hipertireoza, carbimazol i dojenje

[apricot]

post M&A se izgubio, pa otvaram zaseban topic:

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.

[zrinka]

mozda ovo moze pomoci:
http://www.kellymom.com/health/thyroid/index.html
tj ovdje
http://www.kellymom.com/health/thyro...treatment.html

pise:

Anti-thyroid medications
carbimazole (Neo-Mercazole)
methimazole (Tapazole)
propylthiouracil (PTU)
Info on selected anti-thyroid meds
Name of medication AAP approved?* Lactation Risk Category** Notes
carbimazole (Neo-Mercazole) yes L3 (moderately safe) (1)
methimazole (Tapazole) yes L3 (moderately safe) (2)
propylthiouracil (PTU) yes L2 (safer) (3)
* Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.
** Per Medications' and Mothers' Milk by Thomas Hale, PhD (2002 edition).

(1) "Carbimazole is a prodrug of methimazole and is rapidly and completely converted to the active methimazole in the plasma." (Hale 2002, p. 112-113)

(2) Hale describes several studies that looked at infant thyroid function (185 mother-infant pairs in all) - all the infants had normal thyroid function after maternal treatment, even when the mother was taking higher doses. One large study (139 mother-infant pairs) observed mothers & babies for over 12 months. "The authors conclude conclusively that both PTU and methimazole can safely be administered during lactation. However, during the first few months of therapy, monitoring of infant thyroid functioning is recommended." Hale notes that "propylthiouracil may be a preferred choice in breastfeeding women." (Hale 2002, p. 465-466)

(3) "Only small amounts are secreted into breastmilk. Reports thus far suggest that levels absorbed by infant are too low to produce side effects... No changes in infant thyroid have been reported... PTU is the best of antithyroid medications for use in lactating mothers. Monitor infant thyroid function (T4, TSH) carefully during therapy." (Hale 2002, p. 603-604)

mozda upitati za misljenje drugog lijecnika
na poliklinici vuk vrhovec su jako dobri strucnjaci koji se bave problemima sa stitnjacom

[M&A]

Hvala cure
Zrinka isprintat cu ovo i traziti misljenje drugog lijecnika.

Je li tko od vas uz dojenje uzimao neki tretman za hipertireozu?
Jesu li bebe vadile krv za provjeru hormona i kakvi su rezultati?

[paklenica]

LactMed- baza podataka o lijekovima i dojenju

http://toxnet.nlm.nih.gov/cgi-bin/si...temp/~jtAB8M:1


Summary of Use during Lactation:
Despite common practice, propylthiouracil (PTU) therapy is not a reason to discontinue breastfeeding.[1] PTU is considered the antithyroid drug of choice during lactation.[2][3][4] Little passes into milk and infant thyroid suppression does not occur. However, insufficient data exist to support safe use in dosages greater than 450 mg daily.[3] Taking PTU right after nursing and waiting for 3 to 4 hours before nursing again should minimize the infant dosage. Rare idiosyncratic reactions (e.g., agranulocytosis) might occur, and the infant should be watched for signs of infection. Monitoring of the infant's complete blood count and differential is advisable if there is a suspicion of a drug-induced blood dyscrasia.


Drug Levels:
Maternal Levels. A woman (time postpartum not stated) given a single dose of 100 mg of propylthiouracil (PTU) excreted a total of 0.077% of the dose in her breastmilk in 24 hours.[5]

After a single oral dose of 400 mg of propylthiouracil (PTU) in 9 women who were 1 to 9 months postpartum, peak milk levels averaging 0.7 mg/L were reached 1.5 hours after the dose. The authors estimated that the infant of a mother taking 200 mg 3 times a day would receive no more than 462 mg daily or a maximum of 0.025% (range 0.07 to 0.077%) of the maternal dosage.[6]

Infant Levels. Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:
A total of at least 24 infants have been reported to have been safely breastfed during maternal PTU therapy.

