Re: [ozmidwifery] graves disease and breastfeeding

[Anne Clarke]

Dear Jill,   Here is some info. on propylthiouracil.  I will try and get the info. on the breastfeeding too.   Regards, Anne Clarke Brisbane       Labeled Uses Hyperthyroidism Thyrotoxicosis Crisis Unlabeled Uses Neonatal Hyperthyroidism   Uses from AHFS DI� Hyperthyroidism Propylthiouracil is used for the palliative treatment of hyperthyroidism, as an adjunct to ameliorate hyperthyroidism in preparation for surgical treatment or radioactive iodine therapy, and when thyroidectomy is contraindicated or not advisable.Thioamide antithyroid agents, such as propylthiouracil, are used to control the symptoms of hyperthyroidism associated with Graves� disease and maintain the patient in a euthyroid state for a period of several years (generally 1�2 years) until a spontaneous remission occurs. Thioamide antithyroid agents do not affect the underlying cause of hyperthyroidism and generally should not be used for long-term suppression of hyperthyroidism. Spontaneous remission does not occur in all patients receiving therapy with thioamide antithyroid agents and most patients eventually require ablative therapy (i.e., surgery, radioactive iodine). The minimum duration of thioamide therapy necessary before assessing whether spontaneous remission has occurred is not clearly established. Thioamide antithyroid agents may be used in patients with juvenile hyperthyroidism in an attempt to delay ablative therapy; if remission does not occur during propylthiouracil therapy, the drug is sometimes continued for several years to postpone ablation until the child is older.Propylthiouracil is used to return the hyperthyroid patient to a normal metabolic state prior to thyroidectomy and to control the thyrotoxic crisis that may accompany thyroidectomy. Propylthiouracil is also used as an adjunct to radioactive iodine therapy in patients who require control of symptoms of hyperthyroidism prior to administration of radioactive iodine and during radioactive iodine therapy until the ablative effects of the iodine occur.In the management of thyrotoxic crisis, thioamide antithyroid agents are used to inhibit thyroid hormone synthesis. Because propylthiouracil also blocks the peripheral conversion of thyroxine to triiodothyronine, it theoretically may be more useful than methimazole or carbimazole in the management of thyrotoxic crisis. Iodides (e.g., potassium iodide, strong iodine solution) are given to inhibit the release of hormone from the gland but may subsequently be used as a substrate for thyroid hormone synthesis; therefore, treatment with a thioamide antithyroid agent is usually initiated before iodide therapy. A β-Adrenergic blocking agent (e.g., propranolol) is also usually given concomitantly to manage peripheral signs and symptoms of hyperthyroidism, particularly cardiovascular effects (e.g., tachycardia).More..... Dosage and Administration from AHFS DI� Propylthiouracil is administered orally; daily dosage is usually given in 3 equally divided doses at approximately 8-hour intervals. In some cases, more frequent administration (e.g., at 4- or 6-hour intervals) may be necessary.For the treatment of hyperthyroidism, the usual initial adult dosage of propylthiouracil is 300�450 mg daily; occasionally, patients with severe hyperthyroidism and/or very large goiters may require initial dosages of 600�1200 mg daily. In general, once full control of symptoms is achieved, therapy is continued at initial dosage levels for about 2 months. Subsequent dosage should be carefully adjusted according to the patient�s tolerance and therapeutic response. The adult maintenance dosage of propylthiouracil is variable, but generally ranges from one-third to two-thirds of the initial dosage. The manufacturers state that the usual adult maintenance dosage is 100�150 mg daily.For the treatment of thyrotoxic crisis in adults, the usual dosage of propylthiouracil is 200 mg every 4�6 hours on the first day; once full control of symptoms is achieved, dosage is reduced gradually to the usual maintenance levels.For the treatment of hyperthyroidism in children, the usual initial dosage of propylthiouracil is 50�150 mg daily in children 6�10 years of age and 150�300 mg or 150 mg/m2 daily for children 10 years of age or older. Maintenance dosage is determined by the patient�s response. For the treatment of hyperthyroidism in neonates, a propylthiouracil dosage of 5�10 mg/kg daily has been recommended.