No Increase of Blocking Type Anti-Thyrotropin Receptor Antibodies During Pregnancy in Patients with Graves’ Disease

Abstract

Serial changes in serum levels of anti-TSH receptor antibodies were examined during and after pregnancy in six patients with Graves' disease receiving no or minimal maintenance doses of antithyroid drugs. During pregnancy, serum levels of TSH-binding inhibitory Igs (P < 0.001) and thyroid-stimulating antibodies (TSAbs) (P < 0.01) decreased gradually but increased after delivery in all patients. Activities of thyroidstimulation blocking antibodies (TSBAbs) were lower than the cut-off value in early pregnancy, and values significantly decreased in four patients during pregnancy. The other two patients showed no significant change during pregnancy. In contrast, TSBAb levels increased significantly (P < 0.01) after delivery in all patients. We found that activities of TSHbinding inhibitory Igs, TSAb, and TSBAb decrease during pregnancy and increase after delivery, suggesting that amelioration of Graves' disease during pregnancy is induced by decrease of TSAb but not by the appearance of TSBAb. (J Clin Endocrinol Metab 88: 5871-5874, 2003)

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

“…This threshold value was provided by a mother who relapsed with GD late in pregnancy, and for whom no TBII determination had been made before T3. TBII values generally decrease during pregnancy (10,28), as was observed for most of our patients. Therefore, it could be argued that our threshold value, derived from a TBII determination at T3, is underestimated.…”

“…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.…”

Management of Graves' hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy

“…In most instances, pregnancy is associated with a progressive decrease in the autoimmune activity of Graves' disease (13,14), so that in women receiving antithyroid medication for Graves' hyperthyroidism before becoming pregnant it is often feasible to gradually reduce the dose or to withdraw the medication (14,15). Occasionally, as reported in a few studies (16,17), but not confirmed on a large scale (18), the nature of TRAb may change during pregnancy from stimulation to blocking of the TSH receptor. In such patients not only withdrawal of antithyroid medication, but also therapy of the mother with L-T 4 may be necessary.…”

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

“…Several studies reported that the serum TRAb values usually decreased during pregnancy [3,[15][16][17]. As a possible mechanism of this, Amino et al suggested that Th2-dependent humoral immunity is suppressed in human pregnancy [16].…”

“…As a possible mechanism of this, Amino et al suggested that Th2-dependent humoral immunity is suppressed in human pregnancy [16]. However, in some cases including those after radioiodine therapy, the high serum TRAb values might not decrease during pregnancy, resulting in fetal hyperthyroidism [18,19].…”