Create an account to join the conversation, Have your say, get notified on what matters to you and see fewer ads, This is page 1 of 1 (This thread has 22 messages.). Gurney JK, McGlynn KA, Stanley J, et al. The results of our retrospective study showed that treatment with PTU during the first trimester of pregnancy did not increase the incidence of birth defects among newborns. There were 3 newborns with cryptorchidism in the LT4 group, and its prevalence was 1.0% (3/307 male newborns). The second edition of this quick reference handbook for obstetricians and gynecologists and primary care physicians is designed to complement the parent textbook Clinical Obstetrics: The Fetus & Mother The third edition of Clinical ... Prevalence of birth defects in each of the exposed groups. Found inside – Page 509pregnancy is the association between MMI use during the first trimester and ... that PTU, rather than MMI, should be used during the first trimester of ... In 2012, we reported finding that exposure to MMI during the first trimester of pregnancy was associated with an increase in the incidence of congenital malformations, and it significantly increased the incidence of aplasia cutis congenita, omphalocele, and a symptomatic omphalomesenteric duct anomaly. An essential text, this is a fully updated second edition of a classic, now in two volumes. It provides rapid access to information on molecular pharmacology for research scientists, clinicians and advanced students. Found inside – Page 301Both PTU and methimazole are taken up by the fetal thyroid gland after the first trimester . At PTU dosages of 300 mg or greater daily , fetal goiter and ... Get updates on how your baby develops, your body changes, and what you can expect during each week of your pregnancy by signing up to the Mumsnet Pregnancy Newsletters. It is a white, crystalline substance that has a bitter taste and is very slightly soluble in water. The comparison between the PTU group and KI group (30/541 vs 4/109) yielded a P value of .64 by Fisher exact test and a P value of .42 by chi-square test. the first trimester of pregnancy (see Warnings and Precautions). I’m really hoping to get some reassurance from mums who’ve been in a similar situation to me. The prevalence of hyperthyroidism in pregnancy has been estimated to range between 0.1 and 1% [1,2,3,4,5] and if untreated or poorly treated there is an increased risk of adverse outcomes including fetal loss [4,6].Anti-thyroid drugs are the mainstay of treatment throughout pregnancy [7,8].Propylthiouracil (PTU) is generally used first line in pregnancy . I guess I’ve just got to try and tell myself that the benefits of taking it outweigh the risks. aIn the first trimester; median (interquartile range). However, the results were consistent with the findings in an earlier study conducted on a larger cohort that was reported from our institution. Propylthiouracil may be the treatment of choice when an antithyroid drug is indicated during or just prior to the first trimester of pregnancy (see Warnings and . How are you feeling? Then we calculated the rates of birth defects based on the number of infants. Should this low dose if carbimaxole be safe? The study from Denmark showed that PTU was associated with birth defects in the face and neck region and in the urinary system. Registry-based studies in Denmark and Korea, however, showed an increased incidence of congenital anomalies in infants born to mothers exposed to PTU in comparison with an unexposed control group [2, 4]. Accessibility Once my levels were normal it was very quick. The P value for the comparison between the PTU group and the LT4 group (6/255 vs 3/307) was .20. Propylthiouracil may be used when an antithyroid drug is needed during or just before the first trimester of pregnancy. Dosage of PTU should be limited to less than 300 mg during the first and second trimester, PTU can usually be stopped during the third trimester as the natural suppression of the immune system during pregnancy causes a gradual remission of Graves' symptoms. Results: The incidence of malformed infant births was 5.5% (30/541 infants) in the PTU group and 5.7% (27/ 475 infants) in the control group. Abbreviations: FT4, free thyroxine; NS, not significant; PTU, propylthiouracil; TSH, thyrotropin. To use this feature subscribe to Mumsnet Premium - get first access to new features see fewer ads, and support Mumsnet. Propylthiouracil may cross the placenta less readily than carbimazole (which has, on rare occasions, been associated with teratogenic affects) and it is the first choice in pregnancy and breastfeeding . So once you're past this early part of your pregnancy, your provider may recommend switching back to MMI. Thyroid disease in pregnancy can affect the health of the mother as well as the child before and after delivery. Graves disease; birth defects; pregnancy; propylthiouracil. Pregnant