hipertireoza-dojenje?

Imam hipertireozu. tijekom cijele trudnoće sam bila na terapiji propiltiouracil. Rodila sam prije 5 dana i rečeno mi je da ne smijem dojiti? Da li imate neko iskustvo koji bi se zamijenski lijek mogao koristiti i da li je stvarno opasno dojenje za vrijeme terapije/ 50-100 mg propiltiouracila?

[Pingu]

Probaj naći informacije na ovom topiku i sretno!

http://www.roda.hr/rodaphpBB2/viewto...ab7d257a4635c6

[anchie76]

Cvijeta, nerijetko doktori kazu da mama treba prestati dojiti ukoliko konzumira neki lijek. Najcesce se to desi iz jednostavnog razloga - doktor ne zna koliki je zaista utjecaj tog lijeka na dojenje (citajuci upozorenja na lijeku - na vecini njih pise da nisu kompatibilini u trudnoci/dojenju jer se proizvodjaci na taj nacin ogradjuju od mogucih tuzbi).

No, s druge strane, postoje istrazivanja od strane ne-prozivodjaca lijekova koji pokusavaju utvrditi, odvagnuti, koliki je zaista utjecaj lijeka na dojenje i dali je bolje dojiti uz lijek i rizike koje to nosi ili prestati dojiti jer i prehrana adaptiranim mlijekom nosi svoje rizike o kojima se cesto ne razmislja.

Potrazila sam malo info na netu na relevantnim stranicama i evo sto sam nasla. Mislim da ce ti se svidjeti


http://www.perinatology.com/exposure...opylthiouracil

Propylthiouracil CATEGORY:D
BREAST FEEDING: Compatible With Breastfeeding[G3].
NEONATAL SIDE EFFECTS: Potential for hypothyroidism

http://www.kellymom.com/health/thyro...roid-refs.html

Propylthiouracil / PTU
Momotani N, Yamashita R, Makino F, Noh JY, Ishikawa N, Ito K. Thyroid function in wholly breast-feeding infants whose mothers take high doses of propylthiouracil. Clin Endocrinol (Oxf). 2000 Aug;53(2):177-81.

"...Mothers can breast-feed while taking propylthiouracil at doses as high as 750 mg daily without adverse effects on thyroid status in their infants."

http://www.kellymom.com/health/thyro...treatment.html

Name of medication-----------------AAP approved?* -------Lactation Risk Category**
carbimazole (Neo-Mercazole)-------yes---------------------------L3 (moderately safe)
methimazole (Tapazole)------------yes---------------------------L3 (moderately safe)
propylthiouracil (PTU)--------yes-----------------------L2 (safer)

I objasnjenje kategorija:

L1 SAFEST:
Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.

L2 SAFER:
Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.

L3 MODERATELY SAFE:
There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.

L4 POSSIBLY HAZARDOUS:
There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

L5 CONTRAINDICATED:
Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

[Lutonjica]

super za ovo što kaže anchie76.

ali, naši liječnici će strogo zabraniti dojenje kod uzimanja lijekova za hipertireozu.

ja imam hipotireozu, i idem kod stvarno vrhunskog stručnjaka.

u početku se sumnjalo na hipertireozu, on mi je dao dvije opcije: odmah početi uzimati lijekove i prestati dojiti,
ili malo riskirati, ne uzimati lijekove, dojiti i dolaziti na česte kontrole kako situacija ne bi izmakla kontroli.
odlučili smo se na ovo drugo.

srećom, kod mene je na kraju riječ o hipotireozi, tako da bez problema mogu dojiti pijući euthyrox.

ali da imam hipertireozu, poslušala bih ga i prestala dojiti da je to potrebno, jer mu iznimno vjerujem. više nego ovim podacima :/

cvijeta, na tebi je da odlučiš.
možda da potražiš drugo mišljenje.
ili da posjetiš nekog prodojećeg endokrinologa kao što je moj, pa da malo probate bez lijekova, da bar par mjeseci dojiš?

[Lutonjica]

tek sam sad vidjela da je gore linkani topik upravo moj.
kad se sjetim kako sam očajna bila

[anchie76]

ali da imam hipertireozu, poslušala bih ga i prestala dojiti da je to potrebno, jer mu iznimno vjerujem. više nego ovim podacima :/

Vidis, ja bi radje vjerovala dr. Hale-u (iz cijih knjiga su info na Kellymom), koji je medju vodecim expertima u svijetu (ako ne i jedini ) sto se utjecaja lijekova na dojenje tice. To navedeno na kellymom su ujedno i preporuke Americke Pedijatrijske Akademije.

Ne budi mi lijeno, potrudila sam se naci sto dr. Hale o tome kaze osobno na svom forumu. Pa evo 3 pitanja na tu temu i njegovi odgovori:

Shelly Kirkbride
Posted on Monday, December 06, 2004 - 12:46 pm:

Dear Dr. Hale,
I have a new postpartum mother with full term infant,who was on PTU (propylthiouracil) 200 mg TID, for the past year. She would like to breastfeed but her OB/GYNs said it was not safe. Your book mentions doses of 400 mg. Do you have any info on 600 mg.? How often should the infants blood levels be checked if she were to continue with the breastfeeding? Any info would be appreciated. Thank you.

