The relationship between maternal serum thyroid-stimulating immunoglobulin and fetal and neonatal thyrotoxicosis

Peleg, David; Cada, Sarah; Peleg, Aviva; Ben‐Ami, Moshe

doi:10.1016/s0029-7844(02)01961-0

Cited by 90 publications

(42 citation statements)

References 19 publications

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“…Therefore, the threshold value of TSAb needs to be confirmed in a larger study with a bioassay performed in every mother with detectable TBII level during pregnancy. However, our data are concordant with the literature: levels of TSAb reported to be predictive of neonatal hyperthyroidism were a stimulation of cAMP over 350-500% in T3 (10,25,27,30) or over 500% in T2 (31).…”

Section: Discussionsupporting

confidence: 92%

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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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Section: Discussionsupporting

confidence: 92%

“…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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“…TRAb levels fourfold above the reference range predicted neonatal hyperthyroidism with a positive predictive value of 40%, whereas levels less than fourfold above the reference range were associated with a negative predictive value of 100%. 8 In another study describing 230 pregnancies in 172 women with GD, 6 newborns (2.6%) developed overt hyperthyroidism and another 7 (3.0%) developed asymptomatic biochemical hyperthyroidism. Maternal TRAb levels were twofold to fivefold above the reference range in 8 of these 13 newborns.…”

Section: Discussion Question 1: Is There An Association Between Matermentioning

confidence: 98%

“…9 Furthermore, elevated maternal TRAb levels are associated with an increased risk of overt neonatal hyperthyroidism. [7][8][9][27][28][29][30][31][32][33] In a study that included 35 pregnancies in 29 women with GD, 6 newborns (17.1%) developed hyperthyroidism. TRAb levels fourfold above the reference range predicted neonatal hyperthyroidism with a positive predictive value of 40%, whereas levels less than fourfold above the reference range were associated with a negative predictive value of 100%.…”

Section: Discussion Question 1: Is There An Association Between Matermentioning

confidence: 99%

“…[1][2][3][4] The prevalence of transient GD in infants born to these mothers is uncertain, varying from 1.5% to 2.5% [5][6][7] up to 20.0% in observational cohort studies. [7][8][9] The causative antibodies in GD, thyroid-stimulating hormone (TSH) receptor antibodies (TRAb), belong to the immunoglobulin G class and freely cross the placenta, particularly during the second half of pregnancy. 10 There are 2 types of TRAb.…”

Section: Introductionmentioning

confidence: 99%

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Management of Neonates Born to Mothers With Graves’ Disease

2016

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Neonates born to mothers with Graves’ disease are at risk for significant morbidity and mortality and need to be appropriately identified and managed. Because no consensus guidelines regarding the treatment of these newborns exist, we sought to generate a literature-based management algorithm. The suggestions include the following: (1) Base initial risk assessment on maternal thyroid stimulating hormone (TSH) receptor antibodies. If levels are negative, no specific neonatal follow-up is necessary; if unavailable or positive, regard the newborn as “at risk” for the development of hyperthyroidism. (2) Determine levels of TSH-receptor antibodies in cord blood, or as soon as possible thereafter, so that newborns with negative antibodies can be discharged from follow-up. (3) Measurement of cord TSH and fT4 levels is not indicated. (4) Perform fT4 and TSH levels at day 3 to 5 of life, repeat at day 10 to 14 of life and follow clinically until 2 to 3 months of life. (5) Use the same testing schedule in neonates born to mothers with treated or untreated Graves’ disease. (6) When warranted, use methimazole (MMI) as the treatment of choice; β-blockers can be added for sympathetic hyperactivity. In refractory cases, potassium iodide may be used in conjunction with MMI. The need for treatment of asymptomatic infants with biochemical hyperthyroidism is uncertain. (7) Assess the MMI-treated newborn on a weekly basis until stable, then every 1 to 2 weeks, with a decrease of MMI (and other medications) as tolerated. MMI treatment duration is most commonly 1 to 2 months. (8) Be cognizant that central or primary hypothyroidism can occur in these newborns.

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Endocrine Disorders in Pregnancy

Faas

2007

Clinical Obstetrics

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The relationship between maternal serum thyroid-stimulating immunoglobulin and fetal and neonatal thyrotoxicosis

Abstract: Pregnancies complicated by high values of maternal thyroid-stimulating immunoglobulin appear to be at risk of developing neonatal thyrotoxicosis.

Cited by 90 publications

References 19 publications

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

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

Management of Neonates Born to Mothers With Graves’ Disease

Endocrine Disorders in Pregnancy

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