[TammyB]

#1059007

I have been searching through old post to see if it has been mentioned before, but have not seen anything yet. I was started on Methimazole in August 2010 after the heart failure fiasco. Was on it for about a year before going ahead with the RAI. Anyway, was off the Methimazole a few weeks prior and then back on it immediately afterwards 15mg/twice a day. Around that same time I started having problems with my mouth burning like crazy- the very least bit of spice in any food was imposible too eat. My mouth (tongue, cheeks and inner lips) was white, coated and cracked- very, very painful. could only eat cold and mild foods. This went on for a couple of months. I was thinking something like thrush since I knew the RAI and Methimazole both could cause one to be immuno-comprimised. Tried to “fix” it myself ie, eating yogurt with the active cultures, even tried taking Diflucan which did not help at all. Finally went to my family doctor and was told to quit thinking like a Peds nurse because only babies get thrush (????). He then sent me over to my ENT/Thyroid doc. Found out I was on too much Methimazole. He had it written down that he ordered 5mg/twice a day, there was some type of mix up between him and his nurse or his nurse and the pharmacy. His guess about the mouth problem was a reaction to the Methimazole. Had thyroid levels drawn that day and as he had guessed was already very hypo. Was then taken off the med and slowly my mouth cleared up. No one is 100% sure it was the Methimazole but it seemed likely. I have not seen or heard anyone else mention this and was just wondering in case I ever needed to go back on it. Sound familar to anyone?

[Bobbi]

#1171516

Hi, Tammy:

I have not heard of this particular problem. Sorry.

[adenure]

#1171517

I’m only on 5 mg. a day, but no, I haven’t had that happen. I’m glad it got better though for you!

Alexis

[TammyB]

#1171518

Thanks for your responses Bobbi and Alexis. Had another quick question that I had intended to add but my son called and needed some TLC. As he was walking to his apartment from campus the tornado sirens were going off. Having been through a tornado hitting our neighborhood about 15yrs ago, we tend to be a little freaked out when we hear the sirens. Sorry for the rambling. Anyway, I see PTU mentioned a lot and I have never heard of it. I have gathered from reading other post that it is an older ATD that can have severe effects on the liver. Is PTU abbreviated for the name? Is it more commonly used in just certain areas? Just curious.

[snelsen]

#1171519

Hi Tammy, PTU is the other ATD. It is propylthiouracil. This is what I took when I was hyper. i got along fine with it. Generally, methimazole is the first line drug. PTU is contraindicated in pregnancy (and thus, women who do not realize they are pregnant.) Breast feeding, too I think, although might be ok after 4 hours of ingesting by the mom. And, it has the same liver warnings as Methimazole.

Here’s a pretty good link.
http://www.drugs.com/pro/propylthiouracil.html
Now it is used when a person cannot tolerate methimazole. It is not used in kids, more liver issues withe them.
Shirley

[adenure]

#1171520

From what I understand, methimazole & PTU are considered D category medicines for pregnancy which would be “positive evidence of risk”, but not X category which contraindicated. I have read of people taking PTU for an entire pregnancy and methimazole for only the 2nd & 3rd trimesters (but not the 1st when the baby is developing all of it’s organs and systems).

As far as breastfeeding, both PTU & methimazole are considered acceptable. Both medicines pass into breastmilk, although PTU’s concentration isn’t as high as methimazole. Per Dr. Thomas Hale (breastfeeding & medicine expert), PTU is considered an L2 drug (safer) and methimazole is considered an L3 (moderately safe). Often, L3 drugs are labeled as such because there hasn’t been a huge base of studies to justify it as L2 or L1 (safest). Methimazole is considered safe for breastfeeding in doses up to 20 mg. It is considered best to avoid nursing for 3 hours after taking the medicine and, for both PTU & methimazole, to test the infant’s TSH levels every 3 months. I am on methimazole (5 mg. daily) and am breastfeeding my 5 month old. The doctor took a baseline of his TSH when I started & he’ll be retested again in 3 months. One of my friends, a lactation consultant for LLL, had 4 children and breastfed them all on both drugs at one time or another for the last 10 years. As a side note, there are medicines that are considered L4 (possibly hazaradous) and L5 (contraindicated) for breastfeeding as well.

My endo gave me the option between the 2 medicines. He said, given the low dose, my baby should be fine with methimazole & the pediatrician agreed. We’ll see, I’m hoping so. Since a baby doesn’t metabolize the drug, he/ she wouldn’t have the liver issue as an issue.

Alexis

[TammyB]

#1171521

Wow, thanks again Alexis and thanks to you Shirley. I have been learning so much this stormy and gloomy weekend. I think I have learned more this weekend then the whole time I have been dx with GD and nursing school (this has been a little while back though) combined. Out of the 3 MDs I have seen, never heard any mention of this med at all. It is almost embarrassing to admit I am a nurse but I have never had any experiences with this dz at all and I just can’t believe it! In my own defense my main position has always been in Peds and some mother/baby. The info about pregnancy and breastfeeding is of great interest to me and suprised again that I have never come across this before. Thanks again ladies I’m sure I will have more questions to come.

[snelsen]

#1171522

Hi Alexis, great research on those two drugs and breastfeeding. I am out of that world, so not as up on that. I loved feeding babies. I felt so sad when I know I would never nurse (or the baby would never nurse) again!
Tammy, so sorry about the mouth issues. I am not a bit familiar with that. Sure hope it resolves.
Shirley

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