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Haridas K, Sasaki T, Leung AM. Evaluation and Management of Thyrotoxicosis During Pregnancy. Endocrinol Metab Clin North Am 2024; 53:349-361. [PMID: 39084812 DOI: 10.1016/j.ecl.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
This review summarizes the diagnosis and management of thyrotoxicosis in pregnancy. The diagnostic clinical and biochemical considerations used to distinguish the various etiologies of hyperthyroidism from appropriate physiologic changes during pregnancy will be outlined. Finally, the review will discuss the risks and benefits of available options for the treatment of thyrotoxicosis during pregnancy, to mitigate the risks of fetal hyperthyroidism.
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Affiliation(s)
- Keerthana Haridas
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard (111D), Los Angeles, CA 90073, USA
| | - Tamlyn Sasaki
- University of Hawaii John A. Burns School of Medicine, 651 Ilalo Street, Medical Education Building, 3rd Floor, Honolulu, HI 96813, USA
| | - Angela M Leung
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard (111D), Los Angeles, CA 90073, USA.
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Acebedo-Martínez FJ, Alarcón-Payer C, Verdugo-Escamilla C, Martín J, Frontera A, Domínguez-Martín A, Gómez-Morales J, Choquesillo-Lazarte D. Rational Coformer Selection in the Development of 6-Propyl-2-thiouracil Pharmaceutical Cocrystals. Pharmaceuticals (Basel) 2023; 16:ph16030370. [PMID: 36986470 PMCID: PMC10055029 DOI: 10.3390/ph16030370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
Pharmaceutical multicomponent solids have proved to efficiently modulate the physicochemical properties of active pharmaceutical ingredients. In this context, polyphenols are interesting coformers for designing pharmaceutical cocrystals due to their wide safety profile and interesting antioxidant properties. The novel 6-propyl-2-thiouracil multicomponent solids have been obtained by mechanochemical synthesis and fully characterized by powder and single-crystal X-ray diffraction methods. The analysis of supramolecular synthons has been further performed with computational methods, with both results revealing a robust supramolecular organization influenced by the different positions of the hydroxyl groups within the polyphenolic coformers. All novel 6-propyl-2-thiouracil cocrystals show an enhanced solubility profile, but unfortunately, their thermodynamic stability in aqueous media is limited to 24 h.
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Affiliation(s)
| | | | - Cristóbal Verdugo-Escamilla
- Laboratorio de Estudios Cristalográficos, IACT, CSIC-Universidad de Granada, Avda. de las Palmeras 4, 18100 Armilla, Spain
| | - Jesús Martín
- Fundación MEDINA, Centro de Excelencia en Investigación de Medicamentos Innovadores en Andalucía, Parque Tecnológico Ciencias de la Salud, Avda. del Conocimiento 34, 18016 Armilla, Spain
| | - Antonio Frontera
- Department of Chemistry, Universitat de les Illes Balears, Crta de Valldemossa km 7.5, 07122 Palma de Mallorca (Baleares), Spain
- Correspondence: (A.F.); (A.D.-M.); (D.C.-L.)
| | - Alicia Domínguez-Martín
- Department of Inorganic Chemistry, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain
- Correspondence: (A.F.); (A.D.-M.); (D.C.-L.)
| | - Jaime Gómez-Morales
- Laboratorio de Estudios Cristalográficos, IACT, CSIC-Universidad de Granada, Avda. de las Palmeras 4, 18100 Armilla, Spain
| | - Duane Choquesillo-Lazarte
- Laboratorio de Estudios Cristalográficos, IACT, CSIC-Universidad de Granada, Avda. de las Palmeras 4, 18100 Armilla, Spain
- Correspondence: (A.F.); (A.D.-M.); (D.C.-L.)
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Ahmadzai H, Tee LBG, Crowe A. Adverse Drug Reactions in Breastfed Infants: A Cross-Sectional Study of Lactating Mothers. Breastfeed Med 2022; 17:1011-1017. [PMID: 36315169 DOI: 10.1089/bfm.2022.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Breastfeeding-related adverse drug reactions (ADRs) are thought to be uncommon as reported cases are globally low. The nonspecific nature of these reactions and a lack of awareness and difficulty in identification of ADRs by mothers and clinicians may result in these ADRs being underreported. Aims: This study hypothesized that breastfeeding-related infant ADRs are more frequent than reported. As a first-hand account of breastfeeding mothers, this study aimed to evaluate the impact of the perceived ADRs on the continuation of breastfeeding and maternal treatment. Methods: Women currently breastfeeding or having breastfed in the last 12 months were invited to complete an online survey. The survey comprised 42 questions in 5 sections to obtain data from breastfeeding mothers, including their use of medicines during lactation, perceptions of infant adverse reactions attributable to maternal medication use and its potential impact on breastfeeding. Results: This online survey was completed by 339 women, 42% of whom reported taking at least one medication during breastfeeding. ADRs were reported in 23 infants where a possible or probable causal relationship indicated by a Naranjo score of 1-8 was established in 16 (11.3%). Antibiotics (n = 12) and opioids (n = 2), including tramadol and oxycodone were identified as the most common adverse reaction-causing drugs. The average age of infants at the time of the perceived ADR was 25.6 days (95% confidence interval; 4-85 days; median age 17.5 days). Conclusion: Suspected ADR reporting in this study was significantly greater than those reported to the regulatory body, the Australian Therapeutics Goods Administration, which shows that common breastfeeding-related infant ADRs are underreported.
