CC BY-NC-ND 4.0 · AJP Rep 2019; 09(04): e341-e345
DOI: 10.1055/s-0039-1694035
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Role of Maternal Thyroid-Stimulating Immunoglobulin in Graves' Disease for Predicting Perinatal Thyroid Dysfunction

1  Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
,
Asha Rijhsinghani
1  Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
2  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Fetal Diagnosis Unit, University of Iowa, Iowa City, Iowa
› Author Affiliations
Further Information

Publication History

17 February 2019

06 May 2019

Publication Date:
11 November 2019 (online)

  

Abstract

Objective To assess maternal thyroid-stimulating immunoglobulin (TSI) as a predictor of neonatal thyroid hyperthyroidism in pregnancies complicated by Graves' disease.

Methods This is a 10-year retrospective study of patients with a history of Graves' disease and elevated TSI activity level defined as 1.3 times the normal. All subjects underwent cordocentesis for ultrasound findings of suspected fetal thyrotoxicosis (fetal tachycardia, oligohydramnios, hydrops, and thyromegaly). Neonatal diagnosis was made based on neonatal thyroid function testing or symptoms.

Results Fourteen patients were included in the study, seven with active Graves' disease requiring antithyroid drug (“ATD group”) and seven with iatrogenic hypothyroidism on levothyroxine (“levothyroxine group”). Four cases (57%) of neonatal thyrotoxicosis were diagnosed in the levothyroxine group compared with two cases (28%) in the ATD group. The lowest maternal TSI level at which a neonate did not develop hyperthyroidism was 2.6 for the levothyroxine group and 2.5 for the ATD group. The odds ratio of a neonate from the levothyroxine group developing hyperthyroidism compared with one from the ATD group is 3.3 (95% confidence interval: 0.4–30.7).

Conclusion For patients with Graves' disease, those with iatrogenic hypothyroidism and TSI > 2.5 times the basal level are at the highest risk for neonatal thyrotoxicosis.