Treatment of post-partum thyrotoxicosis
Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, P.O. Box 19395-4763, Tehran, IR Iran. Journal of endocrinological investigation
(Impact Factor: 1.45).
04/2006; 29(3):244-7. DOI: 10.1007/BF03345547
Thyrotoxicosis occurs more frequently during the post-partum period than at other times in women of childbearing age. Graves' disease and post-partum thyroiditis are two major causes of thyrotoxicosis in this period. The major task lies in differentiation of these two diseases in the post-partum period; since throtoxicosis caused by post-partum thyroiditis usually does not require treatment. The radioiodine uptake is elevated or normal in Graves' disease and low in post-partum thyroiditis, and TSH-receptor antibodies are positive in Graves' and negative in post-partum thyroiditis. Post-partum thyrotoxicosis due to Graves' disease may be treated with radioiodine but it requires radiation safety measurements for infant and is contraindicated if the mother is breast-feeding. Antithyroid drugs are the mainstay of the treatment of post-partum thyrotoxicosis. Recent investigations conclude that neither propylthiouracil nor methimazole cause any alterations in thyroid function and physical and mental development of infants breast-fed by lactating thyrotoxic mothers, and both can be safely administered in moderately high doses during lactation.
Available from: Ladan Mehran
- "Postpartum thyrotoxicosis due to Graves' disease may be treated with radioiodine but it requires radiation safety measurements for infant and is contraindicated if the mother is breast-feeding. Antithyroid drugs are the mainstay of the treatment of postpartum thyrotoxicosis due to Graves' disease . Recent investigations conclude that neither PTU up to 300 mg nor MMI up to 30 mg daily cause any alterations in thyroid function and physical and mental development of infants breast-fed by lactating thyrotoxic mothers [25–28]. "
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ABSTRACT: Appropriate diagnosis and treatment of hyperthyroidism during pregnancy are of outmost importance, because hyperthyroidism has major adverse impact on both mother and fetus. Since data on the management of thyroid dysfunction during pregnancy is rapidly evolving, two guidelines have been developed by the American Thyroid Association and the Endocrine society in the last 2 years. We compare here the recommendations of these two guidelines regarding management of hyperthyroidism during pregnancy. The comparison reveals no disagreement or controversy on the various aspects of diagnosis and treatment of hyperthyroidism during pregnancy between the two guidelines. Propylthiouracil has been considered as the first-line drug for treatment of hyperthyroidism in the first trimester of pregnancy. In the second trimester, consideration should be given to switching to methimazole for the rest of pregnancy. Methimazole is also the drug of choice in lactating hyperthyroid women.
Journal of Thyroid Research 05/2013; 2013(1):878467. DOI:10.1155/2013/878467
Available from: Julie Wood
Disease-a-month: DM 07/2008; 54(6):343-411. DOI:10.1016/j.disamonth.2008.03.001 · 0.95 Impact Factor
Available from: Atieh Amouzegar
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ABSTRACT: 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.
To review articles related to appropriate management of hyperthyroidism during pregnancy and lactation.
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.'
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.
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.
European Journal of Endocrinology 03/2011; 164(6):871-6. DOI:10.1530/EJE-10-1030 · 4.07 Impact Factor
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