Hyperthyroid Mothers Research Articles

Indications for intensive care unit treatment among neonates born to mothers with thyroid disease: A population-based cohort study.

Thyroid diseases in pregnancy are relatively common and are associated with adverse pregnancy and perinatal outcomes, increasing a neonate's risk of admission to the neonatal intensive care unit (NICU). The aim of this study was to evaluate the indications for increased risk of NICU admission among the neonates of hypothyroid and hyperthyroid mothers. The study data consisted of all singleton deliveries (n=734 773) between 2004 and 2016 in Finland collected from the Finnish Medical Birth Register. The odds of NICU admission (with 95% confidence intervals) were compared between the neonates of hypothyroid or hyperthyroid mothers and of mothers without any thyroid diseases by specified neonatal characteristics and morbidities using logistic regression analysis. The studied neonatal characteristics were preterm birth (<37+0 gestational weeks), low birthweight (<2500 g), the rate of small- and large-for-gestational age infants, and eight disease-specific neonatal outcomes: asphyxia, respiratory distress syndrome, meconium aspiration syndrome, pneumothorax, cardiovascular problems, infections, jaundice and hypoglycemia. The most common indications for NICU care were principally the same in the neonates of the mothers with and without thyroid disease: respiratory distress syndrome, infections, preterm birth, low birthweight and neonatal hypoglycemia. The preterm neonates, neonates with low birthweight, and large-for-gestational-age infants had increased odds of NICU admission if their mother had hypothyroidism. Also neonates with cardiovascular problems, jaundice or hypoglycemia associated with maternal diabetes had increased odds of NICU admissions if their mother had hypothyroidism. Further, the preterm neonates, large-for-gestational-age infants, and term infants with jaundice had increased odds of NICU admission if their mother had hyperthyroidism. The most common indications for NICU care were similar for the neonates of the mothers with and without thyroid disease. However, the neonates of the mothers with thyroid diseases were more likely to need NICU care. The neonates of the mothers with thyroid diseases had higher odds of NICU treatment in cases of preterm birth, large for gestational age, and hypoglycemia.

A hypothyroid mother after subtotal thyroidectomy delivered a newborn with hyperthyroidism from fetal stage: a case report

BackgroundNeonatal hyperthyroidism is an extension of fetal disease. Most cases of neonatal hyperthyroidism are transient but may excessively harm multiple organ functions through the actions of maternal thyroid-stimulating hormone receptor antibodies on the neonatal thyroid gland.Case presentationThe hyperthyroid mother underwent subtotal thyroidectomy before pregnancy and regularly took levothyroxine to avoid hypothyroidism, but still had a high-level thyroid-stimulating hormone receptor antibody (TRAb). The neonate suffered from hyperthyroidism due to the transplacental TRAb. After a regular medication schedule of an antithyroid drug, combined with a β-blocker to control the ventricular rate, the infant gradually recovered, allowing normal motor and intellectual development.ConclusionsMaternal subtotal thyroidectomy cannot prevent the secretion of thyroid receptor antibodies, which may cause either hypothyroidism or hyperthyroidism. The balance between antithyroid drugs and levothyroxine is critical in clinical practice.

Maternal hyperthyroidism and pregnancy outcomes: A population-based cohort study.

