Prediction of neonatal hyperthyroidism in infants born to mothers with Graves disease

Skuza, Kathryn A.; Sills, Irene N.; Stene, Mark; Rapaport, Robert

doi:10.1016/s0022-3476(96)70405-5

Cited by 91 publications

(45 citation statements)

References 21 publications

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“…All seven neonates who developed hyperthyroidism had positive cord blood TRAb tests with values O2 !-ULN, in keeping with earlier studies (33,34,35). It has been reported that TRAb levels above w40 IU/l using the BRAHMS method were predictive of neonatal hyperthyroidism (33).…”

Section: Discussionsupporting

confidence: 87%

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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Section: Discussionsupporting

confidence: 87%

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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“…As in the recent report of Besançon et al (37), we found an increased risk of neonatal hyperthyroidism when neonatal TBII levels were elevated at birth, with a cutoff value of 6 IU/l, higher than that found by Skuza et al (38) on a smaller series of 14 neonates with first-generation TBII determination. Despite its high sensitivity, the clinical usefulness of this threshold may be questionable as results are often delayed.…”

Section: Discussionsupporting

confidence: 73%

“…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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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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“…Skuza et al 38 compared TRAb levels in 14 infants born to mothers with GD. Cord blood TRAb levels were normal in 7 infants who remained euthyroid, whereas levels were threefold to sixfold above the reference range in 7 infants who developed hyperthyroidism.…”

Section: Question 2: Is Determination Of Trab Levels In Cord Blood Usmentioning

confidence: 99%

“…Several other studies also have demonstrated that positive TRAb levels in cord blood correlate with the likelihood of development of hyperthyroidism in the first 2 weeks of life, whereas negative antibodies are associated with little or no risk of neonatal hyperthyroidism. 9,30,38,39 Positive cord TRAb levels (up to 2.5 times the assay upper reference limit), however, have been reported in newborns with normal thyroid function, 40 demonstrating that low levels of antibodies can be seen in euthyroid newborns.…”

Section: Question 2: Is Determination Of Trab Levels In Cord Blood Usmentioning

confidence: 99%

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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Prediction of neonatal hyperthyroidism in infants born to mothers with Graves disease

Cited by 91 publications

References 21 publications

Management of neonates born to women with Graves' disease: a cohort study

Management of neonates born to women with Graves' disease: a cohort study

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

Management of Neonates Born to Mothers With Graves’ Disease

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