The Value of Neonatal Serum Thyroglobulin Determinations in the Follow‐up of Patients with Congenital Hypothyroidism

Ilicki, A; Ericsson, Ulla-Britt; Larsson, Agne; Mortensson, W.; Thorell, Jan I.

doi:10.1111/j.1651-2227.1990.tb11553.x

Cited by 7 publications

(7 citation statements)

References 18 publications

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“…However, an important radioiodine uptake would have been observed on the thyroid scintigraphy [3-5]. Secondly, the mother’s hypothyroidism could have been caused by TBAbs, a hypothesis which is consistent with the absence of radioiodine uptake associated with a normal thyroid gland on ultrasound [4, 5] and a normal rate of thyroglobulin, although this thyroglobulin level may be considered low for a newborn with such a high TSH [4, 5, 17-19]. This second hypothesis is supported by the transitory nature of neonatal hypothyroidism in parallel with the decrease in TRAbs.…”

Section: Discussionmentioning

confidence: 99%

Congenital Hypothyroidism due to a Low Level of Maternal Thyrotropin Receptor-Blocking Antibodies

et al. 2020

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Introduction: Maternal TSH receptor antibodies (TRAbs) can cross the placenta and affect fetal and neonatal thyroid function. Maternal TSH receptor-blocking antibodies (TBAbs) are a rare cause of congenital hypothyroidism. Case Report: Following the discovery of a highly elevated TSH on her neonatal screening test, a 10-day-old girl with no familial history of thyroid disorder was referred to the pediatric endocrinology unit. Hypothyroidism was confirmed with a highly elevated TSH (817 mIU/L, reference range 0.4–3.1) and very low levels of FT4 (1.8 pmol/L, reference range 12–22). Anti-TPO antibodies were at 81 IU/mL (reference range <34), TRAbs at 1.7 IU/L (reference range <1.75), and thyroglobulin at 9.4 µg/L (reference range 3.5–77). The thyroid appeared normal on ultrasonography, and no radioiodine uptake was seen on the scintigraphy after the perchlorate discharge test. Concomitantly, a severe maternal hypothyroidism was discovered (TSH 224 mIU/L). The maternal ultrasound appeared normal, anti-TPO antibodies were moderately elevated, and TRAbs were at 3.2 IU/L. TBAbs activity was measured in the mother and her daughter, and a very high and similar blocking activity was observed in both patients (TBAbs 89%, reference range <10%). L-thyroxine treatment was introduced in the newborn and was successfully discontinued at 6.5 months of age, as the TBAbs activity decreased. Conclusion: We report herein a case of transient congenital hypothyroidism with a normal neonatal TRAbs level. In case of maternal TBAbs, similar activity of maternal TBAbs must be expected in the neonate, independently of the neonatal level of TRAbs.

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Section: Discussionmentioning

confidence: 99%

Congenital Hypothyroidism due to a Low Level of Maternal Thyrotropin Receptor-Blocking Antibodies

et al. 2020

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“…It has been shown that many patients with permanent CH have measurable Tg levels in serum [18][19][20][21][22][23]. These Tg values are believed to be due to secretion from residual thyroid tissue.…”

Section: Discussionmentioning

confidence: 99%

“…The importance of Tg measurement in the follow-up of CH children has never been established. Ilicki et al [18] concluded that serum Tg levels measured at the time of diagnosis are of limited value in forecasting psychomotor development. In this study we demonstrate that more than half (28/51) of our permanent CH children have measurable Tg levels.…”

Section: Discussionmentioning

confidence: 99%

“…It has also been shown that serum Tg levels are increased after brief peri ods of decreased LT4 dosage [17]. However, the impor tance of Tg measurements at birth and during follow-up is still debatable [18][19][20][21][22][23][24]. This study was undertaken to determine the time it takes Tg to reach normal values after LT4 supplementation in CH infants has been begun, to study longitudinally the Tg-TSH correlation over a period of several years and finally to examine whether the Tg levels in CH infants reflect stimulation of residual thy roid tissue by biologically active TSH and whether they can be used to monitor the treatment and therapeutic compliance of CH children.…”

Section: Introductionmentioning

confidence: 99%

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The Importance of Thyroglobulin Levels in Monitoring the Treatment of Congenital Hypothyroidism

