> Antithyroid drugs in pregnancy. Hyperthyroidism

The use of antithyroid drugs should be avoided in the first trimester of pregnancy, to reduce likely congenital malformations. This is what emerges from a study of Danish.

Stine Linding Andersen, and Peter Laurberg the Università di Aalborg have sent an e-mail to Reuters Health: “The physicians who treat young women with anti-thyroid medications should be aware of the importance of a possible pregnancy. It is important to talk with these women about the fact that any pregnancy should be diagnosed as soon as possible”.

hyperthyroidism può have negative effects on pregnant women and on the development of the fetus, but treatment with anti-thyroid medications in the first quarter of può to cause congenital malformations. Current guidelines encourage the use of propylthiouracil (PTU) in the first trimester of pregnancy, then change with the methimazolo/carbamizolo (MMI/CMZ) in the step più advanced.

The team of Andersen used the data of the Register of the Danish nascinte, the Registry, the Danish National requirements, and the National Registry of Danish Hospitals, to examine the frequency of congenital malformations, agranulocytosis (significant reduction of white blood cells), and toxicosis of the liver associated with the use of these drugs in the general population and in pregnant women.

nearly 30,000 prescriptions individual of antithyroid drugs, the majority were of MMI/CMZ (n=27,281) and much less than that of PTU (n=5,895).

side-effects related to the MMI in the general population was double that of those commonly due to the PTU, but this was also due to the fact that the prescription of MMI is almost five times that of PTU, as già reported on the 27th of January 2016 in the Journal of Clinical Endocrinology and Metabolism.

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The frequency of agranulocytosis was significantly più high with PTU (0.27%) which, with the MMI/CMZ (0.11%, p=0.02), while the frequency of toxicity liver was not significantly different.

The agranulocytosis and the toxicosis of the liver are less frequent in pregnant women than in the general population.

Seventy-five children had malformations associated with the use of maternal antithyroid drugs on 2.206 pregnancies, a rate of 340 cases/10,000 exposed).

“We have to warn women who are taking antithyroid drugs to buy a pregnancy test and keep it with you, costs just a few dollars, and do so when they believe that there is a possibilityà of pregnancy. If the test is positive, women should contact their endocrinologist and do not take further medication before having spoken“.

“If the doctor thinks that the woman is in remission from hyperthyroidism, we do not recommend that they are kept under observation without medication and to monitor weekly operation of the thyroid gland until the second trimester of pregnancy.

If the medicine antitiroideo is considered to be indispensable in the first trimester, we recommend the use of propylthiouracil. If the pregnancy is planned, be sure to replace with this medication before pregnancy. If treatment is to continue after the first quarter, the doctor can continue with the PTY.”

To conclude, the authors state:

“pregnancy is a very important moment for the endocrinologist at the beginning and for the obstetrician at the end. Hyperthyroidism untreated può complicating pregnancy is very important and should be carefully treated and controlled. It is necessary toò to pay great attention to the assumption of therapy in the first quarter and evaluate the actual needà of intake in the first trimester of pregnancy to reduce the weight of the side effects of these drugs in the population.”

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February 22, 2016