Risk of congenital anomalies associated with antithyroid treatment during pregnancy: a meta-analysis

To evaluate the association of either propylthiouracil or methimazole treatment for hyperthyroidism during pregnancy with congenital malformations, relevant studies were identified by searching Medline, PubMed, the Cochrane Library and EMBASE. We intended to include randomized controlled trials, but no such trials were identified. Thus, we included cohort studies and case-control studies in this meta-analysis. A total of 7 studies were included in the meta-analyses. The results revealed an increased risk of birth defects among the group of pregnant women with hyperthyroidism treated with methimazole compared with the control group (odds ratio 1.76, 95% confidence interval 1.47-2.10) or the non-exposed group (odds ratio 1.71, 95% confidence interval 1.39-2.10). A maternal shift between methimazole and propylthiouracil was associated with an increased odds ratio of birth defects (odds ratio 1.88, 95% confidence interval 1.27-2.77). An equal risk of birth defects was observed between the group of pregnant women with hyperthyroidism treated with propylthiouracil and the non-exposed group (odds ratio 1.18, 95% confidence interval 0.97-1.42). There was only a slight trend towards an increased risk of congenital malformations in infants whose mothers were treated with propylthiouracil compared with in infants whose mothers were healthy controls (odds ratio 1.29, 95% confidence interval 1.07-1.55). The children of women receiving methimazole treatment showed an increased risk of adverse fetal outcomes relative to those of mothers receiving propylthiouracil treatment. We found that propylthiouracil was a safer choice for treating pregnant women with hyperthyroidism according to the risk of birth defects but that a shift between methimazole and propylthiouracil failed to provide protection against birth defects. .

Impact of propylthiouracil on quality of life in psoriasis patients.

Background: Psoriasis greatly impacts the quality of life (QOL) of patients including several dermatological conditions that are listed in the Dermatology Life Quality Index (DLQI). Decrease in psoriatic lesion as measured by Psoriasis Area Severity Index (PASI) score is associated with improvement in QOL. Propylthiouracil (PTU) was found to be clinically efficient in clearing psoriatic lesions. Our objective is to find the extent of improvement in QOL in psoriatic patients treated with PTU. Materials and Methods:Twenty-three psoriatic patients who were taking 300 mg PTU/day were involved in the study. Clinical improvement was assessed by PASI score and QOL was assessed by DLQI questionnaire at baseline, 6 th and 12 th week of PTU treatment. Results: Psoriatic patients before treatment showed significantly increased DLQI score when compared with 6 and 12 weeks of PTU treatment which was found to be decreased significantly (P < 0.001) after PTU treatment. There was a positive correlation between DLQI and PASI score at all three intervals of treatment period at P < 0.001 (r = 0.793, r = 0.834, r = 0.801), respectively. Conclusion: Since PTU was found to improve the QOL of psoriasis patients, this study adds an advantage of using it as treatment option in psoriasis.

Model of induction of thyroid dysfunctions in adult female mice

It is described the elaboration of a protocol to induce hyperthyroidism and hypothyroidism in mice by administrating thyroxin and propylthiouracil, respectively, in the drinking water. The drugs were administered to adult female mice of the Swiss strain for 30 days in order to obtain a systemic status of thyroid dysfunction. The induction of hyperthyroidism and hypothyroidism in the animals was confirmed by the histomorphological analysis of the thyroid in the end of the experiment, when the state of gland dysfunction in the animals submitted to the treatment was observed

Descreve-se a elaboração de um novo protocolo de indução ao hipertireoidismo e hipotireoidismo em camundongos, por meio da administração de tiroxina e propiltiouracil, respectivamente, na água de beber. As drogas foram administradas a camundongos fêmeas adultas Swiss por 30 dias para obtenção das disfunções tireoidianas sistêmicas. A indução de hipertireoidismo e hipotireoidismo nos animais foi confirmada pela análise histomorfológica e histomorfométrica da glândula tireoidiana ao final do experimento, quando observou-se o estado de disfunção glandular nos animais submetidos ao tratamento

Management of a Pregnant Patient with Graves' Disease Complicated by Propylthiouracil induced Agranulocytosis

Relapse and exacerbation of Graves' disease during pregnancy is rare, and thionamide induced agranulocytosis is an uncommon side effect. We report a case of a pregnant woman in her 24th week of gestation that experienced a relapse of Graves' disease that was complicated by propylthiouracil induced agranulocytosis. Following the discontinuation of propylthiouracil and administration of a broad-spectrum of antibiotics, agranulocytosis subsided within 10 days. A total thyroidectomy to avoid any future relapse was planned and a short course of a beta-adrenergic blocker and Lugol solution were prescribed before the operation. At the 28th week of gestation, a total thyroidectomy was performed without complications and thyroxine replacement therapy was commenced. At the 40th week of gestation, labor was induced and a 3, 370 g healthy male infant was born without clinical features of thyrotoxicosis. We report herein on the patient and the treatment options for this rare and complicated case.

