БАЗЕДОВА БОЛЕСТ - тема 14

HYPERTHYROIDISM
Should the approach to management of Graves’
hyperthyroidism in women of child-bearing age be revised?
BACKGROUND
Graves’ disease is the most common cause of hyperthyroidism in the United States and often occurs in women
of child-bearing age. Because of this, Graves’ disease can
be diagnosed in women during pregnancy. Untreated
hyperthyroidism during pregnancy can result in complications to both the baby and the mother. These complications include heart failure, preterm delivery, low weight at
birth and even fetal death. The antithyroid drugs (ATDs)
propylthiouracil (PTU) and methimazole (MMI) have
been successfully used to treat hyperthyroidism during
pregnancy and prevent these complications. In Europe,
carbimazole (CMZ), which is converted to MMI in the
body, is often used. While antithyroid drugs are usually
well tolerated, several rare birth defects have been reports
during use of MMI and CMZ. Since the risk of birth
defects in prior studies is extremely rare with PTU, this is
currently considered the medication of choice during early
pregnancy. Indeed, it is recommended that women who
got pregnant while on MMI or CMZ be switched to PTU
as soon as possible. However, PTU has its own side effects.
The aim of this study using the Danish National Register
is to evaluate the frequency of birth defects in children
exposed to ATDs in early pregnancy compared to children
not exposed to these drugs.
THE FULL ARTICLE TITLE
Andersen L ey al. Birth defects after early pregnancy use
of antithyroid drugs: a Danish nationwide study. J Clin
Endocrinol Metab 2013;98:4373-81. Epub October 22,
2013.
SUMMARY OF THE STUDY
The study included 817,093 children born in Denmark
between 1996 and 2008. Among these children, 1820
children were born to mothers who took ATDs in early
pregnancy, 3542 children were born to mothers who took
ATDs before and after but not during pregnancy and
811,730 children were born to mothers never exposed
to this treatment. Among the children exposed to ATDs,
564 were exposed to PTU, 1097 were exposed to MMI
or CMZ and 159 were exposed to both MMI or CMZ
and PTU, these medications being changed in early
pregnancy. The frequency of birth defects was higher in
babies exposed to ATDs in early pregnancy compared to
non-exposed babies (PTU, 8.0%; MMI or CMZ, 9.1%;
MMI or CMZ and PTU, 10.1%; babies never exposed to
ATD, 5.7%). These birth defects were usually mild and
affected the skin and GI tract. Maternal ATD treatment
before or after pregnancy was not associated with an
increased risk of birth defects. Interestingly, 16 out of 149
babies born to mothers who changed from MMI or CMZ
to PTU during early pregnancy, had birth defects.
WHAT ARE THE IMPLICATIONS
OF THIS STUDY?
Surprisingly, PTU use during pregnancy had an increased
risk of birth defects, although this risk was slightly less
that exposure to either MMI or CMZ. Importantly, a
significant proportion of the babies born of mothers who
switched from MMI or CMZ to PTU in early pregnancy
still developed birth defects. Further studies are needed
to confirm these results, as this study is at odds with
prior studies. In any event, physicians should discuss the
potential risk of congenital malformations associated with
antithyroid drug use in early pregnancy with all women of
child-bearing age diagnosed with Graves’ disease.
— Alina Gavrila, MD, MMSC
ATA THYROID BROCHURE LINKS
Ето от Българското дружество по ендокринология препоръки - 2019 г /https://endo-bg.com/wp-content/uploads/2019/10/thyroid.pdf

Аз правя 10 г от втория рецидив. И не съм готова за спиране, защото 2020 г Трак се повиши след дългосрочен стрес и проблеми. Хормоните останаха в норма. Повече не съм го гледала. Преди това беше в норма, но пък TSI също ми бяха извън норма.
Четейки днес пак някои нови неща, имат наблюдения при спиране на терапия с повишен Трак и с Трак в норма. При първите следва 80% рецидив, при вторите 20%
Е, аз и двата пъти бях с Трак в норма. Втория път даже 0.330 падна. И пак след 3 месеца рецидив.
Ако бяха писали тези неща в сайта по-рано, с второто лечение 1.5 г и още малко преди това при предния доктор, нямаше да спра хапчетата. Щях да изчакам поне 5 години.
Сега шансът ми е намален драстично, но пък за 10 г хормоните стоят в норма. Рядко пускам, но винаги са били ок.