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Does Propylthiouracil (PTU) cause side effects?
Graves' disease is the most common cause of hyperthyroidism. It is an autoimmune disease where an individual makes antibodies to thyroid-stimulating hormone receptors on cells of the thyroid gland and then trigger overproduction of thyroid hormone by the cells.
The two thyroid hormones manufactured by the thyroid gland, thyroxine (T4) and triiodothyronine (T3), are formed by combining iodine and a protein called thyroglobulin with the assistance of an enzyme called peroxidase.
PTU inhibits iodine and peroxidase from their normal interactions with thyroglobulin to form T4 and T3. This action decreases production of thyroid hormone. PTU also interferes with the conversion of T4 to T3, and, since T3 is more potent than T4, this also reduces the activity of thyroid hormones.
Common side effects of propylthiouracil (PTU) include
- skin effects (such as rash, itching, hives, abnormal hair loss, and skin pigmentation),
- loss of taste,
- joint or muscle aches,
- numbness, and
Serious side effects of propylthiouracil (PTU) include
- decreased white blood cells (agranulocytosis) (symptoms include infectious lesions of the throat, the gastrointestinal tract, and skin with an overall feeling of illness and fever),
- decreased blood platelets (thrombocytopenia) which can lead to excessive bleeding, and
- severe liver injury and acute liver failure, which can be fatal.
Drug interactions of propylthiouracil (PTU) include oral blood thinners, because PTU may increase their effects.
Hyperthyroidism may cause increased elimination of beta-blockers. Once hyperthyroidism is reversed, the excretion of beta-blockers may return to normal and less beta-blocker will be needed to provide the same effect.
Digoxin blood levels may be increased when hyperthyroidism is reversed in patients on a stable digoxin dose. A smaller dose of digoxin may be needed in order to avoid toxicity of digoxin.
Similarly, theophylline elimination may decrease when hyperthyroidism is reversed in patients on a stable theophylline dose.
A reduced dose of theophylline may be needed in order to avoid toxicity of theophylline.
PTU crosses the placenta and may harm a fetus.
- If it is necessary to use PTU during pregnancy the lowest effective dose should be used.
- Since methimazole is associated with fetal abnormalities, PTU is used during the first trimester if an antithyroid drug is needed.
What are the important side effects of Propylthiouracil (PTU)?
The most common side effects are related to the skin, such as:
Other important side effects include:
Less common but serious side effects have occurred with PTU therapy. A decrease of white blood cells in the blood (agranulocytosis) may occur.
Symptoms and signs of agranulocytosis include infectious lesions of the throat, the gastrointestinal tract, and skin with an overall feeling of illness and fever.
A decrease in blood platelets (thrombocytopenia) also may occur. Since platelets are important for the clotting of blood, thrombocytopenia may lead to excessive bleeding.
Severe liver injury and acute liver failure, in some cases fatal, have been associated with PTU. Some adults and pediatric patients required liver transplantation.
Propylthiouracil (PTU) side effects list for healthcare professionals
Major adverse reactions (much less common than the minor adverse reactions) include
- inhibition of myelopoiesis (agranulocytosis, granulopenia, and thrombo-cytopenia),
- aplastic anemia,
- drug fever, a lupus-like syndrome including solenomegaly,
- periartentis, and
- hypoprothrombinemia and bleeding.
There were also reports of the following:
Reports of a vasculitic syndrome associated with the presence of anti-neutrophilic cytoplasmic antibodies (ANCA) have also been received.
Manifestations of ANCA-positive vasculitis may include rapidly progressive glomerulonephritis (crescentic and pauci-immune necrotizing glomerulonephritis) sometimes leading to
- acute renal failure;
- pulmonary infiltrates or alveolar hemorrhage;
- skin ulcers; and
- leucocytoclastic vasculitis.
Minor adverse reactions include
- skin rash,
- epigastric distress,
- loss of taste,
- abnormal Ioss of hair,
- skin pigmentation,
- glomerulonephritis, and
- taste perversion.
It should be noted that about 10% of patients with untreated hyperthyroidism have leukopenia (white blood cell count of less than 4,000/mm³), often with relative granulopenia.
What drugs interact with Propylthiouracil (PTU)?
The activity of anticoagulants may be potentiated by anti-vitamin-K activity attributed to propylthiouracil (propylthiouracil (propylthiouracil (propylthiouracil tablet) tablet) tablet) .
β-Adrenergic blocking agents
Hyperthyroidism may cause an increased clearance of beta blockers with a high extraction ratio. A dose reduction of beta-adrenergic blockers may be needed when a hyperthyroid patient becomes euthyroid.
Serum digitalis levels may be increased when hyperthyroid patients on a stable digitalis glycoside regimen become euthyroid; a reduced dosage of digitalis glycosides may be required.
Theophylline clearance may decrease when hyperthyroid patients on a stable theophylline regimen become euthyroid; a reduced dose of theophylline may be needed.
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Related Disease Conditions
Thyroid Disorders Symptoms and Signs
Thyroid diseases and disorders are caused because the body either makes too much or too little thyroid hormones, which are necessary for vital functions of the body. Thyroid disease and disorder symptoms and signs depend on the type of the thyroid problem. Examples include heat or cold intolerance, sweating, weight loss or gain, palpitations, fatigue, dry skin, constipation, brittle hair, joint aches and pains, heart palpitations, edema, feeling bloated, puffiness in the face, reduced menstrual flow, changes in the frequency of bowel movements and habits, high cholesterol, hoarseness, brittle hair, difficulty swallowing, shortness of breath, a visible lump or swelling in the neck, tremors, memory problems, depression, nervousness, agitation, irritability, or poor concentration. Thyroid problems are more common in women.