patients being treated at our institution were informed during their pregnancy that they would be asked about the outcome of their pregnancy after delivery. In the first trimester, hCG — which is similar to TSH — stimulates production of thyroid hormones. J Obstet Gynaecol Can. Abbreviations: FT4, free thyroxine; KI, potassium iodide; MMI, thiamazole; PTU, propylthiouracil; TSH, thyrotropin. J Clin Endocrinol Metab 2012; 97:2396. There were 6 newborns with cryptorchidism in the PTU group. Propylthiouracil has been considered as the first-line drug for treatment of hyperthyroidism in the first trimester of pregnancy. These findings confirm the importance of minimizing MMI use in the first trimester and suggest that the current recommendation of switching from MMI to PTU after pregnancy detection should be . The increased . When I was first diagnosed my consultant said to hold off TTC as it is so risky being pregnant with a very overactive thyroid - so please take the meds! In the study from Korea, PTU was found to be associated with birth defects in the genital organs and the musculoskeletal system. I was diagnosed with graves after I had DD and took PTU whilst breastfeeding. Medical treatment of GD during the first trimester of pregnancy has been the subject of controversy ever since treatment with MMI during the first trimester of pregnancy was reported to possibly be associated with an increased risk of birth defects in newborns [7]. -If a patient is, or becomes pregnant during therapy, she should be advised of the potential risk of liver toxicity; due to risk of maternal hepatotoxicity, it may be preferable to switch to methimazole for the second and third trimesters of pregnancy. Early pregnancy is critical in a baby's development, and PTU is the safer option. Thanks @Squiff70. I stupidly read some research articles today about birth defects and now I’m worrying myself silly. -. 2011 Jul 6;(7):CD003510. Since 2005, we have been treating GD patients with PTU or KI before conception to avoid MMI exposure during early pregnancy, and that is why the number of patients in the MMI group was so small. Also know, is it safe to take propylthiouracil while pregnant? Found inside – Page iiThis text addresses the need for a book specifically aimed at obstetric anesthesia and covers topics such as pulmonary, cardiac renal, hepatic, hematologic, neurologic, endocrine and other diseases. There was no increase in the overall incidence of birth defects in the PTU group in comparison with the control group (P = .92). Found inside – Page 276The treatment of choice for Graves' disease during pregnancy is antithyroid drugs. Propylthiouracil (PTU) is indicated in the first trimester and ... We reviewed the cases of 1913 women with GD who gave birth between January 1, 2015, and May 31, 2019. It doesn’t seem to run in my family, so it’s all just a lot to try and take in at the moment. These findings confirm the importance of minimizing MMI use in the first trimester and suggest that the current recommendation of switching from MMI to PTU after pregnancy detection should be . Thyroid disorders are prevalent in women of child-bearing age and for this reason commonly present as a pre-existing disease in pregnancy, or after childbirth. Angel. Propylthiouracil (PTU) is the treatment of choice in any woman with Graves disease planning pregnancy or in the first trimester as carbimazole is associated with a rare embryopathy. When I was pregnant I was also prescribed blood pressure medication in the third trimester and there was no adverse affects on DD at all who was born perfectly healthy I wish you well, you have my sympathy as thyroid issues are totally shit! 2012 Jul;97(7):2396-403. doi: 10.1210/jc.2011-2860. The incidence of malformed infants in the MMI group was 0% (0/23 infants), and it was 3.7% in the KI group (4/109 infants). Considering PTU, this drug had not been linked to birth defects by the turn of the century [] and the majority of later observational studies found no association between maternal use of PTU in early pregnancy and birth defects including the large study from Japan published in 2012 (Figs. You should level off during pregnancy but not at the beginning mid to late term you should be on a lower dose you are at most risk before 13 weeks have regular checks take your meds and you should be fine I've stormed a couple of times never during pregnancy, And consultants wont tell everything to you as they wont want to worry you because stress makes it worse I told you because you should know the risks of not taking your meds. MMI alone had been used to treat 1426 of the women, and 1578 women had been treated with PTU alone. x. I have graves disease .Im on low dose of carbimazole 5mg for 2 days and then skip 1 day and repeat . The results of our previous observational study in Japan did not show an association between congenital anomalies and propylthiouracil (PTU) treatment during the first trimester of pregnancy [5]. Two newborns in the control group had 2 birth defects: One had a ventricular septal defect and retractile testis and the other had an inguinal hernia and hydrocele testis. If a birth defect was reported, the physician corresponded with the gynecologist, and we were able to determine whether the fetus had any life-threatening anomalies. Found inside – Page 19The other commonly used ATD, propylthiouracil (PTU), is not associated with ... using PTU during preconception and in the first trimester of pregnancy to ... I’m 5 weeks pregnant; I’ve just been diagnosed with hyperthyroidism and prescribed 300mg a day Propylthiouracil (PTU) to treat it. Should I worry? All of this is normal. Found inside – Page 633PTU can cause hepatic toxicity serious enough to require liver transplantation. When taken during the first trimester of pregnancy, MMI can cause choanal ... Detailed information concerning the outcome of pregnancy and the presence of birth defects was collected at the first visit after the delivery and again 1 year after delivery. We reviewed the cases of 1913 women with GD who gave birth between January 1, 2015, and May 31, 2019. Cochrane Database Syst Rev. and I'm sure he wouldn't have said that if he thought PTU was really dangerous. @TheGreatProcrastinator its important that I tell you that I was NOT pregnant or TTC when I had the thyroid storm. Treatment of graves' disease with antithyroid drugs in the first trimester of pregnancy and the prevalence of congenital malformation. During the mothers’ first visit after delivery, a physician interviewed them about the birth defects diagnosed by the obstetricians. The economy has shafted millennials: now it wants their offspring too, Mumsnet carries some affiliate marketing links, so if you buy something through our posts, we may get a small share of the sale (, Talk widget showing discussions of the day & trending threads, Subscribe to Mumsnet emails direct to your inbox. We investigated the clinical characteristics of the mothers in the PTU group and the control group. Risk Summary: This drug crosses the placental membrane and can cause fetal harm, especially during the first trimester; studies have shown that the incidence of congenital malformations is greater in babies of mothers whose hyperthyroidism has remained untreated than in those who have been treated with anti . Andersen SL, Lönn S, Vestergaard P, Törring O. Gianetti E, Russo L, Orlandi F, et al. PTU and methimazole are the two important drugs used to treat the hyperactivity of the thyroid gland. "Now we are saying we don't know if that is the right approach," she said. It's never been a problem he's always just said let me know asap if you fall pregnant so we can switch to PTU. Duration of exposure was described as "the first trimester of pregnancy" in five studies [6, 8, 13, 16, 21], "during pregnancy" in four studies [7, 14, 15, 20], "between the 4 th and 13 th gestational week" in one study , "6 months before pregnancy to the end of the 10 th gestational week" in one study , and "over the 6 months . In the last guidelines, the experts recommended switching women with hyperthyroidism on methimazole (MMI) to propylthiouracil (PTU) during the first trimester, Dr. Pearce explained. Found inside – Page 923BOX 42-4 SIDE-EFFECT PROFILES OF METHIMAZOLE VERSUS PROPYLTHIOURACIL ... the ATA recommended the use of PTU only in the first trimester of pregnancy with a ... Found inside – Page 52Propylthiouracil (PTU) is the treatment of choice particularly during the first trimester of pregnancy. Methimazole (MMI)/carbimazole can be initiated after ... After the first trimester of pregnancy, the use of an alternative antithyroid medication may be advisable (see Precautions, Pregnancy). @furryleopard it’s really reassuring to hear that you’ve had two children while taking anti-thyroid meds. When switching from MMI to PTU, a ratio of 1:20 is used (i.e., MMI 15 mg = 300 mg of PTU per day dosed as 100 mg PO every 8 h) . For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Medical treatment of Graves disease during the first trimester has been the subject of controversy ever since treatment with an antithyroid drug during the first trimester was reported to possibly be associated with an increased risk of birth defects in newborns. If they require ongoing treatment with antithryoid drug, this may be switched to carbimazole in the 2nd trimester. The mothers in the PTU group had been treated with PTU alone during the first trimester of pregnancy (0-12 weeks’ gestation). I’m feeling so much better about my situation now. Higher doses can result in fetal goiter and hypothyroidism. This volume presents the latest global knowledge of thyroid disorders in infancy, childhood, and adolescence and represents experience and views from a panel of the world's most renowned authorities on thyroid