Skip to main content
Log in

Treatment of post-partum thyrotoxicosis

  • Original Articles
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Thyrotoxicosis occurs more frequently during the post-partum period than at other times in women of childbearing age. Graves’ disease and post-partum thyroiditis are two major causes of thyrotoxicosis in this period. The major task lies in differentiation of these two diseases in the post-partum period; since throtoxicosis caused by post-partum thyroiditis usually does not require treatment. The radioiodine uptake is elevated or normal in Graves’ disease and low in post-partum thyroiditis, and TSH-receptor antibodies are positive in Graves’ and negative in post-partum thyroiditis. Post-partum thyrotoxicosis due to Graves’ disease may be treated with radioiodine but it requires radiation safety measurements for infant and is contraindicated if the mother is breast-feeding. Antithyroid drugs are the mainstay of the treatment of post-partum thyrotoxicosis. Recent investigations conclude that neither propylthiouracil nor methimazole cause any alterations in thyroid function and physical and mental development of infants breast-fed by lactating thyrotoxic mothers, and both can be safely administered in moderately high doses during lactation. (J. Endocrinol. Invest. 29: 244–247, 2006)

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Amino N, Tanizawa O, Mori H, et al. Aggravation of thyrotoxicosis in early pregnancy and after delivery in Graves’ disease. J Clin Endocrinol Metab 1982, 55: 108–12.

    Article  PubMed  CAS  Google Scholar 

  2. Lazarus JH, Lueate M. Prevention and treatment of postpartum Graves’ disease Bailliere’s Clin Endocrinol Metab 1997, 11: 549–60.

    Article  CAS  Google Scholar 

  3. de los Santos ET, Starich GH, Mazzaferri EL. Sensitivity, specificity and cost-effectiveness of the sensitive thyrotropin assay in the diagnosis of thyroid disease in ambulatory patients. Arch Intern Med 1989, 149: 526–32.

    Article  Google Scholar 

  4. Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med 2003, 348: 2646–55.

    Article  PubMed  Google Scholar 

  5. Ross DS. Syndromes of thyrotoxicosis with low radioactive iodine uptake. Endocrinol Metab Clin North Am 1998, 27: 169–85.

    Article  PubMed  CAS  Google Scholar 

  6. Arem R, Munipalli B. Ipodate therapy in patients with severed destruction-induced thyrotoxicosis. Arch Intern Med 1996, 156: 1752–7.

    Article  PubMed  CAS  Google Scholar 

  7. Azizi F, Khoshniat M, Bahrainian M, Hedayati M. Thyroid function and intellectual development of infants nursed by mothers taking methimazole. J Clin Endocrinol Metab 2000, 85: 3233–8.

    Article  PubMed  CAS  Google Scholar 

  8. Williams RH, Kay GA, Jandorf BJ. Thoracic, its absorption, distribution, and excretion. J Clin Invest 1994, 23: 613–27.

    Article  Google Scholar 

  9. Low LC, Lang J, Alexander WD. Excretion of carbimazole and propylthiouracil in breast milk. Lancet 1979, 10: 1011.

    Article  Google Scholar 

  10. Kampmann JP, Johansen K, Hansen JM, Hewleg J. Propylthiouracil in human milk. Revision of a dogma. Lancet 1980, 1: 736–7.

    Article  CAS  Google Scholar 

  11. McDougall IR, Bayer MF. Should a women taking propylthiouracil breast-feed? Clin Nucl Med 1986, 11: 249–50.

    Article  PubMed  CAS  Google Scholar 

  12. Cooper DS. Antithyroid drugs: to breast-feed or not to breast-feed. Am J Obstet Gynecol 1987, 157: 234–5.

    Article  PubMed  CAS  Google Scholar 

  13. Mamotani N, Tamashita R, Toshimoto M, Noh J, Ishikawa N, Ito K. Recovery from foetal hypothyroidism: evidence for the safety of breast-feeding while taking propythouracil. Clin Endocrinol (Oxf) 1989, 31: 591–5.

    Article  Google Scholar 

  14. Momotani N, Yamashita R, Makino F, et al. Thyroid function in wholly breast-feeding infants whose mothers take high doses of propylthiouracil. Clin Endocrinol (Oxf) 2000, 53: 177–81.

    Article  CAS  Google Scholar 

  15. Johansen K, Andersen AK, Kampman JP, Hansen JM, Mortensen HB. Excretion of methimazole in human milk. Eur J Clin Pharmacol 1982, 23: 339–41.

    Article  PubMed  CAS  Google Scholar 

  16. Cooper DS, Bode HH, Nath B, Saxe V, Maloof F, Ridgway EC. Methimazole pharmacology in many studies using a newly developed radioimmunoassay for methimazole. J Clin Endocrinol Metab 1984, 58: 473–9.

    Article  PubMed  CAS  Google Scholar 

  17. Lamberg B.A, Ikonen E, Osterlund K, et al. Antithyroid treatment of maternal hyperthyroidism during lactation. Clin Endocrinol (Oxf) 1984, 21: 81–7.

    Article  CAS  Google Scholar 

  18. Azizi F. Effect of methimazole treatment of maternal thyrotoxicosis on thyroid function in breast-feeding infants. J Pediatr 1996, 128: 855–7.

    Article  PubMed  CAS  Google Scholar 

  19. Azizi F, Hedayati M. Thyroid function in breast-fed infants whose mothers take high doses of methimazole. J Endocrinol Invest 2002, 25: 493–6.

    Article  PubMed  CAS  Google Scholar 

  20. Azizi F, Bahrainian M, Khamseh M, Khoshniat M. Intellectual development and thyroid function in children who were breast-fed by thyrotoxic mothers taking methimazole. J Pediatr Endocrinol Metab 2003, 16: 1239–43.

    Article  PubMed  CAS  Google Scholar 

  21. Azizi F. Thyroid function in breast-fed infants is not affected by methimazole-induced maternal hypothyroidism: Results of a retrospective study. J Endocrinol Invest 2003, 26: 301–4.

    Article  PubMed  CAS  Google Scholar 

  22. Zaton A, Martinez A, DeGandaris JM. The binding of thioureleyne compounds to human serum albumin. Biochem Pharmacol 1988; 37: 3127–3131.

    Article  PubMed  CAS  Google Scholar 

  23. Abe Y, Sato H, Sakai H, Odyama N. Antithyroid treatment of maternal hyperthyroidism during lactation. Proc 11th International Thyroid Congress, Toronto, Canada. Thyroid 1995, 5: S108.

    Google Scholar 

  24. Mountford PJ, Coakley AJ. A review of the secretion of radioactivity in human breast milk: data, quantitative analysis, and recommendations. Nucl Med Commun 1989, 10: 15–27.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Fereidoun Azizi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Azizi, F. Treatment of post-partum thyrotoxicosis. J Endocrinol Invest 29, 244–247 (2006). https://doi.org/10.1007/BF03345547

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03345547

Key Words

Navigation