Clinical Utility of TSH Receptor Antibodies

Barbesino, Giuseppe; Tomer, Yaron

doi:10.1210/jc.2012-4309

Cited by 203 publications

(145 citation statements)

References 72 publications

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“…There is no correlation between maternal thyroid function and maternal serum TRAb concentration in such cases, and the impact of maternal TRAbs on the foetus is uncertain. Our opinion is consistent with other authors [60], who postulate performing TRAb and complementary thyroid stimulating immunoglobulin tests. Similar to previous studies [35], maternal ATD therapy, and low maternal serum TRAb and fT4 levels turned out to be the risk factors for foetal hypothyroidism in our material.…”

supporting

confidence: 93%

Nadczynność tarczycy w ciąży — rola oznaczania przeciwciał przeciwko receptorowi TSH i ultrasonograficznego monitorowania płodu

Gietka-Czernel¹,

Dębska²,

Kretowicz³

et al. 2014

Endokrynologia Polska

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Introduction: To evaluate the usefulness of measuring maternal anti-TSH receptor antibodies (TRAbs) and foetal ultrasound (US) monitoring in cases of current or past maternal hyperthyroidism. Material and methods: 77 pregnant women suffering from hyperthyroidism or with a history of Graves' hyperthyroidism were observed prospectively. Maternal serum TSH, fT4, fT3, TRAbs, and foetal US were performed at baseline and repeated every 2-4 weeks when needed. Neonatal thyroid status was assessed based on serum TSH, fT4 and fT3 obtained in the first days of life. Results: 35 women were diagnosed with gestational hyperthyroidism and 42 with Graves' disease; among them 26 had current and 16 past hyperthyroidism. Foetal and neonatal thyroid dysfunction occurred only in cases of maternal Graves' disease: nine (21%) and three (7%), respectively. Active maternal Graves' hyperthyroidism and TRAbs elevated at least five times above the upper normal limit predisposed to foetal hyperthyroidism. Maternal anti-thyroid drug therapy (ATD) and low TRAbs and fT4 were the risk factors of foetal hypothyroidism. Abnormal foetal thyroid sonogram was the only sign of foetal thyroid dysfunction. Four patients (9.5%) had high TRAbs in the 3 rd trimester (10.8-29.9 IU/mL), but neither foetal nor neonatal thyroid dysfunctions were noted. Conclusions: In the cases of maternal Graves' disease, foetal thyroid dysfunction occurs more often than commonly assumed. Foetal thyroid US is a valuable tool in early diagnosis and monitoring of the foetal thyroid status in pregnancy complicated by maternal Graves' disease. The evaluation of biological activity of maternal TRAbs may be helpful in prenatal diagnosis in some cases.

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supporting

confidence: 93%

Nadczynność tarczycy w ciąży — rola oznaczania przeciwciał przeciwko receptorowi TSH i ultrasonograficznego monitorowania płodu

Gietka-Czernel¹,

Dębska²,

Kretowicz³

et al. 2014

Endokrynologia Polska

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“…Laboratories involved in the care of these newborns should state clearly which assay is used. 36,37 Suggestion:…”

Section: Discussion Question 1: Is There An Association Between Matermentioning

confidence: 99%

Management of Neonates Born to Mothers With Graves’ Disease

2016

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Neonates born to mothers with Graves’ disease are at risk for significant morbidity and mortality and need to be appropriately identified and managed. Because no consensus guidelines regarding the treatment of these newborns exist, we sought to generate a literature-based management algorithm. The suggestions include the following: (1) Base initial risk assessment on maternal thyroid stimulating hormone (TSH) receptor antibodies. If levels are negative, no specific neonatal follow-up is necessary; if unavailable or positive, regard the newborn as “at risk” for the development of hyperthyroidism. (2) Determine levels of TSH-receptor antibodies in cord blood, or as soon as possible thereafter, so that newborns with negative antibodies can be discharged from follow-up. (3) Measurement of cord TSH and fT4 levels is not indicated. (4) Perform fT4 and TSH levels at day 3 to 5 of life, repeat at day 10 to 14 of life and follow clinically until 2 to 3 months of life. (5) Use the same testing schedule in neonates born to mothers with treated or untreated Graves’ disease. (6) When warranted, use methimazole (MMI) as the treatment of choice; β-blockers can be added for sympathetic hyperactivity. In refractory cases, potassium iodide may be used in conjunction with MMI. The need for treatment of asymptomatic infants with biochemical hyperthyroidism is uncertain. (7) Assess the MMI-treated newborn on a weekly basis until stable, then every 1 to 2 weeks, with a decrease of MMI (and other medications) as tolerated. MMI treatment duration is most commonly 1 to 2 months. (8) Be cognizant that central or primary hypothyroidism can occur in these newborns.

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“…The following exclusion criteria were applied: type 2 or other types of diabetes; currently in the honeymoon period, which was defined as a daily insulin requirement <0.5 IU/kg/day and an HbA 1c level <7% (53 mmol/mol);a diabetes duration of <1.5 years; abnormal thyroid function; elevated creatinine level; using contraceptive pills, steroids or any other type of medication, and the presence of other chronic conditions. Autoantibodies were not assessed as inclusion criteria because they exhibit around 20-30% negativity in young Chilean patients with T1D [20,21]. …”

Section: Methodsmentioning

confidence: 99%

Metformin for the Treatment of Hyperandrogenism in Adolescents with Type 1 Diabetes Mellitus

et al. 2013

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Background: A high prevalence of hyperandrogenism has been reported in women with type 1 diabetes (T1D). Metformin has been used as a therapeutic agent in patients with polycystic ovarian syndrome and in T1D patients without hyperandrogenism. This study sought to determine the effect of metformin on hyperandrogenism and ovarian function in adolescents with T1D. Methods: We recruited 24 girls with T1D. The participants had hyperandrogenism and displayed suboptimal metabolic control. The patients were enrolled in a randomized, double-blind, placebo-controlled trial. One group received metformin (850 mg bid) and the other group received a placebo. Treatment was administered for 9 months. Ovulation, steroids and gonadotropin levels were evaluated. Results: Metformin treatment was associated with decreases in testosterone, free androgen index, androstenedione, 17-OH progesterone and estradiol levels. The girls who were treated with placebo showed stable steroid, gonadotropin and sex hormone-binding globulin levels during the analysis. No differences were observed in the Ferriman-Gallwey scores, ovulation rates, HbA_1c levels or daily insulin doses of the girls treated with metformin compared with the placebo group. Conclusion: Treating hyperandrogenic T1D adolescents with metformin significantly decreased the serum androgens compared to the placebo, but metformin therapy did not significantly affect clinical parameters, such as hirsutism, ovulation and metabolic control.

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Clinical Utility of TSH Receptor Antibodies

Cited by 203 publications

References 72 publications

Nadczynność tarczycy w ciąży — rola oznaczania przeciwciał przeciwko receptorowi TSH i ultrasonograficznego monitorowania płodu

Nadczynność tarczycy w ciąży — rola oznaczania przeciwciał przeciwko receptorowi TSH i ultrasonograficznego monitorowania płodu

Management of Neonates Born to Mothers With Graves’ Disease

Metformin for the Treatment of Hyperandrogenism in Adolescents with Type 1 Diabetes Mellitus

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