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What is Propylthiouracil
Propylthiouracil (PTU) is an oral antithyroid agent. Propylthiouracil, a thio-urea derivative, differs both chemically and structurally from methimazole, another antithyroid agent.
Antithyroid agents are indicated for various hyperthyroid conditions including maintenance of a euthyroid state in patients with Graves’ disease or toxic multinodular goiter.
Due to a risk for hepatotoxicity, PTU should be reserved for patients who can not tolerate methimazole and in whom radioiodine therapy or surgery are not appropriate treatments for the management of hyperthyroidism.
An exception to this restriction is that PTU is generally the preferred agent in the first trimester of pregnancy, due to the known teratogenic effects of methimazole.
Propylthiouracil was approved by the FDA in 1947.
Indications
- Graves’ disease
- hyperthyroidism
- thyrotoxicosis
For the treatment of hyperthyroidism (due to Graves’ disease or toxic multinodular goiter) or to ameliorate symptoms of hyperthyroidism prior to thyroidectomy or radioactive iodine therapy
Side Effects
- agranulocytosis
- alopecia
- anorexia
- aplastic anemia
- arthralgia
- bleeding
- drowsiness
- dysgeusia
- edema
- elevated hepatic enzymes
- erythema nodosum
- exfoliative dermatitis
- fever
- glomerulonephritis
- headache
- hepatic failure
- hepatic necrosis
- hepatitis
- hepatotoxicity
- hypoprothrombinemia
- hypothyroidism
- interstitial nephritis
- ischemic colitis
- jaundice
- leukopenia
- lupus-like symptoms
- lymphadenopathy
- malaise
- myalgia
- nausea
- neuritis
- pancytopenia
- paresthesias
- periarteritis
- peripheral neuropathy
- pneumonitis
- pruritus
- rash
- renal failure (unspecified)
- skin hyperpigmentation
- splenomegaly
- Stevens-Johnson syndrome
- teratogenesis
- thrombocytopenia
- toxic epidermal necrolysis
- urticaria
- vasculitis
- vertigo
- vomiting
Monitoring Parameters
- CBC with differential
- LFTs
- thyroid function tests (TFTs)
Contraindications
- agranulocytosis
- bone marrow suppression
- breast-feeding
- children
- fever
- hepatic disease
- hepatitis
- hepatotoxicity
- infants
- jaundice
- neonates
- neutropenia
- pregnancy
- vasculitis
Interactions
- Acebutolol
- Amiodarone
- Atenolol
- Atenolol; Chlorthalidone
- Bendroflumethiazide; Nadolol
- Beta-blockers
- Betaxolol
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Brimonidine; Timolol
- Carteolol
- Carvedilol
- Deferiprone
- Digoxin
- Dorzolamide; Timolol
- Esmolol
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Iodine; Potassium Iodide, KI
- Iodoquinol
- Labetalol
- Levobetaxolol
- Levobunolol
- Macimorelin
- Methylprednisolone
- Metoprolol
- Nadolol
- Nebivolol
- Nebivolol; Valsartan
- Penbutolol
- Pexidartinib
- Pindolol
- Potassium Iodide, KI
- Prednisone
- Propranolol
- Riluzole
- Sodium Iodide
- Sotalol
- Theophylline, Aminophylline
- Thyroid hormones
- Timolol
- Warfarin