Maternal hyperthyroidism and antithyroid medications have been associated with adverse pregnancy and perinatal outcomes. This nationwide register-based study investigated the association of maternal hyperthyroidism and antithyroid drug (ATD) use with pregnancy outcomes and included all singleton births in Finland between 2004 and 2013 (N=571785). Hyperthyroid mothers were identified in the Medical Birth Register, and data on ATD use before and/or during pregnancy were collected from the Prescription Register. The odds ratios, with 95% confidence intervals, for adverse outcomes among hyperthyroid mothers and mothers without thyroid disease were compared using logistic regression. In total, 2144 (0.37%) of all the women had diagnoses of hyperthyroidism, and 580 (27%) of these women had used ATDs before and/or during pregnancy. Compared to the mothers without thyroid disease, maternal hyperthyroidism was associated with older age, multiparity, smoking, previous miscarriages, and overweight or obesity. The mothers diagnosed with hyperthyroidism also had increased odds of gestational hypertensive disorders, caesarean sections, placental abruptions, preterm births, small-for-gestational-age newborns and neonatal intensive care unit treatment. The odds of pregnancy and/or perinatal complications were higher among those who had used ATDs (indicative of active disease), but those who had not received ATD treatment also had increased odds of such complications compared to the mothers without thyroid disease. Women with active hyperthyroidism and those with histories of hyperthyroidism should be considered at risk of developing pregnancy and perinatal complications and should therefore be monitored during pregnancy.

Prevalence of thyroid dysfunction in neonatal population

Background: The objectives of this study was to study the prevalence of thyroid disorders in high risk neonatal populations and to study association of maternal thyroid dysfunction with neonatal thyroid problems and outcome.Methods: This was an observational study, conducted in NICU at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. The study included neonates born to mothers with thyroid disorder or with clinical features suggestive of thyroid dysfunction. Neonates with history of maternal thyroid dysfunction were screened at 72 to 96 hrs of postnatal age. Those with TSH &gt;10 mIU/L or free T4 &lt;1.1 ng /ml were followed up after two weeks. The neonates with clinical features suggestive of thyroid dysfunction were screened at presentation and those with abnormal thyroid profile were followed up after two weeks. Results obtained were statistically analyzed using SPSS 17.0 software.Results: Out of 260 neonates screened, 208 neonates were born to mothers with hypothyroidism, 6 neonates had increased levels of TSH during first week which normalised on follow up during third week. One neonate born to hyperthyroid mother, showed increased TSH levels during first week and 2nd week which declined to normal level on follow up at 3rd week. Out of 51 neonates with clinical features suggestive of thyroid dysfunction, born to euthyroid mothers, 3 neonates had increased levels of TSH on presentation which normalised on further follow up. Thus, majority of high risk neonates at birth show transient hypothyroidism.Conclusions: None of the neonate was labelled as hypothyroid, all the 10 neonates showed transient hyperthyrotropinemia.

Antithyroid drugs during breastfeeding.

Antithyroid drugs (ATDs) are widely used for the treatment of Graves' disease (GD) in the general population. Over the past decade, there has been an increasing awareness that several disturbances of thyroid function may occur in mothers after delivery which may be more prevalent than previously appreciated. Exacerbation of immune reactions occurs 3-12 month following delivery. Management of hyperthyroidism during lactation requires special considerations and should be implemented to prevent any adverse outcomes in mother and neonate. Continuation of breastfeeding is safe and should be encouraged in hyperthyroid mothers taking ATDs, whether these are ATDs being continued after gestation or indeed ATD treatment initiated in the postpartum period. Given PTU hepatotoxicity concerns, experts currently recommend using low-to-moderate MMI doses as a first-line therapy in lactating mothers. PTU should be reserved only as a second-line agent for cases of severe hyperthyroidism (thyroid storm) and allergic reactions to previous MMI treatment. ATD should be administered in divided doses immediately following each feeding. Evaluation of thyroid function tests is advisable at least 3-4 weeks after the initiation of breastfeeding.

Maternal Thyroid Function and Autoimmunity in 3 Trimesters of Pregnancy and their Offspring's Thyroid Function.