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Affiliation(s)
- Hilai Ahmadzai
- Curtin Medical School, Curtin University, Perth, Western Australia.,Department of Pharmacy, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Lisa B G Tee
- Curtin Medical School, Curtin University, Perth, Western Australia
| | - Andrew Crowe
- Curtin Medical School, Curtin University, Perth, Western Australia
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Vaidyanathan P. Update on Pediatric Hyperthyroidism. Adv Pediatr 2022; 69:219-229. [PMID: 35985711 DOI: 10.1016/j.yapd.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Typical symptoms which should lead to suspicion of hyperthyroidism are unintentional weight loss, tachycardia, and palpitations, heat intolerance, and hyperactivity. It is diagnosed by suppressed thyroid-stimulating hormone (TSH) with elevated thyroid hormone (TH) levels. Graves' disease (GD) due to antibodies stimulating the TSH receptor is the leading cause, and first-line treatment is with methimazole (MMI). Emerging data suggest MMI treatment, up to 8 years is effective and safe in improving the rate of remission. Radioactive iodine (RAI) and thyroidectomy offer definitive treatment and induce permanent hypothyroidism. Thyroid storm is a life-threatening condition with systemic decompensation and hyperpyrexia. Neonates of mothers with current or past GD are at risk for neonatal hyperthyroidism (NH). Appropriate identification and follow-up of at-risk neonates will reduce complications.
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Affiliation(s)
- Priya Vaidyanathan
- Department of Pediatric Endocrinology, Children's National Hospital, Washington, DC 20010, USA.
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Peace JM, Hire MG, Peralta FM. Postpartum Thyroid Storm in Poorly Controlled Graves' Disease: A Case Report. A A Pract 2020; 13:299-302. [PMID: 31274513 DOI: 10.1213/xaa.0000000000001059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hyperthyroidism during pregnancy is a relatively rare event, but poor control of hyperthyroidism during pregnancy is associated with a host of issues. These include intrauterine fetal demise, hypertensive disorders of pregnancy, preterm delivery, low birth weight, intrauterine growth restriction, and maternal congestive heart failure. One of the most feared sequelae of hyperthyroidism is thyroid storm, which has a mortality rate >10%. Patients who develop thyroid storm present several challenges to anesthesiologists including hemodynamic instability and medication management. Here, we present the anesthetic management for a parturient whose delivery was complicated by signs and symptoms consistent with thyroid storm.
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Affiliation(s)
- Jack M Peace
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Croce L, Di Dalmazi G, Orsolini F, Virili C, Brigante G, Gianetti E, Moleti M, Napolitano G, Tonacchera M, Rotondi M. Graves' Disease and the Post-partum Period: An Intriguing Relationship. Front Endocrinol (Lausanne) 2019; 10:853. [PMID: 31920967 PMCID: PMC6914725 DOI: 10.3389/fendo.2019.00853] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 11/29/2022] Open
Abstract
The post-partum period is an immunologically peculiar period in a woman's life. Indeed, most of the pregnancy-related immune changes gradually revert in the 12 months following delivery. Although the post-partum period has long been identified as a period of aggravation of autoimmune thyroid diseases, most of the currently available studies took into account the relationship between post-partum and autoimmune thyroiditis. More recently, the potential repercussions of the post-partum period on Graves' disease were also taken into account. The present mini review will briefly overview the most recent advances in our knowledge of the immunology of the post-partum period in relation with the potential repercussions on the clinical course of Graves' disease. Moreover, some peculiar aspects of post-partum Graves' disease in terms of clinical and biochemical presentation, diagnostic challenges, and specific therapeutic considerations also taking into account the recommendation of the latest clinical guidelines on the management of thyroid diseases in pregnancy will be overviewed.
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Affiliation(s)
- Laura Croce
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
- PHD course in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Giulia Di Dalmazi
- Unit of Endocrinology, Department of Medicine and Sciences of Aging, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Francesca Orsolini
- Endocrinology Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Camilla Virili
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Giulia Brigante
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Gianetti
- Endocrinology Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mariacarla Moleti
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giorgio Napolitano
- Unit of Endocrinology, Department of Medicine and Sciences of Aging, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Massimo Tonacchera
- Endocrinology Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- *Correspondence: Mario Rotondi
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