Hyperthyroidism is an excess of thyroid hormone due to an overactive thyroid gland. Symptoms can include increased heart rate, weight loss, heart palpitations, frequent bowel movements, depression, fatigue, fine or brittle hair, sleep problems, thinning skin, and irregular vaginal bleeding. Graves' disease is the most common cause of hyperthyroidism. Many other health problems or taking excess thyroid hormone medication can cause an overactive thyroid gland. Treatment for the condition is with medication, radioactive iodine, thyroid surgery (rarely), or reducing the dose of thyroid hormone. No diet has been shown to treat hyperthyroidism or its symptoms and signs.
There are several types of thyroid disorders including hypothyroidism, hyperthyroidism, goiters, thyroid nodules, and thyroid cancer. Symptoms vary by condition. Diagnosis is made with blood tests, scans, ultrasound, or biopsy. Treatments depend on the disorder and can include medication or surgery.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the rate of thyroid hormone production is controlled by the brain by the pituitary gland. Hypothyroidism is a very common condition and the symptoms of hypothyroidism are often subtle, but may include, constipation, memory loss, hair loss, and depression. There are a variety of causes of hypothyroidism, and treatment depends on the cause.
Hypothyroidism During Pregnancy
Hypothyroidism during pregnancy can be treated with synthetic thyroid hormones to maintain the proper thyroid hormone balance. Hypothyroidism symptoms and signs include fatigue, weight gain, lethargy, and constipation. Treatment of hypothyroidism in pregnant women is important because inadequate levels of thyroid hormones may affect the fetus and child during growth and development.
Hashimoto's thyroiditis or chronic lymphocytic thyroiditis, is an autoimmune disorder causing inflammation of the thyroid gland. Hashimoto's thyroiditis is a type of hypothyroidism, and is the most common cause of hypothyroidism in the US. Symptoms of Hashimoto's thyroiditis may include dry skin, fatigue, weight gain, feeling cold, excessive sleepiness, dry skin, dry coarse hair, difficulty swallowing, a lump in the front of the throat, muscle cramps, mood changes, vague aches and pains, problems concentrating, leg swelling, constipation, and depression. There is no cure for Hashimoto’s thyroiditis. Diet changes, natural supplements, vitamins, or other natural products will not treat Hashimoto’s thyroiditis. Treatment for the autoimmune disorder is with thyroid hormone replacement therapy, which will be necessary for the rest of the person’s life.
Thyroid nodules are the most common endocrine problem in the United States. The term thyroid nodule refers to any abnormal growth that forms a lump in the thyroid gland. The vast majority of thyroid nodules are benign.
There are four major types of thyroid cancer: papillary, follicular, medullary, and anaplastic thyroid cancer. Tumors on the thyroid are referred to as thyroid nodules. Symptoms of thyroid cancer include swollen lymph nodes, pain in the throat, difficulty swallowing, hoarseness, and a lump near the Adam's apple. Treatment usually involves chemotherapy, surgery, radioactive iodine, hormone treatment or external radiation and depends upon the type of thyroid cancer, the patient's age, the tumor size, and whether the cancer has metastasized.
The thyroid gland is a butterfly-shaped gland located in the front of the neck. The thyroid gland produces important thyroid hormones, which are produced by the pituitary gland. There are six types of thyroid problems. Home remedies, medications, surgery, lifestyle changes, and surgery. Usually, most types of thyroid problems can be managed with home remedies, medications, lifestyle changes (diet, yoga), and surgery.
Second Source article from Government
Thyroiditis is the inflammation of the thyroid gland. The inflamed thyroid gland can release an excess of thyroid hormones into the blood stream, resulting in a temporary hyperthyroid state. Some forms of thyroiditis can be diagnosed based on tenderness and enlargement of the thyroid gland. A thyroid scan sometimes is used in making the diagnosis. Thyroiditis can also be diagnosed with a biopsy of the thyroid gland.
Hyperparathyroidism is a disorder of the parathyroid glands. There are two types of hyperparathyroidism, primary and secondary. When the parathyroid glands produce too much hormone, hyperparathyroidism is the resulting condition. Most cases of hyperparathyroidism have no evident cause. Signs and symptoms of hyperparathyroidism include fatigue, weakness, depression, loss of appetite, nausea, vomiting, constipation, or confusion. Increased calcium and phosphorous excretion may cause kidney stones. The main treatment of hyperparathyroidism is surgery (parathyroidectomy).
In hypoparathyroidism, the parathyroid gland does not produce enough parathyroid hormone. Causes of hypoparathyroidism include injury to the parathyroid glands, autoimmune disorder association, or may be present ab birth. Symptoms of hypoparathyroidism include: tingling fingers, toes, and lips, brittle nails, dry, coarse skin, dry hair; memory loss, headaches, severe muscle cramps, cataracts, malformed teeth, and convulsions. Treatment of hypoparathyroidism is to restore the calcium and phosphorus to normal levels in the body.
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Professional side effects and drug interactions sections courtesy of the U.S. Food and Drug Administration.