This study was performed to evaluate maternal thyroid dysfunction and autoimmunity during pregnancy and its correlation with thyroid function of offspring. In this cohort study, Serum TT4, TT3, T3U, TSH, TPOAb, and TgAb were measured. Serum samples of 120 pregnant women were collected during 3 trimesters as well as in 57 cord bloods, 69 neonates, 34, 37, and 36 infants aged 2, 4, and 6 months. Repeated measure and Pearson correlation test were used to compare thyroid hormone values and to assess the correlations, respectively. Main outcomes were correlations between thyroid hormones and antibodies in mothers and offspring. An increasing trend for TT3 (p for trend < 000.1) and TSH (p for trend 0.01) was found over the course of gestation. Among 120 mothers, 10 (8%) had subclinical hyperthyroidism and 18 mothers (15%) showed subclinical hypothyroidism. We found one hypothyroid (0.8%) and 3 hyperthyroid (2.5%) mothers during pregnancy. Correlations among maternal thyroid hormones were found but not with auto-antibodies. A positive correlation between maternal thyroid auto-antibodies in all trimesters with cord blood and neonates was found. Cord blood TSH had a good correlation with maternal TSH, but only in the first trimester (r=0.29, p<0.05). A positive correlation between neonatal TSH and maternal TT4 was found only in the third trimester (r=0.25, p<0.05). Subclinical hypothyroidism was the most common thyroid dysfunction in the pregnant women studied. The association between maternal auto-antibodies and thyroid hormones of offspring was observed mostly in the neonatal period and became weaker after one month of age.

Maternal and Child's Thyroid Function and Child's Intellect and Scholastic Performance.

Maternal hypothyroidism and/or hypothyroxinemia have been associated with child's poor neuropsychological development, but the results have been inconsistent. The Northern Finland Birth Cohort 1986 included all expected births within a year (9362 women, 9479 children) from the two northernmost provinces of Finland. Maternal serum samples (n = 5791) were obtained in early pregnancy (M ± SD = 10.7 ± 2.8 weeks' gestation), and serum samples from their children were obtained at 16 years of age (n = 5829). All samples were analyzed for thyrotropin, free thyroxine (fT4), and thyroid peroxidase antibodies. The children's school performance was evaluated by their main teachers at eight years of age, as well as by the adolescents themselves at 16 years of age. Data on possible severe intellectual deficiency and mild cognitive limitation were collected from healthcare records and registries for all children. Logistic regression estimated the odds of poor school performance or severe intellectual deficiency/mild cognitive limitation associated with exposure to maternal thyroid dysfunction. The odds of poor school performance associated with the adolescents' own thyroid function at age 16 were also estimated. Results are presented as odds ratios (OR) with confidence intervals (CI), adjusted for maternal/family covariates and child's sex. Girls of mothers with subclinical hypothyroidism had more self-evaluated difficulties in mathematics than did girls of euthyroid mothers (OR 1.62 [CI 1.06-2.49]). Boys of hypothyroxinemic mothers repeated a school class more often than did boys of euthyroid mothers (OR 5.46 [CI 1.19-25.06]). Adolescents of hyperthyroid mothers had increased odds of poor self-evaluated performance in mathematics (OR 1.61 [CI 1.01-2.49]). Maternal thyroid dysfunction did not increase the odds of a child having severe intellectual deficiency/mild cognitive limitation. At 16 years of age, girls with hyperthyroidism by laboratory measurements had more difficulties in Finnish language (OR 2.82 [CI 1.42-5.61]) than did euthyroid girls. Boys with hypothyroxinemia by laboratory measurement had higher odds of having difficulties in Finnish and/or mathematics (OR 2.13 [CI 1.26-3.62]) than did euthyroid boys. Maternal thyroid dysfunction during early pregnancy was associated with poorer scholastic performance of the adolescent. Additionally, adolescents' own thyroid dysfunction was associated with difficulties in school performance assessed by self-evaluation.

