Treatment of Graves' hyperthyroidism with thionamides: a position paper on indications and safety in pregnancy

M Tonacchera, L Chiovato, L Bartalena, A F Cavaliere, P Vitti

Research output: Contribution to journalReview articlepeer-review


CONTEXT: Graves' disease affects 3% of women and 0.5% of men in the general population. The first line treatment of Graves' hyperthyroidism is based on the administration of antithyroid drugs (ATD), propylthiouracil (PTU), methimazole (MMI) and carbimazole. A recent warning from the Italian Drug Agency (Agenzia Italiana del Farmaco AIFA) reported the risk of MMI-induced acute pancreatitis. In addition, AIFA highlighted the possible association of MMI treatment during the first trimester of pregnancy with congenital malformations, thus recommending the use of effective contraceptive methods in women of childbearing age treated with MMI.

METHODS AND RESULTS: Revision of literature reported less than ten cases of the alleged MMI pancreatitis, allowing the inclusion of MMI in class III drug regarding the relative risk for drug-induced pancreatitis. Data available on the effect of hyperthyroidism per se on the risk of fetal malformations, although scanty, are sufficient to recommend treatment with ATD of the hyperthyroid pregnant woman. Case reports and population studies either suggesting or not suggesting MMI-induced fetal malformations do not allow unquestionable conclusions on this matter.

CONCLUSIONS: This consensus by experts from Italian Endocrine and Gynecologic Scientific Societies has edited recommendations derived form the available data and published guidelines of International Scientific Societies.

Original languageEnglish
Pages (from-to)257-265
Number of pages9
JournalJournal of Endocrinological Investigation
Issue number2
Publication statusPublished - Feb 2020


  • Antithyroid Agents/adverse effects
  • Consensus
  • Female
  • Graves Disease/diagnosis
  • Humans
  • Hyperthyroidism/diagnosis
  • Italy/epidemiology
  • Methimazole/adverse effects
  • Pancreatitis/chemically induced
  • Practice Guidelines as Topic/standards
  • Pregnancy
  • Pregnancy Complications/diagnosis


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