Hyperthyroidism during pregnancy: the role of measuring maternal TSH receptor antibodies and fetal ultrasound monitoring

Gietka-Czernel, Małgorzata; Dębska, Marzena; Kretowicz, P.; Zgliczyński, Wojciech; Ołtarzewski, Mariusz

doi:10.1530/endoabs.35.p1061

Cited by 7 publications

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“…Inadequately treated maternal hypothyroidism can cause fetal hypothyroidism, which impairs neurocognitive development. Fetal goiter, bradycardia, growth restriction, and delayed bone age may occur (9,10). Conversely, in maternal GD, elevated levels of TSAbs, which freely cross the placenta after 20 weeks gestation, can overstimulate the fetal thyroid gland, causing hyperthyroidism, goiter, tachycardia, heart failure, advanced bone age, growth restriction, and hydrops (10).…”

Section: Discussionmentioning

confidence: 99%

“…Fetal goiter, bradycardia, growth restriction, and delayed bone age may occur (9,10). Conversely, in maternal GD, elevated levels of TSAbs, which freely cross the placenta after 20 weeks gestation, can overstimulate the fetal thyroid gland, causing hyperthyroidism, goiter, tachycardia, heart failure, advanced bone age, growth restriction, and hydrops (10). The American Thyroid Association recommends serial fetal ultrasound (US) for assessment of heart rate, growth, amniotic fluid volume, and fetal goiter in patients with past or current history of GD and positive TRAb (11).…”

Section: Discussionmentioning

confidence: 99%

“…The American Thyroid Association recommends serial fetal ultrasound (US) for assessment of heart rate, growth, amniotic fluid volume, and fetal goiter in patients with past or current history of GD and positive TRAb (11). Fetal thyroid function can be assessed by measuring thyroid hormone levels via cordocentesis; however, this carries risk of fetal morbidity and mortality (10,11). Furthermore, measurements of cord blood hormone concentrations have limitations; there are no well-established reference intervals, and interpretation may be challenging.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, measurements of cord blood hormone concentrations have limitations; there are no well-established reference intervals, and interpretation may be challenging. Thus, cordocentesis should be restricted to circumstances where clinical and biochemical data are conflicting and results would influence management (10,11).…”

Section: Discussionmentioning

confidence: 99%

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Pregnancy and Autoimmune Thyroid Disease: Alternating Between Hypothyroidism and Hyperthyroidism And The Role of Thyrotropin-Receptor Antibodies

Awad

Dutton

Shaw

et al. 2017

AACE Clinical Case Reports

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Objective: To report the case of a female patient with hypothyroidism who spontaneously developed Graves hyperthyroidism during pregnancy and then reverted back to hypothyroidism in a subsequent pregnancy. Methods: The pertinent clinical features, laboratory data, and clinical course of the case are reported, along with a brief literature review. Results: A 30-year-old female with hypothyroidism diagnosed at age 20 years unexpectedly required decreased levothyroxine dosing during her second pregnancy. She was taking levothyroxine 12.5 µg daily when she became pregnant a third time. In the first trimester, levothyroxine was discontinued, and she presented in the third trimester with clinical and biochemical hyperthyroidism and a diffusely enlarged goiter. Propylthiouracil (PTU) was initiated. Thyroid-stimulating hormone-receptor antibodies (TRAbs) were positive. After delivery, her baby developed transient neonatal Graves disease. She was continued on a stable dose of PTU for 10 months postpartum and then became pregnant a fourth time. PTU was discontinued and she remained euthyroid off medications until the second trimester, when she presented with clinical and biochemical hypothyroidism, requiring levothyroxine initiation. TRAb level was elevated. Thyroid-stimulating immunoglobulin (TSI) bioassay was elevated. Despite elevated TSI in her fourth pregnancy, her child did not develop neonatal Graves disease. She remains euthyroid on levothyroxine. Conclusion: Spontaneous transformation from hypothyroidism to hyperthyroidism during pregnancy is rare but can occur. The balance between the activity of stimulating and blocking TRAbs may impact the clinical presentation for both the mother and the fetus.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Pregnancy and Autoimmune Thyroid Disease: Alternating Between Hypothyroidism and Hyperthyroidism And The Role of Thyrotropin-Receptor Antibodies

Awad

Dutton

Shaw

et al. 2017

AACE Clinical Case Reports

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“…five times the upper limit of the normal range [1,[20][21][22] or > 10 IU/L [15]. We therefore used 10 IU/L as the cut-off value for TRAb in the present study.…”

Section: Disclosurementioning

confidence: 99%

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

Yoshioka

Miyauchi

et al. 2016

Endocr J

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Thyroid autoantibodies

2022

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Thyroid-stimulating hormone (TSH) receptor antibody (TSH-R-Ab or TRAb) testing plays a pivotal role in arriving at the aetiological diagnosis in patients with thyrotoxicosis. A positive test establishes the diagnosis of Graves’ disease (GD) while a negative result in conjunction with imaging studies supports other possible aetiologies. In patients with GD, TRAb levels at diagnosis and at the time of withdrawal of antithyroid drugs can identify patients who are unlikely to achieve remission and guide clinical management decisions. We provide an algorithm that incorporates TRAb in the decision-making process for the management of thyrotoxicosis. The utility of TRAb in predicting the risk of fetal and neonatal thyroid dysfunction is established and widely accepted in guidelines. TRAb may also help in the diagnosis of Graves’ orbitopathy, especially in euthyroid or hypothyroid patients and its role in guiding its management is evolving as a useful adjunct to the clinical parameters used in making therapeutic decisions.Anti-thyroid peroxidase antibodies (TPOAb) and anti-thyroglobulin antibodies (TgAb) indicate thyroid autoimmunity. The most common use of TPOAb is to identify patients at a higher risk of progression to treatment-requiring hypothyroidism. They also aid the diagnosis of immune thyroiditis and Hashimoto’s encephalopathy. Thyroglobulin measurement is used to help guide differentiated thyroid cancer treatment. TgAb is used as an accompanying test with thyroglobulin measurement as its presence can interfere with the thyroglobulin assay. A negative TgAb result reduces the likelihood of, but does not exclude, interference with thyroglobulin assay.

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Hyperthyroidism during pregnancy: the role of measuring maternal TSH receptor antibodies and fetal ultrasound monitoring

Cited by 7 publications

References 0 publications

Pregnancy and Autoimmune Thyroid Disease: Alternating Between Hypothyroidism and Hyperthyroidism And The Role of Thyrotropin-Receptor Antibodies

Pregnancy and Autoimmune Thyroid Disease: Alternating Between Hypothyroidism and Hyperthyroidism And The Role of Thyrotropin-Receptor Antibodies

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

Thyroid autoantibodies

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Hyperthyroidism during pregnancy: the role of measuring maternal TSH receptor antibodies and fetal ultrasound monitoring

Cited by 7 publications

References 0 publications

Pregnancy and Autoimmune Thyroid Disease: Alternating Between Hypothyroidism and Hyperthyroidism And The Role of Thyrotropin-Receptor Antibodies

Pregnancy and Autoimmune Thyroid Disease: Alternating Between Hypothyroidism and Hyperthyroidism And The Role of Thyrotropin-Receptor Antibodies

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

Thyroid autoantibodies

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Product

Resources

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