Ectopic cross-talk between thyroid and retinoic acid signaling: A possible etiology for spinal neural tube defects

Previous studies have highlighted the connections between neural tube defects (NTDs) and both thyroid hormones (TH) and vitamin A. However, whether the two hormonal signaling pathways interact in NTDs has remained unclear. We measured the expression levels of TH signaling genes in human fetuses with spinal NTDs associated with maternal hyperthyroidism as well as levels of retinoic acid (RA) signaling genes in mouse fetuses exposed to an overdose of RA using NanoString or real-time PCR on spinal cord tissues. Interactions between the two signaling pathways were detected by ChIP assays. The data revealed attenuated DIO2/DIO3 switching in fetuses with NTDs born to hyperthyroid mothers. The promoters of the RA signaling genes CRABP1 and RARB were ectopically occupied by increased RXRG and RXRB but displayed decreased levels of inhibitory histone modifications, suggesting that elevated TH signaling abnormally stimulates RA signaling genes. Conversely, in the mouse model, the observed decrease in Dio3 expression could be explained by increased levels of inhibitory histone modifications in the Dio3 promoter region, suggesting that overactive RA signaling may ectopically derepress TH signaling. This study thus raises in vivo a possible abnormal cross-promotion between two different hormonal signals through their common RXRs and the subsequent recruitment of histone modifications, prompting further investigation into their involvement in the etiology of spinal NTDs.

Maternal early-pregnancy thyroid function is associated with subsequent hypertensive disorders of pregnancy: the generation R study.

Hypertensive disorders during pregnancy are associated with a wide range of maternal and fetal complications, and only a few risk factors are known for the development of these disorders during pregnancy. Conflicting and limited data are available on the relationship between thyroid (dys)function and the risk of hypertensive disorders of pregnancy. The objective of the investigation was to study the associations between early-pregnancy thyroid dysfunction, thyroid function within the normal range, and the risk of hypertensive disorders. In early pregnancy, serum TSH, free T4 (FT4), and thyroperoxidase antibody (TPOAb) levels were determined in 5153 pregnant women. No interventions were done. The associations of thyroid function with the risk of hypertensive disorders were studied. Mean blood pressures and hypertensive disorders, including pregnancy-induced hypertension (n = 209) and preeclampsia (n = 136), were measured. Hyperthyroid mothers had a higher risk of hypertensive disorders [odds ratio (OR) 3.40 [95% confidence interval (CI) 1.46-7.91], P = .005], which was mainly due to an increased risk of pregnancy-induced hypertension [OR 4.18 (95% CI 1.57-11.1), P = .004]. Hypothyroidism and hypothyroxinemia were not associated with hypertensive disorders. Within the normal range, the high-normal FT4 levels were associated with an increased risk of hypertensive disorders [OR 1.62 (95% CI 1.06-2.47), P = .03], which was mainly due to an increased risk of preeclampsia [OR 2.06 (95% CI 1.04-4.08), P = .04]. The TPOAb status was not associated with hypertensive disorders. We show that biochemical hyperthyroidism and also high-normal FT4 levels during early pregnancy are associated with an increased risk of hypertensive disorders. These data demonstrate that these associations are even seen for a mild variation in thyroid function within the normal range.

Pregnancy Outcome in Hyperthyroidism: A Case Control Study

Background: Data comparing pregnancy outcome in hyperthyroid women with euthyroid women are scarce. Hence, this study was carried out to assess the maternal and fetal outcome in pregnant women with hyperthyroidism to ascertain the effect of disease on pregnancy. Methodology: This retrospective study was conducted over a period of 28 years. We compared the maternal and fetal outcomes of 208 hyperthyroid women with 403 healthy controls, between women with well-controlled and uncontrolled disease and amongst women diagnosed with hyperthyroidism before and during pregnancy. Results: Maternal outcome: women with hyperthyroidism were at increased risk for preeclampsia (OR = 3.94), intrauterine growth restriction (OR = 2.16), spontaneous preterm labor (OR = 1.73), preterm birth (OR = 1.7), gestational diabetes mellitus (OR = 1.8), and cesarean delivery (OR = 1.47). Hyperthyroid women required induction of labor more frequently (OR = 3.61). Fetal outcome: newborns of hyperthyroid mothers had lower birth weight than normal ones (p = 0.0001). Women with uncontrolled disease had higher odds for still birth (OR = 8.42; 95% CI: 2.01-35.2) and lower birth weight (p = 0.0001). Conclusions: Obstetrical complications were higher in women with hyperthyroidism than normal women. Outcome was worsened by uncontrolled disease. Women with pregestational hyperthyroidism had better outcomes than those diagnosed with it during pregnancy.

