Thyroid Autoantibodies in Pregnancy: Their Role, Regulation and Clinical Relevance

Balucan, Francis; Morshed, Syed A.; Davies, Terry F.

doi:10.1155/2013/182472

Cited by 90 publications

(92 citation statements)

References 161 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…9 The interplay between TSH-receptor stimulating and blocking antibodies might explain the switch from hypothyroidism to hyperthyroidism and vice versa. 86,87 Suggestion:…”

Section: Suggestionmentioning

confidence: 99%

Management of Neonates Born to Mothers With Graves’ Disease

2016

View full text Add to dashboard Cite

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.

show abstract

“…9 The interplay between TSH-receptor stimulating and blocking antibodies might explain the switch from hypothyroidism to hyperthyroidism and vice versa. 86,87 Suggestion:…”

Section: Suggestionmentioning

confidence: 99%

Management of Neonates Born to Mothers With Graves’ Disease

2016

View full text Add to dashboard Cite

show abstract

“…Both TPO and Tg are essential in the synthesis and secretion of thyroid hormones, including thyroxine (T4) and triiodothyronine (T3) [1][2][3]. Autoantibodies to TPO (TPOAb) and Tg (TgAb) are considered secondary responses and indicative of thyroid inflammation, and can be detected in 10-20 % of women at childbearing age [4,5]. Production of the above autoantibodies implicates the activation of an autoimmune process in the thyroid gland, but the majority of women with positive thyroid autoantibodies are euthyroid, that is, they have normal thyroid function [6].…”

Section: Introductionmentioning

confidence: 99%

Associations between thyroid autoantibody status and abnormal pregnancy outcomes in euthyroid women

Chen

Zhang

et al. 2014

Endocrine

View full text Add to dashboard Cite

We investigated whether thyroid autoantibody status influences pregnancy outcomes in euthyroid women, by comparing abnormal pregnancy outcome rates between those who tested positive for thyroid autoantibodies (Ab+) and those who tested autoantibody-negative (Ab-). Euthyroid pregnant women (n=7,641) underwent tests for serum thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb). The subjects were divided into 4 groups according to thyroid antibody status: TPOAb-/TgAb- (92.9%); TPOAb+/TgAb- (3.2%); TPOAb-/TgAb+ (2.0%); and TPOAb+/TgAb+ (1.9%). The incidence rates of the following abnormal pregnancy outcomes were compared among the 4 groups and analyzed by Fisher's exact test: gestational diabetes, gestational hypertension, placenta previa, placental abruption, premature rupture of fetal membrane (PROM), intrauterine growth restriction, fetal distress, fetal anomalies, stillbirth, preterm birth, and low birth weight. Among the 4 groups, there were no significant differences in age, gestational age, or in the incidence rates of abnormal pregnancy outcomes, except for PROM and low birth weight. The highest incidence rates for PROM and low birth weight were in the TPOAb-/TgAb+ and TPOAb+/TgAb+ subjects, respectively. TgAb positivity and TPOAb positivity were associated with PROM and low birth weight, respectively. Underlying factors that govern the association between thyroid autoantibodies and PROM and low birth weight require further investigation.

show abstract

“…Similarly, in a smaller prospective study, pregnant women showed a similar decrease of thyroid antibodies during pregnancy with a rebound of anti‐TPO but not of anti‐Tg antibodies at postpartum . The decrease of thyroid antibodies is attributed to the development of maternal immunotolerance during pregnancy . Autoimmune thyroiditis is a Th1‐ and Th17‐driven disease.…”

Section: Introductionmentioning

confidence: 79%