Sack¹,

Kaiserman²,

Eidlitz‐Markus³

1995

Horm Res

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We have previously reported on high thyroid-stimulating hormone (TSH) concentrations in clinically euthyroid children with congenital (CH) undergoing appropriate treatment. Whether this TSH is biologically active or not is still unclear. It has been shown that ectopic thyroid tissue does not involute during thyroxine (T₄) therapy and thus can continue to secrete thyroglobulin (Tg). This study was undertaken to determine whether the Tg levels in ectopic CH infants represent residual thyroid tissue stimulated by biologically active TSH and whether this Tg can be used to help monitor CH treatment. Among the 51 primary CH children (age 2-14 years) diagnosed and followed up by us, 28 had measurable Tg values ( > 2 pmol/l) several years after the T₄ treatment had been started. In 8 of the children, Tg was measured as early as the time of diagnosis and followed up for at least 3 years. The Tg levels decreased much more slowly than the TSH levels did, and secondary Tg rises were observed. By 5 months of age, all children had Tg levels less than 25 pmol/l. Although in some infants the Tg levels paralleled TSH behavior, in others the TSH-Tg correlation was not so obvious. In another group of 8 children who had high TSH values despite normal T₄, the LT₄ replacement dosage was increased by 60% for 1 week (from 3.5 ± 0.2 to 5.5 ± 0.5 μg/kg/day) in order to examine the TSH-Tg dependence. As a result, the serum levels of T₄ increased from 143 ± 10 to 176 ± 12 nmol/l, while the levels of TSH and Tg decreased from 8.1 ± 2.1 mU/l and 4.5 ± 0.5 ρmol/l to 1.7 ± 0.5 mU/l and 2.9 ± 0.6 pmol/l, respectively (p < 0.05). The data suggest that in primary CH children with ectopic thyroid tissue the residual gland is active and secretes Tg in response to endogenous TSH, years after the T₄ replacement treatment has been started. Therefore the high TSH found in some CH children despite adequate LT₄ replacement treatment is biologically active and easily suppressible with the increase in LT₄ dosage. Since Tg is TSH dependent and since Tg clearance is much slower compared to TSH clearance, Tg might be useful in monitoring more accurately the long-term compliance to the therapeutic protocol. Tg monitoring is especially valuable in those infants with fluctuating high TSH levels despite normal T₄ values.

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“…In an early study of congenital hypothyroidism, no significant differences in serum Tg were found between neonates with thyroid aplasia confirmed by thyroid scintigraphy (range ¼ 15-290 mg/L) and a control group of euthyroid neonates (range ¼ 34-700 mg/L). 63 In the neonates with congenital hypothyroidism, irrespective of cause, the range was ,2.0-1100 mg/L. A more recent study 64 found a range of serum Tg of ,1.0 -18.7 mg/L in athyreosis while those with an ectopic gland had a range of 4.5-123 mg/L.…”

Section: Other Indications For the Measurement Of Serum Tgmentioning

confidence: 99%

Can we interpret serum thyroglobulin results?

Clark

Franklyn

2012

Ann Clin Biochem

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Thyroglobulin (Tg) is a tumour marker for differentiated thyroid cancer. Interpretation requires a knowledge of the current thyrotropin (TSH) concentration as secretion is TSH-dependent. While a raised serum Tg may be indicative of residual or recurrent thyroid cancer, trauma to the thyroid (e.g. surgical, biopsy or due to radioiodine treatment) also causes an increase. Tg may be measured when TSH is suppressed and also following recombinant TSH (rhTSH) stimulation. Interpretation of results in pregnancy and in children is discussed. Assay bias and interference by endogenous Tg antibodies (Abs) are the main confounders in the interpretation of results. Although there is an international standard for Tg, there are large differences in results and yet there are few assay-specific clinical decision limits. Patients should therefore be monitored with the same assay. Endogenous TgAbs may cause false-negative interference in immunometric assays and may cause false-positive results in radioimmunoassay. Although the measurement of TgAbs has been advocated for predicting interference, it is now clear that interference can still occur when TgAbs have not been detected, the effect being TgAb-assay-specific. Approaches to identifying those samples where there may be interference are discussed. The laboratory should have a protocol for the investigation of possible interferences and data on the bias of the Tg assay that they use. An appreciation of the clinical uses of the service is required as an understanding by endocrinologists, oncologists and endocrine surgeons of the analytical limitations of the service.

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The Value of Neonatal Serum Thyroglobulin Determinations in the Follow‐up of Patients with Congenital Hypothyroidism

Cited by 7 publications

References 18 publications

Congenital Hypothyroidism due to a Low Level of Maternal Thyrotropin Receptor-Blocking Antibodies

Congenital Hypothyroidism due to a Low Level of Maternal Thyrotropin Receptor-Blocking Antibodies

The Importance of Thyroglobulin Levels in Monitoring the Treatment of Congenital Hypothyroidism

Can we interpret serum thyroglobulin results?

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