MEASUREMENT OF TSH IN HUMAN AMNIOTIC FLUID: DIAGNOSIS OF FETAL THYROID ABNORMALITY <i>IN UTERO</i>

Yoshida, Katsumi; Sato, Toshiro; Takahashi, Tomomi; Furuhashi, N; Kaise, Kazuro; Yoshinaga, Kaoru

doi:10.1111/j.1365-2265.1986.tb01696.x

Cited by 24 publications

(12 citation statements)

References 19 publications

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“…On the other hand, some infants are born with hypothyroidism despite normal maternal serum thyroid hormone concentrations (22), indicating insufficient contribution of maternal T 4 to alter fetal physiology. Also, as was previously stated, AF thyroid hormone concentrations rise throughout gestation independently of maternal concentrations (14). Together, these findings suggest that the majority of AF T 4 concentrations are fetal derived.…”

Section: Discussionsupporting

confidence: 58%

“…Chopra and Crandall (18) reported that TSH changed little between 15 and 42 wk of gestation. A study by Yoshida et al (14) suggested that TSH may peak at gestational wk 28 -36 with a mean of 0.218 mU/liter (n ϭ 5) and drop to a mean of 0.129 mU/liter (n ϭ 21) by more than 37 wk. However, the (19) reported that AF tT 4 concentrations increased during the first half of pregnancy reaching peak concentrations at 25-30 wk.…”

Section: Discussionmentioning

confidence: 97%

“…Although the risk of fetal demise from percutaneous umbilical blood sampling is low, reported as 0.5-1% or less in recent reports (12); amniocentesis is a far easier and safer procedure. Studies indicate that from wk 12 of gestation onwards, there are steady rises in the fetal serum concentrations of T 4 , and TSH (5, 13) that correlate with concentrations in amniotic fluid (14) and are independent of maternal concentrations (5,14). The presence of small concentrations of T 4 in cord blood of fetuses with thyroid agenesis or organification defects indicates that there is some transplacental T 4 transfer (15); however, the evidence overall points to a limited maternal contribution to fetal physiology.…”

mentioning

confidence: 96%

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Establishment of Reference Intervals for Markers of Fetal Thyroid Status in Amniotic Fluid

Singh

Parvin

Gronowski

2003

The Journal of Clinical Endocrinology & Metabolism

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Fetal goiter can arise as a result of fetal hyper or hypothyroidism. Although this condition is rare, it can be life threatening. Detection of fetal goiter in utero is possible with the aid of ultrasound, but proper prenatal treatment depends on knowledge of hormonal status. Amniotic fluid (AF) sampling is less technically demanding and poses fewer risks to the fetus than cordocentesis for fetal serum sampling, but well-established reference ranges for AF thyroid studies are not available in the literature. We have established reference intervals for AF (TSH), total T(4) (tT(4)), and free T(4) using stored AF samples. The reference intervals were: TSH (n = 127), less than 0.1-0.5 mU/liter, with a median of 0.1 mU/liter; tT(4) (n = 129), 2.3-3.9 microg/dl (30-50 nmol/liter), with a median of 3.3 microg/dl (4 nmol/liter); and free T(4) (n = 119) less than 0.4-0.7 ng/dl (5-9 pmol/liter), with a median of 0.4 ng/dl (5 pmol/liter). These intervals represent the largest study done to date on third trimester AF using automated immunoassays. A literature search of fetal goiter revealed a number of cases of hypothyroidism. Seven cases reported AF TSH concentrations (range, 1.1-28.9 mU/liter) and four reported AF tT(4) concentrations [range, 0.98-1.25 micro g/ml (13-16 nmol/liter)], all of which fell outside our reference intervals. These data support the use of AF to diagnose fetal hypothyroidism, reducing the need to resort to a riskier procedure such as cordocentesis.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 96%

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Establishment of Reference Intervals for Markers of Fetal Thyroid Status in Amniotic Fluid

