Fetal Thyrotoxicosis: A Case Report and Recommendations for Prediction, Diagnosis, and Treatment

Wallace, Clarissa; Couch, Robert; Ginsberg, Jody

doi:10.1089/thy.1995.5.125

Cited by 38 publications

(20 citation statements)

References 24 publications

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“…Therefore, the threshold value of TSAb needs to be confirmed in a larger study with a bioassay performed in every mother with detectable TBII level during pregnancy. However, our data are concordant with the literature: levels of TSAb reported to be predictive of neonatal hyperthyroidism were a stimulation of cAMP over 350-500% in T3 (10,25,27,30) or over 500% in T2 (31).…”

Section: Discussionsupporting

confidence: 92%

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Predictive value of maternal second-generation thyroid-binding inhibitory immunoglobulin assay for neonatal autoimmune hyperthyroidism

Payrat

Chikh

Bossard

et al. 2014

European Journal of Endocrinology

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Context: Hyperthyroidism occurs in 1% of neonates born to mothers with active or past Graves' disease (GD). Current guidelines for the management of GD during pregnancy were based on studies conducted with first-generation thyroid-binding inhibitory immunoglobulin (TBII) assays. Objective: This retrospective study was conducted in order to specify the second-generation TBII threshold predictive of fetal and neonatal hyperthyroidism, and to identify other factors that may be helpful in predicting neonatal hyperthyroidism. Methods: We included 47 neonates born in the Lyon area to 42 mothers harboring measurable levels of TBII during pregnancy. TBII measurements were carried out in all mothers; bioassays were carried out in 20 cases. Results: Nine neonates were born with hyperthyroidism, including five with severe hyperthyroidism requiring treatment. Three neonates were born with hypothyroidism. All hyperthyroid neonates were born to mothers with TBII levels O5 IU/l in the second trimester (sensitivity, 100% and specificity, 43%). No mother with TSH receptor-stimulating antibodies (TSAb measured by bioassay) below 400% gave birth to a hyperthyroid neonate. Among mothers of hyperthyroid neonates, who required antithyroid drugs during pregnancy, none could stop treatment before delivery. Analysis of TBII evolution showed six unexpected cases of increasing TBII values during pregnancy. Conclusion: Maternal TBII value over 5 IU/l indicates a risk of neonatal hyperthyroidism. Among these mothers, a TSAb measurement contributes to identify more specifically those who require a close fetal thyroid ultrasound follow-up. These results should be confirmed in a larger series.

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Section: Discussionsupporting

confidence: 92%

“…Individual cases are shown in Table 2. The median age of the women at the beginning of pregnancy was 31 years (range, [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Twenty mothers of 21 neonates (one twin pregnancy) had a past history of GD.…”

Section: Clinical Characteristics Of the Mothersmentioning

confidence: 99%

Predictive value of maternal second-generation thyroid-binding inhibitory immunoglobulin assay for neonatal autoimmune hyperthyroidism

Payrat

Chikh

Bossard

et al. 2014

European Journal of Endocrinology

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“…The remaining 27 women who gave birth to euthyroid infants showed TRAb1 values of below 40 U/L. It is also pointed out by Laurberg et al [7] and Wallace et al [8] that with TRAb1 method of TRAK (Brahms, Berlin, Germany) the levels above approximately 40 U/L are considered high enough to indicate risk of neonatal hyperthyroidism. Interestingly, Momotani reported that the levels above 50% of TRAb1 (Cosmic corporation, Tokyo, Japan) are useful for the prediction of NH and the data obtained from the literature by Matsuura et al [4] and Hale et al [5] strongly supported the view hat positive TRAb1 >50% conveyed high likelihood of NH.…”

Section: Discussionmentioning

confidence: 89%

“…It has thus been recommended to determine TRAb late in pregnancy in women with GD to predict the risk of neonatal hyperthyroidism (NH). An arbitrary limit of 50% [3][4][5] or 40 U/L [6][7][8] using 1st generation TRA (TRAb1) assay was suggested to indicate risk when measured late in pregnancy. In order to substitute TRAb1 assay with the 2nd generation TRAb assay using porcine TSH receptor (pTRAb2) and human recombinant TSH receptor (hTRAb2) and the 3rd generation TRAb (TRAb3) assay, we measured TRAb in these four methods late in pregnancy.…”

mentioning

confidence: 99%

TSH-receptor Antibodies Determined by the First, Second and Third Generation Assays and Thyroid-stimulating Antibody in Pregnant Patients with Graves' Disease

