propylthiouracil and Diseases-in-Twins

A 30-year-old pregnant female was diagnosed to have thyrotoxicosis (TSH= 0.005 µU/ml) at 13th week of gestation. Propylthiouracil (PTU; 200 mg daily) was prescribed to her and four weekly follow ups by the endocrinologist and obstetrician were ensured. At each examination TSH, FT4 and FT3 levels were normal and she became symptom free. Repeated ultrasound examination throughout the pregnancy did not reveal any fetal abnormality. The lady normally delivered heterozygotic twins. Umbilical cord blood of the baby boy twin showed a high TSH (541 µU/ml; reference range 0.270 - 4.20 μU/ml). He was started on thyroxine therapy (50 µg once daily). Ultrasound reported the absence of the thyroid gland. One month later TSH was within normal range and thyroxine dose was adjusted to 25 µg once daily. Repeated ultrasound confirmed the absence of thyroid gland. TSH was repeatedly normal. The boy is currently doing well on thyroxine replacement therapy. The other non-identical twin was a healthy girl with normal thyroid function tests and always thereafter. This case report suggested that PTU could be a hazardous drug to the fetus, since the mother gave birth to a baby with thyroid aplasia.. PTU, Thyroid aplasia, Thyrotoxicosis, TSH.

Topics: Adult; Diseases in Twins; Female; Humans; Hyperthyroidism; Infant, Newborn; Male; Pregnancy; Pregnancy Complications; Pregnancy, Twin; Prenatal Exposure Delayed Effects; Propylthiouracil; Thyroid Dysgenesis; Twins

Aplasia cutis congenita (ACC) has been observed after fetal exposure to the antithyroid drug methimazole (MMI), but not reported after propylthiouracil (PTU), the current antithyroid drug of choice during pregnancy. This occurrence has implications for patient information and causal research.. We describe a surviving term co-twin to a mother with hyperthyroidism exposed to PTU from conception to 34 weeks of gestation presenting with ACC at birth.. The association between PTU exposure and ACC is clinically relevant and allows speculation on the etiology. A similar mechanism to the classical MMI-induced ACC is postulated, unless a vascular etiology suggested by a vanishing twin or maternal hyperthyroidism itself is causal. Coincidence of PTU exposure and ACC seems unlikely.. ACC in a newborn after PTU exposure during pregnancy hitherto observed only after MMI strongly encourages further reports of similar cases that may remain clinically underdiagnosed or unreported. Such confirmation could have significant implications for maternal treatment of hyperthyroidism, common in women of childbearing age.

Topics: Abnormalities, Drug-Induced; Antithyroid Agents; Diseases in Twins; Ectodermal Dysplasia; Female; Gestational Age; Graves Disease; Humans; Infant, Newborn; Maternal Exposure; Pregnancy; Pregnancy Complications; Propylthiouracil

Topics: Congenital Hypothyroidism; Diseases in Twins; Female; Graves Disease; Humans; Infant, Newborn; Male; Pregnancy; Pregnancy Complications; Propylthiouracil; Thyrotropin; Thyroxine

Dizygotic twin sisters were born to a woman who, shortly before becoming pregnant, had developed Graves' disease with markedly elevated triiodothyronine (T3) levels and highly positive TSH receptor antibody titres (TRAb: 169 mU/ml). From the second week of life onwards they had a goitre and hyperexcitability, tachycardia and failure to thrive were noted. In addition, twin I had mild exophthalmos. As thyrostatic treatment of the mother was very difficult, intrauterine hypothyroidism or transitory hyperthyroidism had presumably occurred in the twins.. Twin I had maximal thyroxine (T4) concentration of 26.2 micrograms/dl, while it was 24.7 micrograms/dl in twin II with suppressed TSH. Both twins had high concentrations of TRAb and antibodies against thyroid peroxidase.. With the diagnosis of neonatal Graves' disease established, both twins were treated with propranolol (2 mg/kg.d) and phenobarbitone (2-4 mg/kg.d). Twin I, whose symptoms were more severe, also received propylthiouracil (5 mg/kg.d) until euthyroidism had been achieved. Although twin II became euthyroid spontaneously, she gained weight only slowly and microcephaly developed together with definite motor and mental retardation. It remains unclear whether these were consequences of intrauterine hypothyroidism or post-partum hyperthyroidism.. Graves' disease during pregnancy demands interdisciplinary collaboration between gynaecologist, physician and paediatrician to prevent severe sequelae in the children. Early risk assessment is possible by measuring the TSH receptor antibody titre in umbilical blood.

Topics: Adrenergic beta-Antagonists; Adult; Antithyroid Agents; Autoantibodies; Developmental Disabilities; Diseases in Twins; Female; Fetal Blood; Graves Disease; Humans; Hypnotics and Sedatives; Infant, Newborn; Infectious Disease Transmission, Vertical; Iodide Peroxidase; Microcephaly; Phenobarbital; Pregnancy; Pregnancy Complications; Propranolol; Propylthiouracil; Receptors, Thyrotropin; Thyroxine; Triiodothyronine; Twins, Dizygotic

Topics: Diseases in Twins; Humans; Infant, Newborn; Male; Propylthiouracil; Thyrotoxicosis; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine; Triiodothyronine; Twins, Monozygotic

Topics: Child; Disease; Diseases in Twins; Female; Goiter; Humans; Hyperthyroidism; Infant; Pregnancy; Propylthiouracil; Thiouracil; Twins