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Synthesis and Regulation of Thyroid Hormones01:20

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Low blood levels of the thyroid hormones — triiodothyronine (T3) and thyroxine (T4) — signal the hypothalamus to release the thyrotropin-releasing hormone (TRH). TRH then reaches the pituitary gland and stimulates the release of thyroid-stimulating hormone(TSH) into the bloodstream.
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The thyroid hormone (TH) plays a pivotal role in the intricate orchestration of physiological processes, exerting profound effects on development, metabolism, and homeostasis throughout different life stages.
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The ability of a drug to produce structural deformations and functional abnormalities in the developing embryo or the fetus is called teratogenicity, and the drug producing this effect is known as a teratogen. Teratogenic effects include stillbirth, miscarriage, intrauterine growth restriction, and neurocognitive delay. A teratogen may affect the embryo at different stages of development, which is important in determining the type and extent of the damage. During blastocyst formation, the early...
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Antithyroid drugs and birth defects.

Stine Linding Andersen1,2,3, Stig Andersen2,4

  • 1Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.

Thyroid Research
|July 2, 2020
PubMed
Summary
This summary is machine-generated.

Antithyroid drugs (ATDs) like Methimazole (MMI) are linked to birth defects in pregnancy. More research is needed to confirm risks for Propylthiouracil (PTU) and explore safer alternatives.

Keywords:
Antithyroid drugsBirth defectsCarbimazoleCongenital malformationsGraves’ diseaseHyperthyroidismMethimazolePregnancyPropylthiouracil

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Area of Science:

  • Endocrinology
  • Reproductive Medicine
  • Pharmacology

Background:

  • Antithyroid drugs (ATDs) are standard treatment for hyperthyroidism in pregnant women.
  • Concerns regarding ATD teratogenicity have existed since the 1970s, with recent studies quantifying risks.
  • Both Methimazole (MMI) and Propylthiouracil (PTU) have been associated with birth defects, challenging clinical guidelines.

Purpose of the Study:

  • To review current evidence on birth defect risks associated with ATDs in early pregnancy.
  • To discuss causality determinants, including biological gradients and maternal thyroid function.
  • To examine clinical aspects of ATD treatment timing and type, and explore future research directions.

Main Methods:

  • Review of observational studies and existing literature on ATD use in pregnancy.
  • Analysis of teratogenic potential considering factors like dose, timing, and maternal health.
  • Discussion of evidence supporting or refuting causality for MMI and PTU.

Main Results:

  • Current evidence supports a link between Methimazole (MMI) exposure and birth defects.
  • Further research is required to definitively establish the teratogenic potential of Propylthiouracil (PTU).
  • The role of maternal thyroid function and specific exposure details warrant deeper investigation.

Conclusions:

  • Methimazole (MMI) use in early pregnancy is associated with an increased risk of birth defects.
  • More extensive research, including large cohort studies, is necessary to clarify PTU's teratogenic profile.
  • Future research should focus on detailed exposure assessments and the development of alternative treatments for hyperthyroidism during pregnancy.