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Kérdezz-felelek
Pajzsmirigy túltengésem van,és jelenleg a propicil nevü gyógyzsert szedem napi6db. Szoptatós kismama vagyok 4.hónaposa babám. 'hónapja derült ki. A kérdésem ,h a babának szükséges e vizsgálat,hiszen neki is jut az anyatejből igy gyógyszer. ebből lehet e baja neki? mire figyeljünk oda? köszönettel !
Az elmúlt években kiderült, hogy a Propycilnek több végzetes mellékhatása is van. Erről írtam ezen a honlapon is, az idei endokrinológiai hivatalos továbbképzésen hallhattak róla az endokrinológusok is! Erről szó volt az idei Párizsban rendezett Pajzsmirigy Világkongresszuson is.
Ezért feltétlen mérlegelendő a dózis csökkentése, esetleg másik gyógyszer szedése!
J Natl Med Assoc. 2010 Jun;102(6):531-4.
Gone (from the Physicians' desk reference) but not forgotten: propylthiouracil-associated hepatic failure: a call for liver test monitoring.
Primeggia J, Lewis JH.
Department of Internal Medicine, Georgetown University Hospital, Washington, DC 20007, USA. jxp163@gunet.georgetown.edu
Abstract
A 19-year-old female diagnosed with Graves' disease had treatment initiated with propylthiouracil (PTU). Pretreatment complete blood count and liver-associated enzymes (LAEs) were normal, but no further LAEs were obtained, reflecting U.S. guidelines written in 1995. Three months later, she presented with nausea, vomiting, abdominal pain, and jaundice. LAEs were markedly elevated with: total bilirubin, 6.5 mg/dl; aspartate aminotransferase (AST), 1747 IU/L; and alanine aminotransferase (ALT) 1589 UL/L. After 6 days at an outside hospital, she was transferred to our tertiary care center in acute liver failure with coagulopathy and stage II encephalopathy. Liver transplant evaluation was promptly initiated and she was listed as status 1. PTU was the only medication she had taken; and all serologic, autoimmune, and metabolic studies were negative. She demonstrated rapid clinical deterioration, and on hospital day 7 she underwent orthotopic liver transplant but succumbed to tonsillar herniation immediately after surgery. Pathology from her explanted liver revealed marked necrosis and collapse, consistent with her acute liver failure. PTU-associated hepatotoxicity and myelotoxicity have been well-recognized serious adverse effects for more than 50 years. However, as deaths related to hepatic injury from PTU are rare, American Thyroid Association guidelines do not call for routine monitoring of LAEs, although monitoring of white blood cell count levels is advised. Given the wide spectrum of PTU-related liver injury, ranging from asymptomatic elevations in ALT to fatal acute liver failure, we urge consideration of an LAE monitoring program to prevent irreversible liver damage and call for a reappraisal of monitoring guidelines in the United States.
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Pediatr Endocrinol Rev. 2010 Sep;8(1):25-33.
Pharmacological treatment of hyperthyroidism during lactation: review of the literature and novel data.
Karras S, Tzotzas T, Kaltsas T, Krassas GE.
Department of Endocrinology, Diabetes and Metabolism, Panagia General Hospital, Thessaloniki, Greece. krassas@the.forthnet.gr
Abstract
Antithyroid drugs (ATD) are used as a first line treatment in thyrotoxicosis. Propylthiouracil (PTU), carbimazole (CMZ) and methimazole (MMI) are available. During absorption CMZ is bioactivated to MMI. Initially, mothers were not allowed to breastfeed during treatment with ATD. Newer studies minimized the risk for mother and infant. PTU should be preferred over MMI due to its lower milk concentration. Recent studies have shown severe hepatic dysfunction for both ATD, but especially for PTU, in hyperthyroid patients. Most of those cases were idiosyncratic, not-dose related and presented a latent period of occurrence. No biomarkers could predict hepatic damage. The American Thyroid Association (ATA) has recommended that PTU should not be prescribed as the first line agent in children and adolescents. Its use might be accepted in the first trimester of pregnancy for severe thyrotoxicosis or for patients with previous MMI adverse reactions. Considering the potential harmful effects of PTU, MMI should be used instead during lactation.
PMID: 21037541 [PubMed - in process]