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Tom Hale Ph.D.
Posted on Monday, December 06, 2004 - 01:03 pm:

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Shelly:

I'd suggest it is still safe, but monthly TSH/T4 levels should probably be done at least for several months.

As for dose, if its not in my book, I don't have any such data.

Tom Hale Ph.D.

http://66.230.33.248/discus/messages/45/3463.html

Sherry Gomez
New member
Username: Sherryamanda

Post Number: 1
Registered: 09-2005
Posted on Thursday, September 01, 2005 - 02:36 am:

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Hi I'm a 33yr old mom of 3 kids 6, 4 and 4months, I've never had any major illnesses before but now I just learned that I have hyperthyroidism. I am still breastfeeding my baby and I dont want to stop, I know this is the best milk for her and she also has a ventricular septal defect so I want to do whats best for her health, but now it looks like my hyperthroidism is getting worse. I'm afraid I will go into thyroid storm, but I dont want to take Atenolol or Propanolol ( which my doctor suggests) but she also wants me to continue breastfeeding , so in the meantime she is checking w/ the endocrineologist on what to do. I cant do the nuclear medicine thyroid scan either right??? So what my ? is is that- Do you know what medicine I could take for this that would be safe for the baby??? Please if you have any answers I would appriciate it, Thankyou, Sherry

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Tom Hale Ph.D.
Member
Username: Tom

Post Number: 1247
Registered: 04-2003
Posted on Thursday, September 01, 2005 - 09:16 am:

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Sherry:

For the thyroid storm, Propranolol is ideal for breastfeeding mothers. For treatment of hyperthyroidism, propylthiouracil or methimazole are fine for breastfeeding mothers. As for nuclear scanning, suggest they use I-123, NOT I-131, but avoid this if you can unless your physicians really insist.

All of the these drugs are in my book.

Tom Hale Ph.D.

http://66.230.33.248/discus/messages/53/1902.html

Gonneke van Veldhuizen
Posted on Thursday, May 13, 2004 - 11:17 am:

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Dear dr Hale,

A client with hyperthyroidism has been prescribed thiamazol and her physician ordered weaning. I can't find it in your 2002 ed. and searching this forum was unsuccessfull. All google resources state it enters m'milk, but advice regarding use in lactating women is inconsistent. Patient's package insert says to not use during lactation. Do you have more accurate info?

thank you in advance,

warmly,

Gonneke van Veldhuizen, IBCLC

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Tom Hale Ph.D.
Posted on Thursday, May 13, 2004 - 11:24 am:

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Gonneke:

I think this is called methimazole in the US. It is in my book, and it is fine for a breastfeeding mother. Propylthiouracil is another alternative that is fine for breastfeeding mothers.

Tom Hale Ph.D.

No, na nasu srecu ni ti ni ja Lutonjice ne moramo odlucivati o tome.

Cvijeta, sad znas vise toga. Jednostavnog odgovora nema. Procitaj sve, prosurfaj jos na netu, pa onda donesi odluku. Koju god da doneses, drzim fige da bude sve ok

[anchie76]

Sad sam tek skuzila da si napisala da si taj lijek koristila tjekom trudnoce.

Sudeci prema onom linku gore sto sam navela sa perinatology koji kaze da je lijek kompatibilan s dojenjem, po njima je rizik konzumiranja tog lijeka u trudnoci D (po njihovom objasnjenju kategorija - rizican lijek).

E pa sad imajuci to u vidu, nema mi bas smisla da su ti taj lijek doktori davali cijelo vrijeme u trudnoci a sad ti ne daju da dojis dok ga konzumiras :?

Cvijeta, moram ti napomenuti da nisam lijecnik, ovo su samo moja osobna razmisljanja.

[Lutonjica]

čuj, ja osobno u svom slučaju nekako više vjerujem doktoru koji me jako dobro poznaje, koji poštuje moju želju da dojim i sve će učiniti da se to nastavi (dokle god nije nauštrb mog ili bebinog zdravlja) i koji sjedi nasuprot mene i gleda me u oči dok s njim razgovaram.

kužiš kaj hoću reći, ne?

druga bi bila stvar da imam nekog polunezainteresiranog endokrinologa (ili nedajbože liječnika opće prakse) kojemu sam ja samo n-ti pacijent i boli ga briga što meni dojenje nešto znači u životu.
ali u takvom slučaju bih opet potražila drugo mišljenje.
hm, zapravo i jesam tako sam i našla svog dragog endokrinologa.

e da, sjećam se da je pred te 3 godine kad sam istraživala o svemu ovome, bilo riječi o nekom lijeku za hipertireozu kojeg nema u hrvatskoj i koji je kompatibilan s dojenjem.
možda je to taj, možda ga evo i kod nas (to bi bilo super!!)

