Maternal Thyrotropin Receptor Antibody Concentration and the Risk of Fetal and Neonatal Thyrotoxicosis: A Systematic Review

Dijk, Myrthe M. van; Smits, Iris; Fliers, Eric; Bisschop, Peter H.

doi:10.1089/thy.2017.0413

Cited by 57 publications

(29 citation statements)

References 36 publications

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“…As stated above, maternal TRAbs are able to cross the placenta and have the potential to induce fetal hyperthyroidism. The likelihood that this event will happen ultimately depends on maternal TRAbs, and the higher the maternal TRAb concentrations, the higher the risk for the fetus to develop hyperthyroidism [59]. However, ATDs also cross the placenta and are effective on fetal thyroid, and thus when the mother is treated the net effect on fetal thyroid hormone production will eventually depend on the balance of TRAb stimulation and ATD inhibition.…”

Section: Graves’ Disease (Gd) In Pregnancymentioning

confidence: 99%

Hyperthyroidism in the pregnant woman: Maternal and fetal aspects

Moleti

Mauro

Sturniolo

et al. 2019

Journal of Clinical & Translational Endocrinology

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Hyperthyroidism during pregnancy is uncommon. Nonetheless, prompt identification and adequate management of hyperthyroidism in a pregnant woman is essential, because uncontrolled thyrotoxicosis significantly increases the risk of maternal and fetal complications. Also, fetal prognosis may be affected by the transplacental passage of maternal thyroid stimulating antibodies or thyrostatic agents, both of which may disrupt fetal thyroid function. Birth defects have been reported in association with the use of antithyroid drugs during early pregnancy. Although rarely, offspring of mothers with Graves’ disease may develop fetal/neonatal hyperthyroidism, the management of which requires a close collaboration between endocrinologists, obstetricians, and neonatologists. Because of the above considerations, the management of pregnant and lactating women with hyperthyroidism requires special care, bearing in mind that both maternal thyroid excess per se and related treatments may adversely affect the newborn’s health. In this review we discuss the diagnosis and management of hyperthyroidism in pregnancy, along with the impact of thyrotoxicosis and medications on fetal outcome.

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Section: Graves’ Disease (Gd) In Pregnancymentioning

confidence: 99%

Hyperthyroidism in the pregnant woman: Maternal and fetal aspects

Moleti

Mauro

Sturniolo

et al. 2019

Journal of Clinical & Translational Endocrinology

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“…For example, autoantibodies have been identified as a potential cause of heart or lung disease in adults and may participate in the process of atherosclerosis [15][16][17][18][19][20][21]. A number of maternal autoantibodies show person-to-person transmission of disease to the developing fetus during pregnancy and may have adverse effects, the most outstanding is of these being neonatal lupus, neonatal thyroid disease and thyroid autoantibody related early fetal loss and pre-term birth [22][23][24][25][26][27]. The above findings have significant implications for clinical and public health efforts to control AID.…”

Section: Introductionmentioning

confidence: 99%

Population-based estimates of humoral autoimmunity from the U.S. National Health and Nutrition Examination Surveys, 1960–2014

2020

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ObjectiveBased on US National Health and Nutrition Examination Survey (NHANES) data, we attempted to provide an unbiased, population-based estimate of autoantibody prevalence overall and by age and sex. MethodsUS autoantibody prevalence estimates for detectable rheumatoid factor, anti-thyroglobulin, anti-thyroperoxidase, anti-transglutaminase, anti-endomysial, anti-GAD65, antinuclear autoantibodies, and autoantibodies to extractable nuclear antigens were estimated from the 1960-1962 National Health Examination Survey, NHANES III (1988, and the NHANES 1999-2014 cross-sectional surveys. Survey design variables and sample weights were used to account for differential probabilities of selection within the complex survey design. Data analysis used SAS TM and SUDAAN™ software. US Census Bureau data were used to estimate the absolute numbers of persons with autoantibodies.

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“…17 18 Thus, transplacental passage of these antibodies can lead to in utero thyrotoxicosis that continue into the neonatal period until the disappearance of the transmitted antibodies, usually within the first 3 months of life. 19…”

Section: Discussionmentioning

confidence: 99%

“…20 21 22 There are few published reports on TSI and its effect on the perinatal outcome. 11 19 23 To our knowledge, our study of 14 patients who underwent cordocentesis is the largest study that systematically assessed the relationship of maternal TSI and its impact on neonatal thyroid dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Role of Maternal Thyroid-Stimulating Immunoglobulin in Graves' Disease for Predicting Perinatal Thyroid Dysfunction

Cui

Rijhsinghani

2019

AJP Rep

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Objective To assess maternal thyroid-stimulating immunoglobulin (TSI) as a predictor of neonatal thyroid hyperthyroidism in pregnancies complicated by Graves' disease. Methods This is a 10-year retrospective study of patients with a history of Graves' disease and elevated TSI activity level defined as 1.3 times the normal. All subjects underwent cordocentesis for ultrasound findings of suspected fetal thyrotoxicosis (fetal tachycardia, oligohydramnios, hydrops, and thyromegaly). Neonatal diagnosis was made based on neonatal thyroid function testing or symptoms. Results Fourteen patients were included in the study, seven with active Graves' disease requiring antithyroid drug (“ATD group”) and seven with iatrogenic hypothyroidism on levothyroxine (“levothyroxine group”). Four cases (57%) of neonatal thyrotoxicosis were diagnosed in the levothyroxine group compared with two cases (28%) in the ATD group. The lowest maternal TSI level at which a neonate did not develop hyperthyroidism was 2.6 for the levothyroxine group and 2.5 for the ATD group. The odds ratio of a neonate from the levothyroxine group developing hyperthyroidism compared with one from the ATD group is 3.3 (95% confidence interval: 0.4–30.7). Conclusion For patients with Graves' disease, those with iatrogenic hypothyroidism and TSI > 2.5 times the basal level are at the highest risk for neonatal thyrotoxicosis.

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Maternal Thyrotropin Receptor Antibody Concentration and the Risk of Fetal and Neonatal Thyrotoxicosis: A Systematic Review

Abstract: In women with Graves' disease, intensive fetal monitoring is recommended when maternal TRAb concentrations are >3.7 times the upper limit of normal. This cutoff level should be interpreted with caution, since evidence is limited.

Cited by 57 publications

References 36 publications

Hyperthyroidism in the pregnant woman: Maternal and fetal aspects

Hyperthyroidism in the pregnant woman: Maternal and fetal aspects

Population-based estimates of humoral autoimmunity from the U.S. National Health and Nutrition Examination Surveys, 1960–2014

Role of Maternal Thyroid-Stimulating Immunoglobulin in Graves' Disease for Predicting Perinatal Thyroid Dysfunction

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