Two doctors have warned that a pill used for thyroid disease can cause fatal liver failure in children and should no longer be used to treat them. The drug of choice for treatment of children with Graves’ disease is propylthiouracil or methimazole. This disease is the most common cause of an overactive thyroid. Other treatments are surgery and radioactive iodine. But over the past 60 years, reports have linked the use of propylthiouracil in children to liver failure, sometimes fatal or requiring a liver transplant.
Propylthiouracil (PTU) is also a primary treatment for adults with Graves’ disease. But there appear to be fewer liver complications in adults, according to Dr. Donald R. Mattison of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Drs. Mattison and Scott A. Rivkees of Yale University School of Medicine, who noticed the problem in children and did research so doctors could learn more about the issue, estimate that five to ten children die each year from complications of the drug. Their estimate is based on reports to the Food and Drug Administration and from other sources.
In a letter published in the New England Journal of Medicine on April 9th, the doctors urged colleagues not to give propylthiouracil as an initial treatment to children for an overactive thyroid. Dr. Mattison told the Associated Press there are “no guidelines for treating Graves’ disease in children, and most doctors don’t know of this danger.” Only about 8,000 youngsters have the disease and pediatricians might see only one or two cases in their careers.
Methimazole, sold both as a generic and under the brand name Tapazole, also can hurt the liver, but the damage is less severe and causes obvious symptoms. The damage is reversible once use of the drug stops, unlike with propylthiouracil. Dr. Mattison noted that methimazole is becoming more popular because it can be taken just once a day, instead of the two or three times a day for PTU. It should be noted that parents should contact their doctor before taking a child off either treatment, according to Dr. Mattison.
Source: Associated Press
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