Therapy of Hyperthyroidism in Pregnancy and Breastfeeding

@article{Fumarola2011TherapyOH,
  title={Therapy of Hyperthyroidism in Pregnancy and Breastfeeding},
  author={Angela Fumarola and Agnese Di Fiore and Michela Dainelli and Giorgio Grani and Giovanni Carbotta and A. Calvanese},
  journal={Obstetrical \& Gynecological Survey},
  year={2011},
  volume={66},
  pages={378-385}
}
Uncontrolled hyperthyroidism in pregnancy is associated with an increased risk of perinatal complications. The state of the art discussed here has been derived through a wide MEDLINE search throughout English-language literature by using a combination of words such as hyperthyroidism, propylthiouracil (PTU), methimazole, rituximab, and pregnancy to identify original related works and review articles. Thioamides are the main first-line therapeutic options, whereas beta-blockers and iodine are… 

Degree of Control and Main Complications of Hyperthyroid Pregnant Women in a Real Life Experience with Methimazol

TLDR
In a real life situation there is delay in the diagnosis of hyperthyroidism during pregnancy but even without propylthiuracil, an “Adequate” control can be reached in up to 20.53% of cases based on a methimazole monotherapy.

Diagnosis and Management of Hyperthyroidism in Pregnancy: A Review

TLDR
To describe maternal diagnosis and management of hyperthyroidism, across all stages of pregnancy, and to review clinical signs of fetal thyroid dysfunction due to maternal Graves disease and discuss management considerations.

Influence of screening and intervention of hyperthyroidism on pregnancy outcome.

TLDR
Timely screening for gestational thyroid disease and actively intervention treatment can significantly improve the outcome of pregnancy.

Breastfeeding and Diabetes Mellitus/Thyroid Disease

TLDR
Assessment of the breast feeding rates in nursing mother with chronic disease such as obesity, diabetes, and thyroid disease and the dose of thyroid hormone for treatment of maternal hypothyroidism transfer to breast milk is too small to influence on thyroid hormone levels in neonates.

New-onset Graves' disease in the postpartum period.

  • A. Goldstein
  • Medicine, Biology
    Journal of midwifery & women's health
  • 2013
TLDR
During routine evaluation for lactation failure, hyperthyroidism was discovered in a postpartum woman and she was found to have new-onset Graves' disease.

Propylthiouracil increases sodium/iodide symporter gene expression and iodide uptake in rat thyroid cells in the absence of TSH.

TLDR
PTU induces NIS expression and iodide uptake in rat thyroid FRTL-5 cells in the absence of TSH, and shares similar antithyroid activity with MMI, but their effects on other thyroid functions appear to be quite different, which could affect their therapeutic effectiveness.

Effect of Thyromimetic GC-1 Selective Signaling on Reproductive and Lactational Performance in the Hypothyroid Rat

TLDR
The findings show the differential effect of thyroid hormone selective signaling during gestation and the indirect exposure of the pups; the plausible use of GC-1 for treatment of hypothyroid mothers during the lactation period is emphasized.

Docosahexaenoic Acid and Melatonin Prevent Impaired Oligodendrogenesis Induced by Intrauterine Growth Restriction (IUGR)

TLDR
In all cases, the in vitro rabbit neurosphere assay predicted the outcome of the in vivo administration of the therapies and confirmed the reliability of the model, making it a powerful and consistent tool to select new neuroprotective therapies.

Revista Española de Anestesiología y Reanimación

TLDR
Most of the severe traumas with a massive haemorrhage develop coagulopathy, with some controversy over what is the best treatment for this.

References

SHOWING 1-10 OF 68 REFERENCES

Graves hyperthyroidism and pregnancy: a clinical update.

  • Komal Patil-SisodiaJ. Mestman
  • Medicine, Biology
    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
  • 2010
TLDR
Preconception counseling and a multifaceted approach to care by the endocrinologist and the obstetric team are imperative for a successful pregnancy in women with Graves hyperthyroidism.

Inadvertent 131I therapy for hyperthyroidism in the first trimester of pregnancy.

  • S. StofferJ. Hamburger
  • Medicine
    Journal of nuclear medicine : official publication, Society of Nuclear Medicine
  • 1976
TLDR
Survey responses indicate that routine pregnancy testing prior to radioiodine therapy for patients in the child-bearing age is not yet a standard procedure and it should be.

Consequences of inadvertent radioiodine treatment of Graves’ disease and thyroid cancer in undiagnosed pregnancy. Can we rely on routine pregnancy testing?

TLDR
The possibility of pregnancy should be considered in all fertile women before therapy with radionuclides or cytostatic regimens, and a clinical investigation undertaken on wide indications with determination of serum β-hCG, preferably together with an ultrasound examination.

Pregnancy outcome, thyroid dysfunction and fetal goitre after in utero exposure to propylthiouracil: a controlled cohort study.

TLDR
PTU does not seem to be a major human teratogen, however, it could cause fetal/neonatal hypothyroidism with or without goitre, and Fetal thyroid size monitoring and neonatal thyroid function tests are important for appropriate prevention and treatment.

Medical treatment of hyperthyroidism: state of the art.

TLDR
Methimazole and propylthiouracil are the main antithyroid drugs used for hyperthyroidism and Rituximab, a monoclonal antibody directed against human CD20, was recently proposed as a biological therapy for cases of Graves' disease unresponsive to traditional drugs.

Propylthiouracil Versus Methimazole in Treatment of Graves' Disease During Pregnancy

TLDR
PTU should still be considered as the first-line agent in the treatment of Graves' disease during pregnancy, and methimazole should be considered a viable second choice if the patient is intolerant toPTU, has an allergic reaction to PTU, or fails to become euthyroid while receiving PTU.

Effects of propylthiouracil and methimazole on fetal thyroid status in mothers with Graves' hyperthyroidism.

TLDR
Little relationship was observed between maternal doses and fetal thyroid status; in fact, when low doses of both PTU and MMI were administered, high TSH levels in the fetus were observed in 7 of the 34 fetuses and in 6 of the 43 fetuses, respectively.

Pharmacologic treatment of hyperthyroidism during lactation.

TLDR
Women with hyperthyroidism using methimazole or propylthiouracil should not be discouraged from breastfeeding, as the benefits of breastfeeding largely outweigh the theoretical minimal risks.

Aggravation of thyrotoxicosis in early pregnancy and after delivery in Graves' disease.

TLDR
Graves' disease is aggravated in early pregnancy and after delivery and ameliorates in the latter half of pregnancy, and postpartum relapse of persistent hyperthyroidism could be predicted from an early increase in the FT4 index during pregnancy.

Putting propylthiouracil in perspective.

TLDR
The role of PTU during pregnancy has been reevaluated and the role of biochemical monitoring of liver integrity in patients taking drugs known to cause hepatic damage was discussed at two meetings, a complex and incomplete but, nonetheless, worrisome picture emerged from these meetings.
...