Carbimazole embryopathy: implications for the choice of antithyroid drugs in pregnancy.
Maternal thyrotoxicosis, predominantly secondary to Graves' disease, affects 0.2% of all pregnancies. The Endocrine Society guidelines recommend the use of propylthiouracil as a first-line drug for thyrotoxicosis in pregnancy because of associations between carbimazole or methimazole and congenital anomalies. However, recent studies have highlighted the risk of severe liver injury with propylthiouracil. Here, we report another case with multiple congenital anomalies following in utero exposure to carbimazole and review the literature to consider the risks and benefits of available pharmacological treatments for thyrotoxicosis in pregnancy.
Department of Paediatrics, Royal Devon & Exeter Hospital, Exeter, UK. pamelabowman@nhs.net
P
P
Bowman
N J
NJ
Osborne
R
R
Sturley
B
B
Vaidya
D013956:Antithyroid Agents / Q000009:adverse effects*; D002231:Carbimazole / Q000009:adverse effects*; D004476:Ectodermal Dysplasia / Q000139:chemically induced*; D005145:Face / Q000002:abnormalities*; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007766:Lacrimal Apparatus Diseases / Q000151:congenital; D008713:Methimazole / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011441:Propylthiouracil / Q000009:adverse effects; D013971:Thyrotoxicosis / Q000188:drug therapy; D013974:Thyroxine / Q000627:therapeutic use
D013956:Antithyroid Agents; D008713:Methimazole; D011441:Propylthiouracil; D002231:Carbimazole; D013974:Thyroxine