Thyrotropin-Blocking Autoantibodies and Thyroid-Stimulating Autoantibodies: Potential Mechanisms Involved in the Pendulum Swinging from Hypothyroidism to Hyperthyroidism or Vice Versa

McLachlan, Sandra M.; Rapoport, Basil

doi:10.1089/thy.2012.0374

Cited by 190 publications

(184 citation statements)

References 72 publications

(82 reference statements)

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“…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

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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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“…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

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“…autoimmune disease (Acar et al, 2013 andRapoport, 2013). A connection among TPO, TPO antibody, and breast cancer prognosis has been proposed (Muller et al, 2014).…”

mentioning

confidence: 99%

Thyroid autoimmunity as a window to autoimmunity: An explanation for sex differences in the prevalence of thyroid autoimmunity

Merrill

2015

Journal of Theoretical Biology

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“…The TSHR antibodies in the mother may have stimulatory or blocking activity or may be ineffective. Rarely, the stimulatory antibodies in the patient may be transformed into blocking antibodies or vice versa (8). Measurement of TSHR antibodies is initiated in the [20][21][22][23][24] th gestational week because the fetal TSH receptors start to respond from the 20 th week.…”

Section: Graves' Disease In Pregnancymentioning

confidence: 99%

“…Other problems found in the babies of mothers with Graves' disease include transient central hypothyroidism, primary hypothyroidism, and isolated hyperthyrotropinemia (28,30,(48)(49)(50). This condition may be observed in the early postnatal period, following a short-term picture of hyperthyroidism or euthyroidism, or the picture of hypothyroidism may be observed before the stage of hyperthyroidism (8,30). Thyroid-stimulating hormone was found increased with a rate of 14-21% and FT4 was found decreased with a rate of 6-7% in the chord blood of babies whose mothers used antithyroid drugs (48).…”

Section: Use Of Biotinmentioning

confidence: 99%

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Fetal neonatal hyperthyroidism: diagnostic and therapeutic approachment

Kurtoğlu¹,

Özdemır²

2017

Turk Pediatri Ars

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Fetal and neonatal hyperthyroidism may occur in mothers with Graves' disease. Fetal thyrotoxicosis manifestation is observed with the transition of TSH receptor stimulating antibodies to the fetus from the 17th-20th weeks of pregnancy and with the fetal TSH receptors becoming responsive after 20 weeks. The diagnosis is confirmed by fetal tachycardia, goiter and bone age advancement in pregnancy and maternal treatment is conducted in accordance. The probability of neonatal hyperthyroidism is high in the babies of mothers that have ongoing antithyroid requirement and higher antibody levels in the last months of pregnancy. Clinical manifestation may be delayed by 7-17 days because of the antithyroid drugs taken by the mother. Neonatal hyperthyroidism symptoms can be confused with sepsis and congenital viral infections. Herein, the diagnosis and therapeutic approach are reviewed in cases of fetal neonatal hyperthyroidism. (Turk Pediatri Ars 2017; 52: 1-9)

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Thyrotropin-Blocking Autoantibodies and Thyroid-Stimulating Autoantibodies: Potential Mechanisms Involved in the Pendulum Swinging from Hypothyroidism to Hyperthyroidism or Vice Versa

Cited by 190 publications

References 72 publications

Management of Neonates Born to Mothers With Graves’ Disease

Management of Neonates Born to Mothers With Graves’ Disease

Thyroid autoimmunity as a window to autoimmunity: An explanation for sex differences in the prevalence of thyroid autoimmunity

Fetal neonatal hyperthyroidism: diagnostic and therapeutic approachment

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