,38 ].…”

Section: Maternal Outcomesmentioning

confidence: 99%

See 4 more Smart Citations

Hyperthyroidism in Pregnancy: the Delicate Balance between too Much or too Little Antithyroid Drug

Gheorghiu¹,

Borş²,

Gheorghisan-Galateanu³

et al. 2021

Preprint

View full text Add to dashboard Cite

Overt hyperthyroidism during pregnancy is associated with risk of maternal-fetal complications. The antithyroid drugs (ATD) have a potential risk for teratogenic effects and fetal–neonatal hy-pothyroidism. This study evaluated ATD treatment and thyroid function control during preg-nancy, and pregnancy outcome in women with hyperthyroidism. Patients and methods: retro-spective analysis of 36 single fetus pregnancies in 29 consecutive women (median age 30.3 ± 4.7 years) with hyperthyroidism diagnosed before or during pregnancy; a control group of 39 healthy euthyroid pregnant women was used. Results: 26 women had Graves’ disease (GD, 33 pregnan-cies), 1 had a hyperfunctioning autonomous nodule, 2 had gestational transient thyrotoxicosis (GTT). Methimazole (MMI) was administered in 22 pregnancies (78.5%), Propylthiouracil (PTU) in 2 (7.1%), switch from MMI to PTU in 4 (14.2%), no treatment in 8 pregnancies (3 with subclinical hyperthyroidism, 5 euthyroid with previous GD remission before conception). One spontaneous abortion at 5 weeks (3.4% of pregnancies) and 1 premature delivery at 32 weeks with perinatal death in 24h (3.4%) were recorded in 2 of the 8 pregnancies of GD patients diagnosed shortly before (< 6 weeks) or during gestation. In women treated more than 6 months until conception (20 pregnancies): a) median ATD doses were lower than those in women diagnosed shortly before or during pregnancy; b) ATD was withdrawn in 40% of pregnancies in trimester (T) I, all on MMI < 10 mg/day (relapse in 14.2%), and in up to 55% in TIII; c) TSH level was below normal in 37%, 35% and 22% of pregnancies in T I, II and III respectively; FT4 was increased in 5.8% (T I) and sub-normal in 11.75% in TII and III; d) one fetal death due to a true umbilical cord knot was recorded. Hyperthyroidism relapsed postpartum in 83% of GD patients (at median 3 ± 2.6 months). One child had neonatal hyperthyroidism (3.3% of live children in GD women) and a small atrial sept defect (4% of live children in ATD treated women). Mean birth weight did not differ from that of the control group. Conclusion. In hyperthyroid women with long-term ATD control before con-ception, drugs could be withdrawn in TI in a third of them, and fetal complications were rare. Frequent serum TSH and FT4 monitoring is needed in order to maintain optimal thyroid function during pregnancy.

show abstract