Nódulo tiroídeo en enfermedad de Basedow Graves y cáncer tiroídeo: experiencia en 6 pacientes / Thyroid nodules in Basedow Graves disease and thyroid cancer: experience in 6 patients

Traditionally, Basedow graves disease was considered a protection against cancer. However, recent reports suggest that cancer occurs with a higher frequency than expected and is more aggressive in this disease. We report six patients with hyperthyroidism due to a Basedow Graves disease that presented a palpable thyroid nodule, which was cold in the scintiscan and solid in the ultrasound examination. Fine needle cytology disclosed cancer in 5 cases (2 with cytological features of greater aggressiveness) and a nodular hyperplasia in one. The diagnosis was confirmed in the surgical piece in all patients. We conclude that Basedow Graves disease and thyroid cancer, which can have an increased aggressiveness, may coexist

Terapêutica descontínua como fator precipitante de reaçöes adversas ao propiltiouracil / Discontinuous treatment as a precipitant factor of adverse reaction to propylthiouracil

As drogas antitiroidianas sao amplamente prescritas para controle dos estados hipertiroidianos desde 1940. Existem evidências de que as reaçoes adversas ao propiltiouracil (PTU) sao imunologicamente mediadas. A sua utilizaçao é, em geral prolongada e a descontinuidade da terapêutica nao é infrequente. Esta exposiçao repetida ao PTU poderia estar associada a um maior risco de desencadeamento das reaçoes adversas por induzir mecanismo de hipersensibilidade. Estudamos, retrospectivamente 56 pacientes (média de idade = 38,7+ 14,6 anos; 43 femininos e 13 masculinos) com hipertiroidismo tratados com PTU e que tiveram necessidade de internaçao, sendo que 46,4 por cento tiveram o tratamento descontinuado por pelo menos 15 dias. Efeitos adversos ao PTU foram observados em 23,2 por cento dos pacientes estudados. Daqueles com uso descontínuo, 34 por cento apresentaram efeitos adversos, sendo 56 por cento dos casos potencialmente graves (agranulocitose e hepatite), enquanto somente 13,3 por cento daqueles que usaram continuamente a medicaçao (p=OO3) presentaram reaçoes - um caso de anemia aplástica e 3 casos de reaçoes consideradas de menor importância clínica(leucopeniae e "rash" cutâneo). Sugerimos que as reaçoes imunes adversas ao PTU podem ser desencadeadas mais frequentemente em pacientes que fazem uso descontínuo desta medicaçao.

Doenças de graves: uso clínico de drogas antitireoidianas

Os autores sintetizam um pouco da história do emprego dos antitireoidianos na prática clínica, especificamente em relaçäo ao tratamento do hipertireoidismo da doença de Graves, apresentando razöes para seu uso. Na experiência do Instituto de Endocrinologia da Santa Casa do Rio de Janeiro, as taxas de remissäo do hipertireoidismo, 1 ano após a interrupçäo da medicaçäo foram melhores no grupo de doentes que fez uso da medicaçäo por período superior a 1 ano do que naquele de pacientes que receberam a medicaçäo por período inferior a 1 ano (taxas respectivamente de 44,28% e 12,96%). Os antitireoidianos devem continuar sendo empregados como primeira opçäo no tratamento do hipertireoidismo da doença de Graves. Em caso de impossibilidade de controle da doença, deve-se recorrer às formas ablativas de tratamento, uso do lado radioativo ou cirurgia

Papel del infiltrado linfocitario en el hipotiroidismo posquirúrgico de paciente con bocio tóxico difuso preparados con propranolol / Role of lymphocytic infiltration in postsurgical hypothyroidism of patients with diffuse toxic goiter prepared with propranolol

Se presentan los resultados obtenidos con dos tipos de preparaciones prequirúrgicas de pacientes con BTD. Un número recibió sólo propranolol (grupos I, II, III) y otro con propiltiouracilo y lugol (grupo IV). En el grupo I con un remanente igual al del grupo IV, el porcentaje de hipotiroidismo, poco tiempo después de la operación fue superior al del grupo IV. En el grupo II (remanente algo mayor) dicho hipotiroidismo fue similar al del grupo IV. De los factores analizados para tratar de darle una explicación a este fenómeno sólo el grado de infiltración linfocitaria parece haber sido el determinante, pues es mayor en los tiroides de pacientes preparados con propranolol que en aquellos preparados con propiltiouracilo más lugol. Esto puede estar relacionado con la acción que sobre el sistema inmunológico posee el antitiroideo de síntesis y que no tiene el beta bloqueador. La implicación terapéutica de nuestros resultados está dada por la necesidad de dejar un remanente tiroideo algo mayor cuando a los pacientes con bocio tóxico difuso, se les prepara con propranolol

Histological study of the thyroids of rats treated with propyl thyouracil, parotidectomyzed and parotidectomyzed treated with propyl thyouracil

Os autores estudaram, histologicamente, as glândulas tireóides de quatro grupos experimentais de ratos: Grupo controle (I), ratos submetidos à extirpaçäo cirúrgica das glândulas parótidas (Grupo II), ratos tratados com 25 mg diários de 6-propil-2-tiouracil (Grupo III) e ratos parotidectomizados e posteriormente tratados com 25 mg diários de 6-propil-2-tiouracil (Grupo IV). Após 26 dias consecutivos de administraçäo de 6-propil-2-tiouracil, todos os animais foram sacrificados. O aspecto histológico da tireóide dos animais tratados com a droga antitireoideana (Grupo III) foi compatível com o de hipofunçäo da glândula. Nos animais parotidectomizados (Grupo II), o aspecto histológico foi o de hiperfunçäo glandular. Nos animais parotidectomizados e tratados com o 6-propil-2-tiouracil (Grupo IV), o aspecto histológico mostrou características intermediárias entre o dos Grupos II e III. Estes resultados sugerem que a parotidectomia atenua a hipofunçäo tireoideana causada pela administraçäo do 6-propil-2-tiouracil, bem como vem enfatizar a hipótese da inter-relaçäo funcional entre glândulas salivares e tireóide