Francis Thanuya, Francis Niroshan, Lazarus John H, Okosieme Onyebuchi E
Endocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil, UK.
Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK.
Expert Opin Drug Saf. 2020 May;19(5):565-576. doi: 10.1080/14740338.2020.1748007. Epub 2020 Apr 1.
: The thionamide antithyroid drugs, methimazole (MMI), its pro-drug derivative carbimazole (CMZ), and propylthiouracil (PTU) are the mainstay of treatment for hyperthyroidism in pregnancy. However, antithyroid drugs carry risks of adverse effects that can affect fetal and maternal well-being.: This review provides an update on the safety of antithyroid drugs in pregnancy, focusing on the most serious concerns of severe liver disease and congenital anomalies.: PTU-induced liver disease is uncommon but can run a catastrophic course in pregnancy with a risk of liver failure and threats to maternal or fetal survival. Acute pancreatitis is a relatively rare occurrence that has been linked to thionamide use in a handful of reports in non-pregnant individuals. Observational studies on the risk of birth defects with antithyroid drug exposure in pregnancy overall show an increase in birth defect risk with exposure to CMZ/MMI, and to a lesser extent, PTU. Further studies are required to determine whether the currently recommended approach of switching between thionamide drugs in pregnancy improves outcomes. Ultimately, a preventative strategy of offering definitive therapy to hyperthyroid women of childbearing potential offers the best approach to truly reduce the risks of antithyroid drug adverse effects in pregnancy.
硫酰胺类抗甲状腺药物，甲巯咪唑（MMI）、其前体药物衍生物卡比马唑（CMZ）和丙硫氧嘧啶（PTU）是妊娠期甲状腺功能亢进症治疗的主要药物。然而，抗甲状腺药物存在不良反应风险，可能影响胎儿和母亲的健康。
本综述提供了妊娠期抗甲状腺药物安全性的最新信息，重点关注严重肝病和先天性异常等最严重的问题。
PTU引起的肝病并不常见，但在妊娠期可能会发展为灾难性病程，有肝衰竭风险，并对母亲或胎儿的生存构成威胁。急性胰腺炎相对罕见，在少数非妊娠个体的报告中与硫酰胺类药物的使用有关。关于妊娠期接触抗甲状腺药物导致出生缺陷风险的观察性研究总体显示，接触CMZ/MMI会增加出生缺陷风险，接触PTU的影响较小。需要进一步研究以确定目前推荐的妊娠期在硫酰胺类药物之间切换的方法是否能改善结局。最终，为有生育潜力的甲状腺功能亢进女性提供确定性治疗的预防策略是真正降低妊娠期抗甲状腺药物不良反应风险的最佳方法。
