Karras Spiros, Krassas Gerasimos E
Department of Endocrinology, Diabetes and Metabolism, Panagia General Hospital, Thessaloniki, Greece.
Eur Thyroid J. 2012 Apr;1(1):30-3. doi: 10.1159/000336595. Epub 2012 Feb 29.
The aim of this communication is to provide information regarding the use of antithyroid drugs (ATD) during lactation. Three ATD are used today: propylthiouracil (PTU), methimazole (MMI) and carbimazole (CMZ). The latter is a prodrug which is bioactivated to MMI. PTU is transferred in small amounts (0.025%) into milk. These amounts were considered nonsignificant for inducing adverse effects for the suckling infant. The amount of MMI excreted in milk is equal to MMI levels in serum. Due to its lower concentrations in milk, PTU was used for decades as the treatment of choice during breastfeeding. Recent studies have demonstrated that physical development, intelligence scores and thyroid status of children whose mothers had received MMI while breastfeeding were similar to those of healthy children. These new data offered clinicians an alternative drug approach. Several hepatic dysfunction studies have been published so far. Clinical manifestations varied from mild to severe hepatic failure, liver transplantation or death. Most PTU cases were more severe, idiosyncratic and not dose related. We recommend that PTU should not be prescribed for thyrotoxicosis during lactation. MMI should be used instead, in doses up to 30 mg/day, while PTU should be used in special cases for a restricted time period.
本交流的目的是提供有关哺乳期使用抗甲状腺药物（ATD）的信息。目前使用的三种抗甲状腺药物为：丙硫氧嘧啶（PTU）、甲巯咪唑（MMI）和卡比马唑（CMZ）。后者是一种前体药物，可生物活化成甲巯咪唑。丙硫氧嘧啶少量（0.025%）转移至乳汁中。这些量被认为对哺乳婴儿产生不良反应无显著意义。乳汁中排泄的甲巯咪唑量与血清中甲巯咪唑水平相当。由于其在乳汁中的浓度较低，丙硫氧嘧啶数十年来一直被用作母乳喂养期间的首选治疗药物。最近的研究表明，母亲在母乳喂养期间接受甲巯咪唑治疗的儿童的身体发育、智力评分和甲状腺状况与健康儿童相似。这些新数据为临床医生提供了另一种药物治疗方法。迄今为止，已发表了几项关于肝功能障碍的研究。临床表现从轻度至严重肝功能衰竭、肝移植或死亡不等。大多数丙硫氧嘧啶病例更为严重，属于特异质性且与剂量无关。我们建议哺乳期甲状腺毒症不应开具丙硫氧嘧啶处方。应改用甲巯咪唑，剂量最高为每日30毫克，而丙硫氧嘧啶应在特殊情况下在限定时间段内使用。
