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Hyperthyroidism medication(PTU) and breastfeeding

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  • #16
    Yeahbuddy:

    Methimazole is an ideal choice for breastfeeding mothers. We have a number of studies with this drug and less than 2.3% of the medication gets to the infant. Thus far we've had no infants with thyroid problems. It's our current drug of choice in breastfeeding mothers.

    Tom Hale Ph.d.
    Professor
    Director, InfantRisk Center

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    • #17
      Good afternoon, I have a question related to this thread. My doctor prescribed me Ptu 3x a day 50mg at a time. Mommymeds shows it is an l2, but the alternative, Methimazole is also an l2. Can you please go into detail about the differences in these two and if one is better than the other? Also, how much it will affect my daughter. My doctor told me it was safe, but he isn't exactly up to date with lactation and meds. Help please! I don't want to take it if it is going to affect my daughter.

      2.3% sounds like a lot. How much is that in comparison to ibuprofen or aspirin?

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      • #18
        Slindberg617,

        ​PTU (propylthioracil) is rated an L2-limited data-probably compatible. The amount transferred into breast milk is 1.8% of your dose. [COLOR=#333333][FONT=lucida grande]Propylthiouracil is the preferred antithyroid agent in breastfeeding mothers. Only small amounts are secreted into milk, and side effects to the infant are minimal. To be safe, monitor thyroid function of the infant (TSH,T4 and T3). No changes in infant thyroid have been reported.

        Methimazole is rated an L2-limited data-probably safe. The amount transferred into breast milk is 2.3% of your dose. Methimazole usage during breastfeeding is probably safe. There are lots of data reporting no untoward effects to the infant for periods up to 12 months. Monitor thyroid function of the breastfed infant to be safe. In a large study of over 134 thyrotoxic lactating mothers and their infants, even at methimazole doses of 20 mg/day, no changes in infant TSH, T4 or T3 were noted in over 12 months of study.

        The authors conclude that both propylthiouracil and methimazole can safely be administered during lactation.

        I hope this helps.

        Sandra Lovato R.N.
        InfantRisk Center
        806-352-2519[/FONT][/COLOR]

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        • #19
          That definitely helps some, but I have a follow-up question or two. First, since the max dose of methimazole is 60mg\day while I'm currently prescribed 250 mg\day of ptu...with the percentages listed, my daughter would get more of the medication via ptu than methimazole.
          also, above Dr. Hale mentioned methimazole being the preferred medication. Should I ask my doctor to switch me?

          Lastly, do you know what the half life on the med is? Like if II took the medication right after she was done eating and then fed her 2.5 hours later...(every three hours) how much would she still be getting? I'm not going to lie, I am quite nervous about starting this med, any med really. (Which is why I've had it for a week and haven't started taking it yet.)
          I really want to make sure it is safe.
          Thank you for your time.

          Comment


          • #20
            Slindberg617

            Actually 2.3% of methimazole is passed into breast milk and 1.8% of PTU is passed into breast milk so slightly more methimazole is passed. As far as dosing you cannot compare the mg in different medications, it is like comparing apples to oranges. Either medication is probably ok as long as it works for you and the infants thyroid functions are normal.

            Half-life of methimazole is 6-13 hours and PTU is 1.5-5 hours


            Sandra Lovato R.N.
            InfantRisk Center
            806-352-2519
            Last edited by Sandra; 11-30-2015, 08:36 AM.

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            • #21
              Hi I would just like to ask if you have an email address where I can contact you. I badly need your help on the I-131 I read in your previous reply that we can consult when its safe to breastfeed. please I need your help on this I did my RAI due to I am hyperthyroid and I am breastfeeding too J want to breastfeed my baby back soon ive had 12 RAI since my thyroid is not that big but is palpable

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              • #22
                Yona,

                We have some questions, could you please call the InfantRisk Center at 806-352-2519.

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                • #23
                  Yona,

                  I spoke with Dr Hale he advised to wait a minimum of 45 days to resume breastfeeding, and to avoid close contact (within 6 feet) for 14 days.
                  I hope this helps,

                  Sandra Lovato R.N.