pathophysiology and clinical ... Yes,50mg of PTU is safe during first trimester of pregnancy but in second and third trimester she has to switch to methimazole tablets ( these are more safe drugs). Higher doses can result in fetal goiter and hypothyroidism. I had a thyroid storm at the end of 2017 and spent a month in a coma in critical care and on life support, so I STRONGLY advise you take prescribed medss for your thyroid whilst pregnant as you certainly don't want a thyroid storm which WILL harm your baby!Best wishes and good luck x. MMI, PTU is still recommended as the drug of choice during the first trimester of pregnancy (31). Yoshihara A, Noh J, Yamaguchi T, Ohye H, Sato S, Sekiya K, Kosuga Y, Suzuki M, Matsumoto M, Kunii Y, Watanabe N, Mukasa K, Ito K, Ito K. J Clin Endocrinol Metab. After initial stabilisation the dose is reduced as rapidly as possible (and is While, some physicians may prefer to use methimazole throughout pregnancy, Hershman said he believes that PTU is a better first option. I really like my consultant he's got a very dry sense of humour! Eight weeks into your pregnancy, or six weeks after conception, your baby's lower limb buds take on the shape of paddles. 8600 Rockville Pike Recent reports . PTU & Aspirin in pregnancy. Prevention and treatment information (HHS). Addresses the challenges of managing critically ill obstetric patients, with chapters authored by intensivists/anesthesiologists and obstetricians/maternal-fetal medicine specialists. Also my consultant has known all along that I wanted a family, I was first diagnosed in 2011. Dichotomous data were compared by using the chi-square test or Fisher exact test, whichever was appropriate, and were expressed as percentages. This book is a compact question-based review of the most critical topics an obstetrician will come across in practice. These reports of hepatic reactions include cases requiring liver transplant. "Up to 16 weeks of pregnancy, it is better to use PTU. In women diagnosed with symptomatic, moderate to severe hyperthyroidism during the first trimester of pregnancy, treatment with PTU should be initiated. So I've called my drs to see if we can get some help so fingers crossed we can h have some tests done Thank you x. Andersen SL, Olsen J, Wu CS, Laurberg P. Birth defects after early pregnancy use of antithyroid drugs: a Danish nationwide study. Severity of birth defects after propylthiouracil exposure in early pregnancy. Siegfried N, van der Merwe L, Brocklehurst P, Sint TT. The limitation of this study was the small number of cases both in the PTU-exposed group and the control group. Also if you stop or decrease your dose you are risking losing your baby did they not explain this to you? However, liver toxicity has been recently reported. Thread Tools. Propylthiouracil may be the t reatment of choice when an antithyroid drug is indicated during or just prior to . . Search for other works by this author on: Maternal thyroid function, use of antithyroid drugs in early pregnancy, and birth defects, Antithyroid drugs and congenital malformations: a nationwide Korean cohort study, Congenital anomalies in children exposed to antithyroid drugs in-utero: a meta-analysis of cohort studies, Birth defects after early pregnancy use of antithyroid drugs: a Danish nationwide study, Treatment of Graves’ disease with antithyroid drugs in the first trimester of pregnancy and the prevalence of congenital malformation, Treatment of hyperthyroidism in pregnancy and birth defects, 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum, Risk of adverse perinatal outcomes with antithyroid treatment during pregnancy: a nationwide population-based study, Birth defects after use of antithyroid drugs in early pregnancy: a Swedish nationwide study, Pregnancy outcome in women treated with methimazole or propylthiouracil during pregnancy, Prevalence of thyrotoxicosis, antithyroid medication use, and complications among pregnant women in the United States, Gestational thyrotoxicosis, antithyroid drug use and neonatal outcomes within an integrated healthcare delivery system, Trends in the treatment outcomes and features of cryptorchidism in boys: a single-institute experience, 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. 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Neonatal hypothyroidism preferred over methimazole methimazole for the second trimester, consideration should used... Mothers take high doses of propylthiouracil can be given to switching to methimazole for the of. You need to create a Mumsnet account was a well respected consultant and said he had had a few get. Defects [ 8-12 ] propylthiouracil ; TSH, thyrotropin defects in the first trimester 301Both and. Tid or ; methimazole 5 to 30mg divided into BID ; Adverse events months delivery! 1 year after delivery hospital is a fully updated second edition of Prescribing in pregnancy infection.