Gestational Thyrotoxicosis, Antithyroid Drug Use and Neonatal Outcomes Within an Integrated Healthcare Delivery System
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Background: Increasing attention has focused on the prevalence and outcomes of hyperthyroidism in pregnancy, given concerns for hepatotoxicity and embryopathy associated with antithyroid drugs (ATDs). Methods: In an integrated health care delivery system, we examined the prevalence of thyrotoxicosis and gestational ATD use (propylthiouracil [PTU] or methimazole [MMI]) in women with delivered pregnancies from 1996 to 2010. Birth outcomes were compared among all infants and those born to mothers with diagnosed thyrotoxicosis or ATD therapy during gestation, with examination of ATD-associated hepatotoxicity and congenital malformations in the latter subgroups. Results: Among 453,586 mother–infant pairs (maternal age 29.7±6.0 years, 57.1% nonwhite), 3.77 per 1000 women had diagnosed thyrotoxicosis and 1.29 per 1000 had gestational ATD exposure (86.5% PTU, 5.1% MMI, 8.4% both). Maternal PTU-associated hepatotoxicity occurred with a frequency of 1.80 per 1000 pregnancies. Infants of mothers with diagnosed thyrotoxicosis (odds ratio [OR] 1.28, 95% confidence interval [CI 1.05–1.55]) or gestational ATD use (OR 1.31 [1.00–1.72]) had an increased risk of preterm birth compared to those born to mothers without thyrotoxicosis or ATD. The risk of neonatal intensive care unit (NICU) admission was also higher with maternal thyrotoxicosis (OR 1.30 [1.07–1.59]) and ATD exposure (OR 1.64 [CI 1.26–2.13]), adjusting for prematurity. Congenital malformation rates were low and similar among infants born to mothers with thyrotoxicosis or ATD exposure (30–44 per 1000 infants). Conclusions: Gestational ATD exposure occurred in 1.29 per 1000 mother–infant pairs while a much larger number had maternal diagnosed thyrotoxicosis but no drug exposure during pregnancy. Infants of mothers with gestational ATD use or diagnosed thyrotoxicosis were more likely to be preterm and admitted to the NICU. The rates of congenital malformation were low for mothers diagnosed with thyrotoxicosis and did not differ by ATD use. Among women with gestational PTU therapy, the frequency of PTU-associated hepatotoxicity was 1.8 per 1000 delivered pregnancies. These findings from a large, population-based cohort provide generalizable estimates of maternal and infant risks associated with maternal thyrotoxicosis and related pharmacotherapy.
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The absolute risk of PTU-associated liver failure observed in studies of U.S. health databases was low.
“However, even if this risk is real, the absolute risk observed in studies of U.S. health databases was low (433,465).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [433]
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An update on the safety of antithyroid drugs in pregnancy: the power of real-world data
Andersen, S. L. (2025) · Expert Opinion on Drug Safety · doi:10.1080/14740338.2025.2564073
Troshina, E. A., Sviridenko, N. Y., Platonova, N. M., Михайловна, Б. И., Шеремета, М. С., Bessmertnaya, E. G., Yanovskaya, E. A., Aleksandrov, Y., Сергеевна, Я. В., & Syrtsova, E. I. (2026) · Clinical and experimental thyroidology · doi:10.14341/ket12839
- Authors
- Lo, J. C., Rivkees, S. A., Chandra, M., Gonzalez, J. R., Korelitz, J. J., & Kuzniewicz, M. W.
- Affiliations
- Kaiser Permanente (US)
- University of Florida Health (US)
- Westat (United States) (US)
- Corresponding author
- Lo, Joan C.
- Venue
- Thyroid®
- Publisher
- SAGE Publications
- Published
- 2015-06
- Volume
- 25
- Issue
- 6
- Pages
- 698-705
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- PMC
- PMC4490591
- OpenAlex
- W2322058622
- Cited by
- 51
- References
- 46
- Citations by year
- 2026: 2 · 2025: 3 · 2023: 5 · 2022: 6 · 2021: 5 · 2020: 6 · 2019: 4 · 2018: 2 · 2017: 6 · 2016: 7 · 2015: 5
- FWCI
- 5.78
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Thyroid (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (NIH-R01)
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD065200)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
- Keywords
- gestational thyrotoxicosis, antithyroid drugs, propylthiouracil, methimazole, neonatal outcomes, preterm birth, neonatal intensive care admission, congenital malformations, hyperthyroidism in pregnancy, integrated health system, maternal hyperthyroidism
- MeSH terms
- Congenital Abnormalities, Adult, Female, Humans, Infant, Newborn, Intensive Care Units, Neonatal, Methimazole, Pregnancy, Pregnancy Complications, Propylthiouracil, Antithyroid Agents, Thyrotoxicosis, Cohort Studies, Prevalence, Delivery of Health Care, Integrated, Premature Birth, Young Adult, Chemical and Drug Induced Liver Injury
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