Abstract
Exposure to propylthiouracil in early pregnancy may be associated with an increased risk of birth defects. But the spectrum of associated congenital anomalies is not yet well defined. While preliminary reports suggest that most cases of propylthiouracil-associated birth defects are restricted to the preauricular and urinary systems, careful consideration should be given to other possible manifestations of teratogenicity. We propose that congenital bands may potentially represent a rare yet serious complication of propylthiouracil exposure in early pregnancy, possibly arising from an early mesenteric developmental anomaly. We report a case of a 17-day-old girl that presented with acute small bowel obstruction associated with intestinal malrotation arising from several anomalous congenital bands. Her mother was treated for Graves' disease during pregnancy with first trimester exposure to propylthiouracil but remained clinically and biochemically euthyroid at conception and throughout the duration of pregnancy. This case suggests that the use of propylthiouracil in early pregnancy may be associated with congenital bands and intestinal malrotation. More reports are needed to further support this association.
Highlights
Antithyroid drugs, such as propylthiouracil (PTU) and methimazole (MMI), are widely considered to be first line therapy in the treatment of hyperthyroidism in pregnancy [1,2,3]
In order to balance these risks, a number of expert panels, such as the American Thyroid Association and the Endocrine Society, have recommended treatment of hyperthyroidism during the first trimester of pregnancy with PTU to reduce the risk of teratogenicity to the fetus but recommended switching to MMI for the remainder of pregnancy to minimize unnecessary PTU exposure for the mother [1, 2]
PTU was widely believed to pose no major threat to fetal development and was recommended as the preferred therapy during the first trimester of pregnancy [1, 2]. This notion was challenged by a large Danish cohort study, which reported a higher prevalence of congenital malformations of the face, neck, and urinary systems in children exposed to PTU in early pregnancy [4]
Summary
Antithyroid drugs, such as propylthiouracil (PTU) and methimazole (MMI), are widely considered to be first line therapy in the treatment of hyperthyroidism in pregnancy [1,2,3]. In order to balance these risks, a number of expert panels, such as the American Thyroid Association and the Endocrine Society, have recommended treatment of hyperthyroidism during the first trimester of pregnancy with PTU to reduce the risk of teratogenicity to the fetus but recommended switching to MMI for the remainder of pregnancy to minimize unnecessary PTU exposure for the mother [1, 2]. These recommendations were initially formed in response to studies linking MMI (but not PTU) exposure to a variety of birth defects. We report the first case of congenital bands resulting in intestinal malrotation in a neonatal girl following PTU exposure in early pregnancy
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