Management of Graves’ Disease during Pregnancy: The Key Role of Fetal Thyroid Gland Monitoring

Luton, Dominique; Gac, Isabelle Le; Vuillard, E.; Castanet, Mireille; Gadrey, Jean; Noël, Michèle; Toubert, Marie‐Elisabeth; Léger, Juliane; Boissinot, C.; Schlageter, Marie‐Hélène; Garel, Catherine; Tébeka, Brigitte; Oury, Jean‐François; Czernichow, P; Polak, Michel

doi:10.1210/jc.2004-2555

Cited by 260 publications

(197 citation statements)

References 29 publications

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“…Amniotic fluid levels of T 3 , T 4 , and thyroidstimulating hormone do not consistently reflect fetal plasma concentrations, and direct assessment via percutaneous umbilical cord blood sampling carries a 1% risk of fetal mortality (13). Serial ultrasonographic examinations are relatively cumbersome (14). The possibility that the transferred compound W may serve as a convenient and noninvasive marker of fetal thyroid function deserves further exploration.…”

Section: Discussionmentioning

confidence: 99%

3,3′-Diiodothyronine sulfate cross-reactive material (compound W) in human newborns

Chen

Yu²,

Bao³

et al. 2012

Pediatr Res

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Background: Thyrosulfoconjugation appears to facilitate fetal-to-maternal transfer of 3,3′-diiodothyronine-sulfate (T 2 s). elevated maternal levels of T 2 s cross-reactive material (compound W) are found in humans, with higher levels found in venous cord blood than in arterial samples. These findings are consistent with the postulate that the placenta plays an essential role in compound W production. Methods: serum compound W levels were measured by a T 2 s-specific radioimmunoassay in 60 serum samples from newborns with hyperbilirubinemia, age 1-30 d. In addition, 59 maternal serum samples, from day 1 to day 7 after uneventful deliveries, were studied. results: as compared with day 1, at day 5, the mean (±se) compound W level fell to 43.5 ± 6.8% (decay half-life (t 1/2 ) = 4.12 d) and to 33.7 ± 4.6% (decay t 1/2 = 2.82 d) in the newborn and maternal groups, respectively. In the mothers, the level continued to decline along the same slope through day 7. In the newborns, however, the mean compound W level entered a slower phase of decay after the fifth day with a decay t 1/2 = 10.9 d. conclusion: compound W is cleared at similar rates in newborn and postpartum maternal sera. This is consistent with the postulate that compound W is produced in the placenta.

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Section: Discussionmentioning

confidence: 99%

3,3′-Diiodothyronine sulfate cross-reactive material (compound W) in human newborns

Chen

Yu²,

Bao³

et al. 2012

Pediatr Res

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“…We studied the cohort of pregnant women with GD and their babies from a previous study by our group (17). The women were included prospectively and managed over a 3-year period (between 1999 and 2002) at the Robert Debré Teaching Hospital (Paris, France).…”

Section: Patientsmentioning

confidence: 99%

“…Fetal thyroid dysfunction precedes neonatal hyperthyroidism. Optimal management of GD during pregnancy is crucial to prevent fetal death or permanent neurological impairments (8,9,10,11,12,13,14,15,16,17,18,19). Neonatal hyperthyroidism has been evaluated in several studies (2,3,7) but recent case reports (20,21,22) indicate that this transient disease is still overlooked by clinicians, leading to severe complications that could have been prevented.…”

Section: Introductionmentioning

confidence: 99%

Management of neonates born to women with Graves' disease: a cohort study

Besançon

Beltrand

Gac

et al. 2014

European Journal of Endocrinology

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Objective: Hyperthyroidism in neonates born to mothers with Graves' disease (GD) can be associated with significant morbidity and mortality, but is still overlooked by clinicians. Management of neonatal hyperthyroidism would be improved by a better understanding of the predictive factors involved. The aim of this study was to evaluate the course of thyroid function and clinical outcomes during the first postnatal month in babies born to mothers with GD. Design: Prospective observational study. Methods: Sixty-eight neonates born to mothers with GD were managed from birth and divided into three groups based on thyrotropin receptor antibody (TRAb) and anti-thyroid drug (ATD) status in the mother: TRAb /ATDCve neonates, 24 (72.7%) had positive TRAb on cord blood assays, and seven of these developed neonatal hyperthyroidism. FT 4 elevation between days 3 and 7 but not at birth was predictive of the development of hyperthyroidism. Conclusions: TRAb status should be checked in the third trimester in mothers with GD and on cord blood in their neonates; if positive, it indicates a high risk of neonatal hyperthyroidism. FT 4 measurement at birth should be repeated between days 3 and 5 (and by day 7 at the latest); rapid FT 4 elevation during the first postnatal week is predictive of hyperthyroidism and warrants ATD therapy.

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“…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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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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Management of Graves’ Disease during Pregnancy: The Key Role of Fetal Thyroid Gland Monitoring

Cited by 260 publications

References 29 publications

3,3′-Diiodothyronine sulfate cross-reactive material (compound W) in human newborns

3,3′-Diiodothyronine sulfate cross-reactive material (compound W) in human newborns

Management of neonates born to women with Graves' disease: a cohort study

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

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