Anti TSH‐receptor antibodies in pregnant patients with autoimmune thyroid disorder

Clavel, Sylvaine; Madec, Anne-Marie; Bornet, H; Deviller, P; Stefanutti, A.; Orgiazzi, Jacques

doi:10.1111/j.1471-0528.1990.tb02472.x

Cited by 44 publications

(26 citation statements)

References 27 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: 82%

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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: 82%

“…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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“…The FT 4 increase and TSH decrease developed gradually, after day 3 but before day 15 in neonates who subsequently developed hyperthyroidism. (Table 1) are consistent with the previously described time-course of FT 4 , FT 3 , and TSH values in neonates, once gestational age at birth is taken into account (25,36,37). When interpreting thyroid function data in neonates, the values must be compared with age-specific normal ranges.…”

Section: /Atdsupporting

confidence: 57%

“…Mean age of the women was 33 years (range, 26-43 years) and gestational age at inclusion was 17 weeks (range, 10-28 weeks). We divided the women into three groups based on the risk of fetal and neonatal thyroid dysfunction determined according to the TRAb assay results and need for ATD therapy: controls, consistently negative TRAb assays and no ATD treatment (TRAb Kve /ATD Kve group), indicating a low risk for fetal thyroid dysfunction (25); consistently negative TRAb assays in the third trimester of pregnancy but need for ATD therapy (TRAb Kve /ATD Cve group); and at least one positive TRAb assay in the third trimester and need for ATD therapy (TRAb Cve /ATD Cve group). In this third group, fetuses and neonates were considered at risk for thyroid dysfunction.…”

Section: Patientsmentioning

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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“…It has thus been recommended to determine TRAb late in pregnancy in women with GD to predict the risk of neonatal hyperthyroidism (NH). An arbitrary limit of 50% [3][4][5] or 40 U/L [6][7][8] using 1st generation TRA (TRAb1) assay was suggested to indicate risk when measured late in pregnancy. In order to substitute TRAb1 assay with the 2nd generation TRAb assay using porcine TSH receptor (pTRAb2) and human recombinant TSH receptor (hTRAb2) and the 3rd generation TRAb (TRAb3) assay, we measured TRAb in these four methods late in pregnancy.…”

mentioning

confidence: 99%

TSH-receptor Antibodies Determined by the First, Second and Third Generation Assays and Thyroid-stimulating Antibody in Pregnant Patients with Graves' Disease

Kamijo

2007

Endocr J

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Abstract. The measurement of TSH receptor antibody (TRAb) has been recommended to predict the risk of neonatal hyperthyroidism (NH) in pregnant women with Graves' disease (GD). For the first generation TRAb (TRAb1) assay with commercial kit (Brahms, Berlin, Germany; or Cosmic co., Tokyo, Japan) an arbitrary limit of 40 U/l or 50% was suggested to indicate risk when measured late in pregnancy. In order to substitute TRAb1 with the second generation TRAb using porcine TSH receptor (pTRAb2) and human recombinant TSH receptor (hTRAb2) and the third generation TRAb (TRAb3) assay for this purpose, we measured TRAb in these four methods late in pregnancy in a total of 62 pregnant women with Graves' disease. The data showed that no cases with TRAb1 >50% has been missed if the TRAb1 assay was replaced by the pTRAb2, hTRAb2 or TRAb3 assay using their equivalent cut-off value of 70%, 10 IU/l, and 75%, respectively, but that an additional group of women would have been included in the risk group, especially in the TRAb3 assay. Next, the effect of maternal TRAb on thyroid function of offspring was studied in the 47 pregnant women with GD (43 with TRAb1 <50% and 4 with TRAb1 >50% during late pregnancy). In 2 women who gave birth to hyperthyroid children at days 6 and 14 of life, the maternal sera had strongly positive levels of TRAb1 (73.5% and 84.1%), pTRAb2 (84.9% and 91.5%), hTRAb2 (40.68 IU/L and 89.70 IU/L) and TRAb3 (92.1% and 93.5%) late in pregnancy, with one case displaying high positive (1114.3%) thyroid stimulating antibody (TSAb) level and the other case had moderate positive (433%) TSAb level. Of the remaining 45 women, 43 had TRAb1 <50% and the other 2 had TRAb >50% including 1 with low TSAb positive and 1 with positive thyroid stimulating blocking antibody (TSBAb) and negative TSAb; all of them gave birth to euthyroid children. Finally, a serial study regarding TRAb in 23 women with Graves' disease during pregnancy showed that TRAb1, pTRAb2, hTRAb2, TRAb3 value and TSAb level decreased significantly as pregnancy progressed. In conclusion, the present study supported TRAb as a useful marker to predict the risk of NH.

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Anti TSH‐receptor antibodies in pregnant patients with autoimmune thyroid disorder

Cited by 44 publications

References 27 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 women with Graves' disease: a cohort study

TSH-receptor Antibodies Determined by the First, Second and Third Generation Assays and Thyroid-stimulating Antibody in Pregnant Patients with Graves' Disease

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