Singh

Parvin

Gronowski

2003

The Journal of Clinical Endocrinology & Metabolism

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“…Amniotic fluid TSH measured with a sensi¬ tive radioimmunometric assay seems to correlate with fetal cord serum TSH (22). Indeed, Perelman et al, using PUBS, showed a parallel decrease in fetal TSH and amniotic fluid TSH during prenatal treatment of a hypothyroid fetus (5).…”

mentioning

confidence: 97%

The Fetus in Maternal Hyperthyroidism

Perelman¹,

Clemons²

1992

Thyroid

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A recent article in the New England Journal of Medicine reported the successful diagnosis and treatment of fetal goitrous hypothyroidism in a mother with Graves' disease. The fetus is being recognized as an important patient in its own right in terms of thyroid disease. The fetal thyroid system develops independently of the normal maternal thyroid axis. Presence of feedback suppression of TSH by T4 has been demonstrated in a 35-week fetus. Information learned from congenital hypothyroidism suggests that lack of fetal thyroid hormones may have a negative impact on the developing fetal brain with lack of normal myelination. It is uncertain at what gestational age the fetus and the developing central nervous system become adversely affected by thyroid hormone deficiency. Since congenital hypothyroidism is sporadic and since there is no current method for easily screening all pregnancies for hypothyroidism, the thrust in fetal diagnosis and therapy has been in those pregnancies suspected of having a hypothyroid fetus when a fetal goiter is detected by ultrasonography or in a hyperthyroid mother who may be on antithyroid therapy. Intraamniotic injections of L-thyroxine have proven successful for fetal therapy. Amniotic fluid TSH may prove useful in the diagnosis and treatment of a hypothyroid fetus. Previous studies have suggested that the period of thyroxine dependency of the fetal central nervous system is limited predominantly to the last 4-8 weeks of gestation. Fetal hyperthyroidism due to transplacental transmission of thyroid-stimulating immunoglobulins may occur in a mother with a history of hyperthyroidism due to Graves' disease.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…Amniotic fluid TSH and fT 4 levels provide useful information as the levels reflect fetal thyroid status and are independent of the thyroid status of the mother [18]. How fetal TSH reaches the amniotic fluid is not known.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Dyshormonogenetic Fetal Goiter Responding to Intra-Amniotic Thyroxine Injections

2014

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Fetal goiter was detected by routine ultrasound in early pregnancy, gestational week (GW) 18, in a 28-year-old woman with no thyroid history, normal thyroid hormone levels and no TSH receptor or thyroid peroxidase antibodies. An umbilical cord blood sample was drawn in GW 23. The analysis indicated fetal hypothyroidism with TSH >100 mU/l (reference value 6.8 ± 2.9, mean ± SD), fT₄ 3.8 pmol/l (reference value 16.5 ± 5.3, mean ± SD). Intra-amniotic injections of thyroxine were given in conjunction with ultrasound every 7-10 days, in total nine times during GW 24-33. A dose of 10 µg thyroxine/kg of estimated fetal weight per day was administered on six occasions, and 5 µg/kg/day the last three times. Upon injections of thyroxine further growth of the goiter was reduced. Elevated amniotic TSH levels fell from 13 to 2.5 mU/l (reference range 0.04-0.51). Throughout pregnancy, fetal heart rate and skeletal maturation were within normal limits. In week 34, chorioamnionitis was suspected and the child was delivered by cesarean section. Cord blood revealed TSH 596 mU/l (reference value 8.0 ± 5.12, mean ± SD), fT₄ 4.4 pmol/l (reference value 19.3 ± 4.3, mean ± SD) and total T₃ 1.18 nmol/l (reference value 0.5 ± 0.3, mean ± SD); the newborn was put on thyroxine supplementation. Psychomotor development of the child, now 3 years old, has been uneventful. The reported experience of treating dyshormonogenetic fetal goiter is limited but growing, creating a need for guidelines on administration of intra-amniotic thyroxine and monitoring treatment.

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MEASUREMENT OF TSH IN HUMAN AMNIOTIC FLUID: DIAGNOSIS OF FETAL THYROID ABNORMALITY IN UTERO

Cited by 24 publications

References 19 publications

Establishment of Reference Intervals for Markers of Fetal Thyroid Status in Amniotic Fluid

Establishment of Reference Intervals for Markers of Fetal Thyroid Status in Amniotic Fluid

The Fetus in Maternal Hyperthyroidism

A Rare Case of Dyshormonogenetic Fetal Goiter Responding to Intra-Amniotic Thyroxine Injections

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