A mother was taking oral propylthiouracil 100 mg daily during pregnancy and 125 mg daily after delivery. In her infant, serum thyroxine (T4) concentration dropped slightly below the lower limit of normal on day 4 of life, but both T4 and thyrotropin (TSH) concentrations were normal on day 19 with continued maternal PTU therapy.[7] The drop in T4 was possibly due to propylthiouracil in breastmilk, but more likely from PTU received transplacentally.

An infant whose mother was taking 200 to 300 mg of propylthiouracil daily was followed for 5 months and found to have normal thyroid function tests.[6]

A mother took PTU in a starting dose of 100 mg 3 times daily that tapered off to 50 mg twice daily over a period of 6 months. Her breastfed infant had normal thyroid function tests during this period at the ages of 9 to 13 months of age.[8]

Eight mothers taking PTU during pregnancy and doses of 50 to 300 mg daily after delivery exclusively or nearly exclusively breastfed their infants. The infants all had slightly low free T4 levels at birth and TSH levels were above normal in 7 of the 8, indicating that they had been affected by PTU in utero. All of their infants had normal free T4 and TSH levels when measured between 18 days and 8 months of age and none had any adverse effects reported from PTU in milk.[9]

The mothers of 11 fully breastfed infants were taking 300 to 750 mg daily of PTU starting at various times between delivery and 11 months postpartum. One infant had slightly elevated TSH level at 19 weeks of age when his mother was taking PTU 450 mg daily. Two other infants had elevated TSH levels at birth. TSH normalized in both infants with maternal PTU doses of 600 mg daily in one and a dose starting at 300 mg daily at term and increasing to 600 mg daily in the other.[10]

Two other infants were reported to be hypothyroid at birth but to have normal thyroid function at 1 month of age despite maternal PTU therapy during breastfeeding.[1]


Possible Effects on Lactation:
Relevant published information was not found as of the revision date.


AAP Category:
Usually compatible with breastfeeding.[4]


References:
1. Lee A, Moretti ME, Collantes A et al. Choice of breastfeeding and physicians' advice: a cohort study of women receiving propylthiouracil. Pediatrics. 2000;106(1 pt. 1):27-30. PMID: 10878145
2. Cooper DS. Antithyroid drugs: to breast-feed or not to breast-feed. Am J Obstet Gynecol. 1987;157:234-5. PMID: 2441601
3. Mandel SJ, Cooper DS. The use of antithyroid drugs in pregnancy and lactation. J Clin Endocrinol Metab. 2001;86:2354-9. PMID: 11397822
4. American Academy of Pediatrics. Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108:776-89. PMID: 11533352
6. Low LCK, Lang J, Alexander WD. Excretion of carbimazole and propylthiouracil in breast milk. Lancet. 1979;2:1011. Letter.
7. Kampmann JP, Johansen K, Hansen JM et al. Propylthiouracil in human milk: revision of a dogma. Lancet. 1980;1:736-7. PMID: 6103158
8. Lamberg B-A, Ikonen E, Osterlund K et al. Antithyroid treatment of maternal hyperthroidism during lactation. Clin Endocrinol (Oxf). 1984;21:81-7. PMID: 6744638
8. McDougall IR, Bayer MF. Should a woman taking propylthiouracil breast-feed? Clin Nucl Med. 1986;11:249-50. PMID: 3754191
9. Momotani N, Yamashita R, Yoshimoto M et al. Recovery from foetal hypothyroidism: evidence for the safety of breast-feeding while taking propylthiouracil. Clin Endocrinol (Oxf). 1989;31(5):591-5. PMID: 2627753
10. 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(2):177-81. PMID: 10931098



Substance Identification:


Substance Name: Propylthiouracil

CAS Registry Number: 51-52-5

Drug Class:
Antithyroid Agents
Thionamides

Administrative Information:


LactMed Record Number:
230


Last Revision Date:
20071227

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

Prepisujem savjet o drugom mišljenju.
Eventualno konzultirati i pedijatra (ukoliko je prodojeći).
Ako prihvaća sugestije uputiti ga na LactMed ili Thomas Hale-a.