Antenatal management of recurrent fetal goitrous hyperthyroidism associated with fetal cardiac failure in a pregnant woman with persistent high levels of thyroid-stimulating hormone receptor antibody after ablative therapy

Kinetic analyses of changes in serum TSH receptor antibody values after total thyroidectomy in patients with Graves’ disease

“…As a possible mechanism of this, Amino et al suggested that Th2-dependent humoral immunity is suppressed in human pregnancy [16]. However, in some cases including those after radioiodine therapy, the high serum TRAb values might not decrease during pregnancy, resulting in fetal hyperthyroidism [18,19]. In light of these findings, surgery is considered the most secure treatment to reduce serum TRAb values in Graves' disease patients, and our present results support this therapeutic strategy.…”

Sonographic Diagnosis of Fetal Goiter

“…The two common antibodies that are tested for with Graves' disease are thyrotropin receptor antibodies and thyroid stimulating immunoglobulin. 1,3,9 The fetus relies solely on the maternal contribution of thyroid hormones through the placenta until the 17th week of gestation when the fetal thyroid begins functioning. After this point, if maternal antibodies are present, they are able to cross the placenta and affect the fetal thyroid.…”

“…After this point, if maternal antibodies are present, they are able to cross the placenta and affect the fetal thyroid. 3,9 Antibody levels naturally decrease during pregnancy, which can lead to remission of Graves' disease. 4,6 The maternal contribution of thyroid hormones is around 30% at term, and the maternal component is not fully cleared from the neonate until the second to the fourth month of life.…”

“…Fetuses of affected mothers are at risk for intrauterine growth restriction (IUGR), prematurity, cardiomegaly, decreased brain development, and fetal death. 3,9 The fetal brain relies on maternal thyroxine for proper development. 8 Abnormalities in maternal thyroid status can cause neurologic deficiencies including lower IQ, lethargy, motor disabilities, and intellectual development disorders.…”

“…By sampling fetal blood from the umbilical cord, fetal thyroid status can be definitively diagnosed and proper treatment can ensue. 4,9 In cases of hyperthyroid goiter, increased doses of ATD can be helpful in decreasing the size of the goiter and improving fetal thyroid function. In cases of fetal hypothyroidism, maternal ATD therapy may be decreased or stopped and in utero injections of levothyroxine into the amniotic fluid may be given to the fetus to improve thyroid function and reduce the size of the goiter.…”