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Propylthiouracil, shortened as PTU, and Methimazole are thionamide drugs that are used in the treatment of hyperthyroidism. They work by inhibiting the enzyme thyroid peroxidase, which prevents the organification or coupling of oxidized iodide to thyroglobulin in order to form thyroid hormones. PTU specifically also has a second mechanism of blocking the peripheral conversion of T4 to T3. All of these mechanisms are useful in the treatment of hyperthyroidism. An adverse effect of both drugs is bone marrow suppression, which presents in a variety of ways, including agranulocytosis and anemia. PTU specifically may cause life-threatening hepatotoxicity, while methimazole specifically acts as a teratogen during pregnancy. Due to these side effects, methimazole is preferred over PTU for the treatment of hyperthyroidism, except during pregnancy!

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