Maternal hyperthyroidism increases the prevalence of foregut atresias in fetal rats exposed to adriamycin

Gastrointestinal malformations such as esophageal atresia with tracheoesophageal fistula (EA/TEF) and duodenal atresia (DA) have been reported in infants born to hyperthyroid mothers or with congenital hypothyroidism. The present study aimed to test whether maternal thyroid status during embryonic foregut division has any influence on the prevalence of EA/TEF and DA in an accepted rat model of these malformations. Pregnant rats received either vehicle or 1.75 mg/kg i.p. adriamycin on gestational days 7, 8 and 9. Transient maternal hyper or hypothyroidism was induced by oral administration of levothyroxine (LT4, 50 μg/kg/day) or propylthiouracil (PTU, 2 mg/kg/day), respectively, on days 7 to 12 of gestation. Plasma cholesterol, total T3, free T4 and TSH were measured at gestational days 7, 12, and 21. At the end of gestation, the mothers were sacrificed and embryo-fetal mortality was recorded. Fetuses were dissected to determine the prevalence of esophageal and intestinal atresias. At gestational day 12, mothers treated with LT4 or PTU had hyper or hypothyroid status, respectively; plasma cholesterol levels were similar. In the adriamycin-exposed fetuses from hyperthyroid mothers, the embryonal resorption rate and the prevalence of both EA/TEF and DA were significantly higher than in the other groups; maternal hypothyroidism during the same period did not have significant effect on the prevalence of atresias. Maternal hyperthyroidism during the embryonic window corresponding to foregut cleavage increased the prevalence of both EA/TEF and duodenal atresia in fetal rats exposed to adriamycin. This suggests that maternal thyroid hormone status might be involved in the pathogenesis of foregut atresias and invites further research on this likely clinically relevant issue in humans.

Maternal Thyroid Dysfunction During Pregnancy and Thyroid Function of Her Child in Adolescence

Normal maternal thyroid function is important for fetal development. No knowledge exists on how maternal thyroid function and thyroid antibodies during early pregnancy affect thyroid function of the offspring. The aim of this study was to investigate the relationship between maternal and adolescent thyroid function parameters. A total of 3673 mother-child pairs from the prospective, population-based Northern Finland Birth Cohort 1986 participated in the study. Maternal serum samples were drawn in early pregnancy (<20th gestational week), and children's samples were drawn at the age of 16 years and analyzed for TSH, free T4 (fT4), and thyroid peroxidase antibodies (TPO-Abs). TSH, fT4, and TPO-Ab concentrations were measured at the age of 16 years. Children of mothers with thyroid dysfunction (hypothyroidism, hyperthyroidism, or hypothyroxinemia) or TPO-Ab positivity were compared to those of euthyroid or TPO-Ab-negative mothers. The distributions are expressed as medians with 5th to 95th percentiles. Boys of hypothyroid mothers had higher TSH concentrations than those of euthyroid mothers: 2.0 (0.9-4.0) vs 1.7 (0.8-3.3) mU/L; P = .001. Children of hyperthyroid mothers had lower TSH concentrations than those of euthyroid mothers: 1.3 (0.6-4.2) vs 1.7 (0.8-3.3) mU/L, P = .013, for boys; and 1.3 (0.5-3.5) vs 1.6 (0.7-3.4) mU/L, P = .034, for girls. There were no differences in TSH or fT4 concentrations between children of hypothyroxinemic and euthyroid mothers. TPO-Ab-positive mothers more often had TPO-Ab-positive children (prevalence, 9.0 vs 3.7% among boys, and 22.7 vs 7.5% among girls). Maternal thyroid dysfunction and TPO-Ab positivity during pregnancy seem to modify thyroid function parameters of offspring even in adolescence. Whether this increases the thyroid disease risk of the children is still unknown.

