Thyrostatic treatment and its adverse effects
Authors:
A. Dokupilová 1; J. Payer 2
Authors‘ workplace:
Kardiologická klinika FN Nitra, Slovenská republika, prednosta MU Dr. Pavol Poliačik, PhD.
1; V. interná klinika Lekárskej fakulty UK a UN Bratislava, Slovenská republika, prednosta prof. MU Dr. Juraj Payer, CSc.
2
Published in:
Vnitř Lék 2013; 59(11): 989-995
Category:
Review
Overview
Antithyroid drugs are relatively simple molecules known as thionamides, which contain a sulfhydryl group and a thiourea moiety within a heterocyclic structure. Propylthiouracil (6- propyl‑ 2- sulfanylidene‑ 1,2,3,4- tetrahydropyrimidin‑4- one) and methimazole (1- metyl‑ 2,3- dihydro‑1H‑ imidazole‑ 2- thione) are the antithyroid drugs used in the United States. Methimazole is used in most of Europe and Asia, and carbimazole – methimazole analogue, is used in the United Kingdom and parts of the former British Commonwealth. Their primary effect is to inhibit thyroid hormone synthesis by interfering with thyroid peroxidase‑ mediated iodination of tyrosine residues in thyroglobulin and is an important step in the synthesis of thyroxine and triiodothyronine. Propylthiouracil (but not methimazole or carbimazole), can block the conversion of thyroxine to triiodothyronine within the thyroid and in peripheral tissues. Antithyroid drugs may have clinically important immunosuppressive effects. Side effects of thionamides are usually mild, serious untoward effects are observed in < 5% of cases, more frequently during the initial phases of treatment, when the drug daily dose is higher.
Key words:
antithyroid drugs – side effects
Sources
1. Laurberg P, Wallin G, Tallstedt L et al. TSH‑ receptor autoimmunity in Graves’disease after therapy with anti‑thyroid drugs, surgery, or radioiodine: a 5‑year prospective randomized study. Eur J Endocrinol 2008; 158: 69– 75.
2. Sonnet E, Massart C, Gibassier J et al. Longitudinal study of soluble intercellular adhesion molecule‑ (ICAM‑1) in sera of patients with Graves’ disease. J Endocrinol Invest 1999; 22: 430– 435.
3. Tsatsoulis A, Vlachoyiannopoulos PG, Dalekos GN et al. Increased serum interleukin‑1 beta during treatment of hyperthyroidism with antithyroid drugs. Eur J Clin Invest 1995; 25: 654– 658.
4. Salvi M, Girasole G, Pedrazzoni M et al. Increased serum concentrations of interleukin‑6 (IL‑6) and soluble IL‑6 receptor in patients with Graves’ disease. J Clin Endocrinol Metab 1996; 81: 2976– 2979.
5. Zantut‑ Wittmann DE, Tambascia MA, da Silva Trevisan MA et al. Antithyroid drugs inhibit in vivo HLADR expression in thyroid follicular cells in Graves’ disease. Thyroid 2001; 11: 575– 580.
6. Cooper DS, Steigerwalt S, Migdal S. Pharmacology of propylthiouracil in thyrotoxicosis and chronic renal failure. Arch Intern Med 1987; 147: 785– 786.
7. Hegedus L. Treatment of Graves’ hyperthyroidism: evidence based and emerging modalities. Endocrinol Metab Clin North Am 2009; 38: 355– 371.
8. Rivkees Scott A, Sklar C, Freemark M. Clinical Review 99: The Management of Graves’ Disease in Children, with Special Emphasis on Radioiodine Treatment. J Clin Endocrinol Metab 1998; 83: 3767– 3776.
9. Jiskra J, Kubinyi J, Telička Z. Léčba hypertyreózy radiojodem 131I v ambulantním režimu – bezpečná, účinná a ekonomická varianta: Vnitř Lék 2012; 58: 94– 98.
10. Shikara MM, Polena S, Solinas A et al. Clinical Manifestations of Hyperthyroidism after Treatment with Selective b1 Adrenoceptor Blocking Agents. Proc West Pharmacol Soc 2003; 46: 125– 126.
11. Podoba J, Zajacová H. Amiodarón a poruchy funkcie štítnej žľazy. Cardiol 2000; 9 (Suppl 1): S20– S24.
12. Harjai KJ, Licata AA. Effects of Amiodarone on Thyroid Function. Ann Intern Med 1997; 126: 63– 73.
13. Nakamura H, Noh JY, Itoh K et al. Comparison of Methimazole and Propylthiouracil in Patients with Hyperthyroidism Caused by Graves Disease J. Clin Endocrinol Metab 2007; 92: 2157– 2162.
14. Glinoer D, Cooper DS. The propylthiouracil dilemma. Curr Opin Endocrinol Diabetes Obes 2012; 19: 402– 407.
15. Azizi F, Amouzegar A. Management of hyperthyroidism during pregnancy and lactation. Eur J Endocrinol 2011; 164: 871– 876.
16. Chen CH, Xirasagar S, Lin CC et al. Risk of adverse perinatal outcomes with antithyroid treatment during pregnancy: A nationwide population‑based study. Int J Obst Gynaecol 2011; 118: 1365– 1373.
17. Karras S, Tzotzas T, Krassas GE. Toxicological considerations for antithyroid drugs in children. Expert Opin Drug Metab Toxicol 2011; 7: 399– 410.
18. Ahmed K, Rao S, Simha V. ANCA‑ positive vasculitis in a patient with Graves’ disease: cross‑ reaction between propylthiouracil and methimazole. Endocr Pract 2010; 9: 1– 11.
19. Bartalena L, Bogazzi F, Martino E. Adverse effects of thyroid hormone preparations and antithyroid drugs. Drug Safety 1996; 15: 53– 63.
20. Diav‑ Citrin O, Ornoy A. Teratogen Update: Antithyroid Drugs – Methimazole, Carbimazole, and Propylthiouracil. Teratology 2002; 65: 38– 44.
21. Clementi M, Di Gianantonio E, Cassina M et al. SAFE‑ Med Study Group. Treatment of hyperthyroidism in pregnancy and birth defects. J Clin Endocrinol Metab 2010; 95: E337– E341.
22. Toti L, Manzia TM, Romano P et al. Successful management of a same day emergency delivery and liver transplant in a 27 weeks pregnant woman with fulminant hepatic failure. Transpl Int 2010; 23: 114– 115.
23. Rahman TM, Wendon J. Severe hepatic dysfunction in pregnancy. QJM 2002; 95: 343– 357.
24. Karras S, Memi E, Kintiraki E et al. Pathogenesis of propylthiouracil‑related hepatotoxicity in children: present concepts. J Pediatr Endocrinol Metab 2012; 25: 623– 630.
25. Cin MO, Gursoy A, Morris Y et al. Prevalence and clinical significance of antineutrophil cytoplasmic antibody in Graves’ patients treated with propylthiouracil. Int J Clin Pract 2009; 63: 299– 302.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2013 Issue 11
Most read in this issue
- Thyrostatic treatment and its adverse effects
- Inflammatory response and C‑ reactive protein value in patient with acute coronary syndrome
- The value of ECG assessment in pulmonary embolism diagnostics
- Management of superficialis thrombophlebitis. Guidelines of the Angiologiy Section of the Slovak Medical Chamber (2013)