[anchie76]

Nisam u dodiru s ovakvim pitanjima svaki dan, pa me ovo zaintrigiralo pa sam odlucila jos malo kopati. Mozda je Lut ovo zaista taj lijek o kojem ti pricas. Jer gle sta kaze AAP Policy (American Academy of Pediatrics):

http://aappolicy.aappublications.org...cs%3b108/3/776 (pa se klikne na tablicu 6)

(malo ovo slampavo izgleda kad se kopira, al se valjda kuzi)

TABLE 6

Maternal Medication Usually Compatible With Breastfeeding*



Drug --------------------Reported Sign or Symptom in Infant or Effect on Lactation

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Procainamide ------------None
Progesterone ------------None
Propoxyphene ------------None
Propranolol ---------------None
Propylthiouracil -------------None
Pseudoephedrine -----------None
Pyridostigmine ------------None
Pyrimethamine ------------None
Quinidine -------------------None
Sulfapyridine ----------------Caution in infant with jaundice or G-6-PD deficiency and ill, stressed, or premature infant; appears in infant's milk
Sulfisoxazole --------------Caution in infant with jaundice or G-6-PD deficiency and ill, stressed, or premature infant; appears in infant's milk
Sumatriptan -------------None
Suprofen -----------------None
Terbutaline--------------- None
Terfenadine ---------------None
.
.
.
.
.
.
.
.
itd.

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* Drugs listed have been reported in the literature as having the effects listed or no effect. The word "none" means that no observable change was seen in the nursing infant while the mother was ingesting the compound. Dashes indicate no mention of clinical effect on the infant. It is emphasized that many of the literature citations concern single case reports or small series of infants.

+ Drug is concentrated in human milk.

[Luna Rocco]

Imam hipertireozu. tijekom cijele trudnoće sam bila na terapiji propiltiouracil. Rodila sam prije 5 dana i rečeno mi je da ne smijem dojiti? Da li imate neko iskustvo koji bi se zamijenski lijek mogao koristiti i da li je stvarno opasno dojenje za vrijeme terapije/ 50-100 mg propiltiouracila?

Cvijeta, ovo je na onom topicu na koji ti je Pingu dala link napisala mama koja ima hipertireozu, imia:

Lijek koji ja uzimam je PTU (propylthiouracil), uzimam ga 250 mg na dan. To je srednja doza. Prije sam uzimala manje, ali nije bilo dosta. Sad vise ne dojim tako puno jer mi je beba skoro 11 mjeseci pa je to OK. Americka Akademija za Pedijatriju ovaj lijek dozvoljava uz dojenje, do doze od 650 mg na dan.

To je ovaj tvoj lijek, nije li? Ona je uzimala više nego duplu dozu u odnosu na tvoju. Sretno.

[anchie76]

Cvijeta, da li je dijete rodjeno u terminu ili prije? Kolika je tezina djeteta?

Ovo te pitam jer ukoliko je dijete ranije rodjeno, to moze biti problematicno (sto je dijete vece, manji je los utjecaj lijeka)

[M&A]

Da ne otvaram novu temu,prilijepit cu se ovdje

Evo gotovo godinu dana nakon poroda,pocele mi smetnje sa stitnjacom...
Dijagnosticirana mi hipertireoza,prepisan tretman carbimazolom i zabrana dojenja jer je preopasno za bebu,kroz mlijeko primati tireostatik (19% od moje doze kako tvrdi gospon doktor)sto moze dovesti do hipotireoze kod bebe cija stitnjaca trenutno radi normalno.

Prekopala sam net uzduz i poprijeko i pronasla neke tekstove kako se uz dojenje moze uzimati propiltiouracil.
Sretnija nego Kolumbo kad je otkrio Ameriku,zovem doktora i trazim promjenu terapije (koju jos nisam ni pocela) i dobijem odgovor da i propiltiouracil kroz mlijeko odlazi bebi u nesto manjoj kolicini od carbimazola,ali dovoljno da dovede bebu do hipotireoze.

Ponovo me uvjerava da je najbolje da prekinemo dojenje,da je beba dojenjem do sad dobila sve sta joj traba i da sad mozemo slobodno prijeci na polumasno mlijeko iz tetrapaka.
Pregovarala sam makar da zadrzimo dojenje ujutro i navecer(umjesto dojenja na zahtjev 24/24),i da uzimam lijek nakon dojenja,ali doktor ne odobrava.

A kako prekinuti dojenje na takav brutalan nacin?
Kad bocicu nece ni blizu?
Za prekid dojenja nismo spremni
Sta uraditi?
Doduse,malac je zadnjih dana dosta nemiran po noci.Prima li mozda kroz mlijeko dio mojih "podivljalih"hormona?

Ajmo cure,tko ima...neznam...neki savjet,iskustvo,misljenje...nesto...samo izvolite.