Kamijo

2007

Endocr J

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Abstract. The measurement of TSH receptor antibody (TRAb) has been recommended to predict the risk of neonatal hyperthyroidism (NH) in pregnant women with Graves' disease (GD). For the first generation TRAb (TRAb1) assay with commercial kit (Brahms, Berlin, Germany; or Cosmic co., Tokyo, Japan) an arbitrary limit of 40 U/l or 50% was suggested to indicate risk when measured late in pregnancy. In order to substitute TRAb1 with the second generation TRAb using porcine TSH receptor (pTRAb2) and human recombinant TSH receptor (hTRAb2) and the third generation TRAb (TRAb3) assay for this purpose, we measured TRAb in these four methods late in pregnancy in a total of 62 pregnant women with Graves' disease. The data showed that no cases with TRAb1 >50% has been missed if the TRAb1 assay was replaced by the pTRAb2, hTRAb2 or TRAb3 assay using their equivalent cut-off value of 70%, 10 IU/l, and 75%, respectively, but that an additional group of women would have been included in the risk group, especially in the TRAb3 assay. Next, the effect of maternal TRAb on thyroid function of offspring was studied in the 47 pregnant women with GD (43 with TRAb1 <50% and 4 with TRAb1 >50% during late pregnancy). In 2 women who gave birth to hyperthyroid children at days 6 and 14 of life, the maternal sera had strongly positive levels of TRAb1 (73.5% and 84.1%), pTRAb2 (84.9% and 91.5%), hTRAb2 (40.68 IU/L and 89.70 IU/L) and TRAb3 (92.1% and 93.5%) late in pregnancy, with one case displaying high positive (1114.3%) thyroid stimulating antibody (TSAb) level and the other case had moderate positive (433%) TSAb level. Of the remaining 45 women, 43 had TRAb1 <50% and the other 2 had TRAb >50% including 1 with low TSAb positive and 1 with positive thyroid stimulating blocking antibody (TSBAb) and negative TSAb; all of them gave birth to euthyroid children. Finally, a serial study regarding TRAb in 23 women with Graves' disease during pregnancy showed that TRAb1, pTRAb2, hTRAb2, TRAb3 value and TSAb level decreased significantly as pregnancy progressed. In conclusion, the present study supported TRAb as a useful marker to predict the risk of NH.

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“…Thus they cross the placenta more readily. Conversely, the effect of PTU in the fetus is heightended by a slow fetal clearance of this drug [27], Doses of PTU between 200 and 600 mg have been reported [3,6,8,21,28]. Carbimazole is used less than PTU.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Successful in utero Treatment of a Fetal Goitrous Hyperthyroidism Caused by Maternal Graves′ Disease

Heckel¹,

Favre²,

Schlienger³

et al. 1997

Fetal Diagn Ther

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A case of maternal treated Graves’ disease associated with hyperthyroid fetal goiter is presented. Fetal goiter is diagnosed by ultrasound and hyperthyroidism is confirmed by fetal blood sampling. Fetal thyroid status is normalized by maternal carbamizole treatment whereas the mother is euthyroid with replacement therapy after subtotal thyroidectomy. Repeated funipuncture allows us to adjust the fetal treatment. The infant is euthyroid at birth. Pathogenesis, diagnosis and treatment of fetal thyrotoxicosis complicated with maternal Graves’ disease are discussed.

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Fetal Thyrotoxicosis: A Case Report and Recommendations for Prediction, Diagnosis, and Treatment

Cited by 38 publications

References 24 publications

Predictive value of maternal second-generation thyroid-binding inhibitory immunoglobulin assay for neonatal autoimmune hyperthyroidism

Predictive value of maternal second-generation thyroid-binding inhibitory immunoglobulin assay for neonatal autoimmune hyperthyroidism

TSH-receptor Antibodies Determined by the First, Second and Third Generation Assays and Thyroid-stimulating Antibody in Pregnant Patients with Graves' Disease

Diagnosis and Successful in utero Treatment of a Fetal Goitrous Hyperthyroidism Caused by Maternal Graves′ Disease

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