                  Comment


                  • #24
                    Hi
                    I am Mona
                    my baby is 24 days old and i am taking 10 mg of carbimazole, divided into 2 doses each of 5 mg. and i am breastfeeding my baby only once so as to avoid any affect of the drug on my baby.
                    i am worried if carbimazole will have any kind of side effect on my baby's health and will it be safe if i continue feeding him once?
                    i usually feed him after 7-8 hrs after orally taking the drug

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                    • #25
                      Mona,

                      Carbimazole is rated an L3-limited data-probably compatible. The amount that transfers into breast milk is 2.3-5.3 % of your dose. We think at this low dose it is unlikely to affect your infant, you could probably breastfeed more often if you prefer. We recommend monitoring your infants thyroid functions especially during the first few months of therapy.

                      Sandra Lovato R.N.
                      InfantRisk Center
                      806-352-2519

                      Comment


                      • #26
                        Hi there,
                        I was diagnosed with hypothyroidism during g pregnancy and was taking 62.5 eutirox throughout pregnancy and for one month after my baby boy was born. At that point my bloods showed I was hyper and my doctor took me off the eutirox. In the next blood test six weeks later my levels were the following: TSH 0.01, FT3 6.8, FT4 2.6 (with quite severe symptoms). Here in Spain, the general choice of drug is Carbimazol, but my doctor was aware that I was breastfeeding and it is a level 3 drug, so she prescribed Propilitiouracilo instead, on the lowest dose, 50mg once a day. I've just been to see the endocrinologist and although my FT3 and FT4 are better (2 .4, 1.02) my TSH is still at 0.01 after a month taking Propilitiouracilo. He wants me to go on Carbimazol (5mg + 2.5mg) as he says it is more effective, suggesting I stop breastfeeding if there's a risk to the baby. I really don't want to do that, especially as I will be introducing solids in just over a month and will be feeding less frequently. What do you suggest? Many thanks.

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                        • #27
                          Betty,

                          Carbimazole is a prodrug of methimazole. It is rated an L3-limited data-probably compatible. The amount that transfers into breastmilk is 2.3-5.3% of your dose. Milk levels will depend on your dose, but appear too low to produce clinical effects in the infant. A normal dose is 15-60mg in 2-3 divided doses. We think it is probably ok to breastfeed with this medication if you have your infants thyroid functions monitored regularly and they stay within normal limits, and if you monitor your infant for signs of hypothyroidism.

                          Propylthiouracil (Propilitiouracilo) is rated an L2-limited data-probably compatible. The amount that transfers into breast milk is 1.8% of your dose. A normal dose is 100mg 3 times a day. This medication is also probably ok. Monitor your infants thyroid functions, and for signs of hypothyroidism.

                          Either of these medications is probably ok to use in breastfeeding as long as the infants thyroid functions are monitored and they are within normal limits. It appears your doses would be low on either medication, but the decision on which medication to use is up to your Endocrinologist to decide which would work best for you in your situation.

                          Sandra Lovato R.N.
                          InfantRisk Center
                          806-352-2519

                          Comment


                          • #28
                            Hello,
                            I'm diagnosed with Graves' disease and I started the treatment 2 weeks ago taking methimazole 20mg in 2 divided doses.
                            however I'm still breastfeeding my 20month old girl.
                            since the beginning of methimazole I started decreasing breastfeeding from three times to two and now only one time!
                            but since she's allergic to cow's protein she only gets her milk from me and it was working with us plus she's not taking her day nap anymore because I stopped nursing her through the day.
                            can I breastfeed her twice a day? And how long should I wait after taking the pills to decrease its exposure? Is 12h waiting the same as 6h for example?
                            please I'm searching for zero risk
                            Last edited by Francp; 06-04-2017, 12:29 PM.

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                            • #29
                              Francp,

                              Methimazole is rated an L2-limited data-probably compatible. The amount that transfers into breast milk is 5.88-14.7% of your dose. The half-life ranges from 6-13 hours. I think since your infant is older breastfeeding twice a day would be minimal exposure or risk, but we do recommend monitoring your child's thyroid functions to be safe. I am afraid zero risk would probably mean waiting 5-6 half-lives to nurse.

                              Sandra Lovato R.N.
                              InfantRisk Center
                              806-352-2519

                              Comment


                              • #30
                                You said before "Actually 2.3% of methimazole is passed into breast milk" how come it's 5.88-14.7% now?
                                Please I signed in here to rest my mind about methimazole intake while breastfeeding l. 14% is too much
                                or you mean the first two hours are high and later decreases

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