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Review
. 2019 Fall;18(Suppl1):1-12.
doi: 10.22037/ijpr.2020.112892.14005.

Antithyroid Drugs

Hengameh Abdi  1 , Atieh Amouzegar  1 , Fereidoun Azizi  1
Affiliations
Review

Antithyroid Drugs

Hengameh Abdi et al. Iran J Pharm Res. 2019 Fall.

Abstract

The thionamide drugs, i.e. carbimazole and its metabolite methimazole (MMI), and propylthiouracil (PTU) have extensively been used in the management of various forms of hyperthyroidism over the past eight decades. This review aims to summarize different aspects of these outstanding medications. Thionamides have shown their own acceptable efficacy and even safety profiles in treatment of hyperthyroidism, especially GD in both children and adults and also during pregnancy and lactation. Of the antithyroid drugs (ATDs) available, MMI is the preferred choice in most situations taking into account its better efficacy and less adverse effects accompanied by once-daily dose prescription because of a long half-life and similar cost. Considering the more severe teratogenic effects of MMI, PTU would be the selected ATD for treatment of hyperthyroidism during pre-pregnancy months and the first 16 weeks of gestation. Recent studies have confirmed the efficacy and safety of long-term MMI therapy with low maintenance doses for GD and toxic multinodular goiter. Despite the long-term history of ATD use, there is still ongoing debate regarding their pharmacology and diverse mechanisms of action, viz. their immunomodulatory effects, and mechanisms and susceptibility factors to their adverse reactions.

Keywords: Antithyroid; Graves; Hyperthyroidism; Methimazole; Propylthiouracil; Thionamide.

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Figures

Figure 1
Figure 1
The structure of propylthiouracil and methimazole
Figure 2
Figure 2
Schematic diagram of a thyroid follicle showing the main intrathyroidal actions of two thionamides, propylthiouracil and methimazole
Figure 3
Figure 3
The status of passage of thyrotropin (TSH), thyroid hormones, TRAb (TSH receptor antibody) and antithyroid drugs from the maternal to fetal circulation
See this image and copyright information in PMC

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