open access

Vol 65, No 4 (2014)
Original papers
Published online: 2014-08-29
Submitted: 2014-01-20
Accepted: 2014-02-25
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Hyperthyroidism during pregnancy — the role of measuring maternal TSH receptor antibodies and foetal ultrasound monitoring

Małgorzata Gietka-Czernel, Marzena Dębska, Piotr Kretowicz, Wojciech Zgliczyński, Mariusz Ołtarzewski
DOI: 10.5603/EP.2014.0035
·
Endokrynologia Polska 2014;65(4):259-268.

open access

Vol 65, No 4 (2014)
Original papers
Published online: 2014-08-29
Submitted: 2014-01-20
Accepted: 2014-02-25

Abstract

Introduction: To evaluate the usefulness of measuring maternal anti-TSH receptor antibodies (TRAbs) and foetal ultrasound (US) monitoring in cases of current or past maternal hyperthyroidism.

Material and methods: 77 pregnant women suffering from hyperthyroidism or with a history of Graves’ hyperthyroidism were observed prospectively. Maternal serum TSH, fT4, fT3, TRAbs, and foetal US were performed at baseline and repeated every 2–4 weeks when needed. Neonatal thyroid status was assessed based on serum TSH, fT4 and fT3 obtained in the first days of life.

Results: 35 women were diagnosed with gestational hyperthyroidism and 42 with Graves’ disease; among them 26 had current and 16 past hyperthyroidism. Foetal and neonatal thyroid dysfunction occurred only in cases of maternal Graves’ disease: nine (21%) and three (7%), respectively. Active maternal Graves’ hyperthyroidism and TRAbs elevated at least five times above the upper normal limit predisposed to foetal hyperthyroidism. Maternal anti-thyroid drug therapy (ATD) and low TRAbs and fT4 were the risk factors of foetal hypothyroidism. Abnormal foetal thyroid sonogram was the only sign of foetal thyroid dysfunction. Four patients (9.5%) had high TRAbs in the 3rd trimester (10.8–29.9 IU/mL), but neither foetal nor neonatal thyroid dysfunctions were noted.

Conclusions: In the cases of maternal Graves’ disease, foetal thyroid dysfunction occurs more often than commonly assumed. Foetal thyroid US is a valuable tool in early diagnosis and monitoring of the foetal thyroid status in pregnancy complicated by maternal Graves’ disease. The evaluation of biological activity of maternal TRAbs may be helpful in prenatal diagnosis in some cases. (Endokrynol Pol 2014; 65 (4): 259–268)

Abstract

Introduction: To evaluate the usefulness of measuring maternal anti-TSH receptor antibodies (TRAbs) and foetal ultrasound (US) monitoring in cases of current or past maternal hyperthyroidism.

Material and methods: 77 pregnant women suffering from hyperthyroidism or with a history of Graves’ hyperthyroidism were observed prospectively. Maternal serum TSH, fT4, fT3, TRAbs, and foetal US were performed at baseline and repeated every 2–4 weeks when needed. Neonatal thyroid status was assessed based on serum TSH, fT4 and fT3 obtained in the first days of life.

Results: 35 women were diagnosed with gestational hyperthyroidism and 42 with Graves’ disease; among them 26 had current and 16 past hyperthyroidism. Foetal and neonatal thyroid dysfunction occurred only in cases of maternal Graves’ disease: nine (21%) and three (7%), respectively. Active maternal Graves’ hyperthyroidism and TRAbs elevated at least five times above the upper normal limit predisposed to foetal hyperthyroidism. Maternal anti-thyroid drug therapy (ATD) and low TRAbs and fT4 were the risk factors of foetal hypothyroidism. Abnormal foetal thyroid sonogram was the only sign of foetal thyroid dysfunction. Four patients (9.5%) had high TRAbs in the 3rd trimester (10.8–29.9 IU/mL), but neither foetal nor neonatal thyroid dysfunctions were noted.

Conclusions: In the cases of maternal Graves’ disease, foetal thyroid dysfunction occurs more often than commonly assumed. Foetal thyroid US is a valuable tool in early diagnosis and monitoring of the foetal thyroid status in pregnancy complicated by maternal Graves’ disease. The evaluation of biological activity of maternal TRAbs may be helpful in prenatal diagnosis in some cases. (Endokrynol Pol 2014; 65 (4): 259–268)

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Keywords

maternal Graves’ disease; pregnancy; TRAb; foetal ultrasonography

About this article
Title

Hyperthyroidism during pregnancy — the role of measuring maternal TSH receptor antibodies and foetal ultrasound monitoring

Journal

Endokrynologia Polska

Issue

Vol 65, No 4 (2014)

Pages

259-268

Published online

2014-08-29

DOI

10.5603/EP.2014.0035

Bibliographic record

Endokrynologia Polska 2014;65(4):259-268.

Keywords

maternal Graves’ disease
pregnancy
TRAb
foetal ultrasonography

Authors

Małgorzata Gietka-Czernel
Marzena Dębska
Piotr Kretowicz
Wojciech Zgliczyński
Mariusz Ołtarzewski

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