Propylthiouracil versus methimazole in treatment of Graves' disease during pregnancy

被引:35
作者
Chattaway, Jeanne M. [1 ]
Klepser, Teresa B. [1 ]
机构
[1] Ferris State Univ, Coll Pharm, Dept Clin Pharm, Big Rapids, MI USA
关键词
Graves' disease; methimazole; pregnancy; propylthiouracil;
D O I
10.1345/aph.1H535
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Objective: To evaluate the evidence supporting the use of Propylthiouracil (PTU) versus methimazole for the treatment of Graves' disease during pregnancy. Data Sources: An English-language literature search was conducted using MEDLINE (1966-March 2007). Identified articles were then reviewed for additional sources. Search terms included hyperthyroidism, Graves' disease, pregnancy, propylthiouracil, and methimazole. Study Selection and Data Extraction: All clinical trials and case reports that were published in English and reported either subjective or objective outcomes were reviewed. Data Synthesis: Rationale supporting the use of PTU over methimazole in treatment of Graves' disease during pregnancy is limited. Theories suggesting that PTU has less placental transfer to the fetus than methimazole are not supported by current literature. Studies demonstrating a causal relationship between methimazole use during pregnancy and congenital anomalies and/or fetal hypothyroidisin do not exist. Conclusions: The selection of PTU versus methimazole for the treatment of Graves'disease during pregnancy should not be based solely on the following assumptions: that PTU crosses the placenta less than methimazole, that PTU leads to less fetal hypothyroidism, or that exposure to methimazole during pregnancy leads to decreased intellectual function in children. However, due to a possible association between the use of methimazole during pregnancy and fetal anomalies such as aplasia cutis, esophageal atresia, and choanal atresia, methimazole may be a less desirable first-line treatment for Graves'disease in pregnancy than PTU. Therefore, in the absence of a compelling indication for the use of methimazole, PTU should still be considered as the first-line agent in the treatment of Graves' disease during pregnancy. Methimazole should be considered a viable second choice if the patient is intolerant to PTU, has an allergic reaction to PTU, or fails to become euthyroid while receiving PTU.
引用
收藏
页码:1018 / 1022
页数:5
相关论文
共 25 条
[1]   Drug therapy for hyperthyroidism in pregnancy - Safety issues for mother and fetus [J].
Atkins, P ;
Cohen, SB ;
Phillips, BJ .
DRUG SAFETY, 2000, 23 (03) :229-244
[2]   Thyroid function and intellectual development of children of mothers taking methimazole during pregnancy [J].
Azizi, F ;
Khamseh, ME ;
Bahreynian, M ;
Hedayati, M .
JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, 2002, 25 (07) :586-589
[3]  
BRIGGS GG, 2002, DRUGS PREGNANCY LACT, P884
[4]  
BRIGGS GG, 2002, DRUGS PREGNANCY LACT, P1180
[5]   Drug therapy: Antithyroid drugs [J].
Cooper, DS .
NEW ENGLAND JOURNAL OF MEDICINE, 2005, 352 (09) :905-917
[6]   Adverse effects of prenatal methimazole exposure [J].
Di Gianantonio, E ;
Schaefer, C ;
Mastroiacovo, PP ;
Cournot, MP ;
Benedicenti, F ;
Reuvers, M ;
Occupati, B ;
Robert, E ;
Bellemin, B ;
Addis, A ;
Arnon, J ;
Clementi, M .
TERATOLOGY, 2001, 64 (05) :262-266
[7]  
Dwarakanath C. S., 1999, SMJ, V40, P70
[8]   Malformations following methimazole exposure in utero: An open issue [J].
Ferraris, S ;
Valenzise, M ;
Lerone, M ;
Divizia, MT ;
Rosaia, L ;
Blaid, D ;
Nemelka, O ;
Ferrero, GB ;
Silengo, M .
BIRTH DEFECTS RESEARCH PART A-CLINICAL AND MOLECULAR TERATOLOGY, 2003, 67 (12) :989-992
[9]   Management of hypo- and hyperthyroidism during pregnancy [J].
Glinoer, D .
GROWTH HORMONE & IGF RESEARCH, 2003, 13 :S45-S54
[10]   DIAGNOSIS AND MANAGEMENT OF GRAVES-DISEASE IN PREGNANCY [J].
HAMBURGER, JI .
THYROID, 1992, 2 (03) :219-224