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

Abstract

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.

Maternal Graves Disease and Abnormal CYP2D6 Genotype with Fetal Hyperthyroidism

“…Abbreviations: ATD = antithyroid drug; BID = twice a day; BPM = beats per minute; MMI = methimazole; PTU = propylthiouracil; TID = three times a day; TSH = thyroid-stimulating hormone. Along with timing, there have been many case studies that have documented an increased risk of fetal hyperthyroidism when TRAb levels are elevated >3 times the upper limit of normal (5)(6)(7)(8)(9). Another challenging aspect to the management of this case was the discordance between fetal heart rate normalization and cordocentesis laboratory results.…”

Management of Severe Graves’ Hyperthyroidism in Pregnancy Following Immune Reconstitution Therapy in Multiple Sclerosis

“…TRAb should be measured in pregnant women with GD or past history of GD (through pregnancy and GW 20-28) to assess the risk of fetal hyperthyroidism. A maternal TRAb level >5 IU/L or 3 times the upper reference range is associated with a higher risk for neonatal hyperthyroidism [ 28 , 29 ]. ALZ-induced GD patients may present considerably high levels of TRAb as in the current case (TRAb 240 IU/L, mainly stimulating antibodies) with a high risk of fetal thyrotoxicosis.…”

Multigravida With Uncontrolled Hyperthyroid and Bilateral Pleural Effusion

“…The prevalence of hyperthyroid during pregnancy was 0.1-0.4%. 2,3 Overt hyperthyroidism can be divided into different subtypes from the underlying etiology, and the three most common subtypes are Graves' disease, multinodular toxic goiter, and solitary toxic adenoma. Out of all, grave's disease is the most common presentation which accounted for 85% case.…”

“…Out of all, grave's disease is the most common presentation which accounted for 85% case. 2,4 Grave's disease is an autoimmune disease due to circulating autoantibody (Ab) which stimulate the thyroid stimulating hormone-receptor (TSH-R). 5,6 The hypertiroid diagnosis usually made by clinical manifestation, using the Wayne Score.…”

“…The prevalence of hyperthyroid during pregnancy is 0.1-0.4%, and 85% of case presented as grave's disease. 2 Hypermetabolic symptom in maternal has similarities with hyperthyroid clinical symptom such as tachycardia, warm body, and heat intolerance. The abnormalities on the thyroid hormone test result are suppressed thyroid stimulating hormone (TSH) level and elevated tetraiodothyronine (T4) and/or triiodothyronine (T3) level.…”