Severe congenital non-autoimmune hyperthyroidism associated to a mutation in the extracellular domain of thyrotropin receptor gene

Activating mutations in the TSH Receptor (TSHR) gene have been identified as the molecular basis for congenital non-autoimmune hyperthyroidism. We describe the clinical findings and molecular characterization in a girl who presented severe non-autoimmune hyperthyroidism since birth, born to a mother with autoimmune thyroid disease. She was treated with methylmercaptoimidazol and β-blockers, but remained hyperthyroid and required total thyroidectomy. To characterize the presence of an activating mutation, the whole coding sequence and intron-exon boundaries of TSHR gene were analyzed. The patient was heterozygous for p.Ser281Asn mutation and p.Asp727Glu polymorphism. This recurrent mutation, p.Ser281Asn, characterized in vitro by increased basal production of cAMP, is the unique germline activating gene variant described so far in the extracellular domain of TSH receptor. Interestingly, the patient's mother presented hyperthyroidism but without any TSHR gene activating mutation. Although congenital non-autoimmune hyperthyroidism is a rare condition, it should be investigated when severe disease persists, even in a newborn from an autoimmune hyperthyroid mother, in order to differentiate it from the more common congenital autoimmune disease.

Fetal Free Thyroxine Concentrations in Pregnant Women with Autoimmune Thyroid Disease

Fetuses from mothers with autoimmune thyroid disease (AITD) may be affected by antithyroid antibodies, antithyroid drugs, and iodine. The study correlated fetal free T(4) (fT4) with fetal ultrasound parameters and maternal thyroid function, thyroid antibodies, and medication dose from mothers with AITD. The study was designed as a prospective cohort study and conducted in an academic referral center. Eighty-three of 85 women with AITD completed the study; 38 were treated for hyperthyroidism and 25 for hypothyroidism, and 20 were euthyroid. Outcomes were as follows: 1) fetal-fT4, TSH, ultrasound parameters (morphology, biometrics, heart rate); and 2) maternal-fT4, TSH, antithyroid drug dose, and antithyroid antibodies, thyroid peroxidase and TSH receptor (TRAK). Parameters were determined at the same time, between the 22nd and 33rd wk gestation. A total of 48.3% of fetuses from hyperthyroid mothers, 60% of fetuses from hypothyroid mothers, and 10% of fetuses from euthyroid mothers had elevated fT4 levels (P = 0.006). In hypothyroid mothers, the presence of both thyroid antibodies was related to fetal hyperthyroidism, whereas absence was related to fetal euthyroidism (P = 0.019). Hyperthyroid mothers (TRAK-positive, thyroid peroxidase-negative) with hyperthyroid fetuses had significantly higher mean TRAK than hyperthyroid mothers with euthyroid fetuses (13.7 vs. 3.7 IU/liter; P = 0.02). Fetal fT4 correlated weakly negatively with maternal TSH within the normal range, but not with ultrasound parameters or with antithyroid drug dose. High fetal fT4 levels were unexpectedly frequent in women with AITD, including maternal autoimmune hypo- and hyperthyroidism. Further studies are needed, as well as noninvasive methods to assess fetal thyroid function.

Effects of experimentally induced maternal hypothyroidism and hyperthyroidism on the development of rat offspring: II—The developmental pattern of neurons in relation to oxidative stress and antioxidant defense system

Excessive concentrations of free radicals in the developing brain may lead to neurons maldevelopment and neurons damage and death. Thyroid hormones (THs) states play an important role in affecting the modulation of oxidative stress and antioxidant defense system. Thus, the objective of this study was to clarify the effect of hypothyroidism and hyperthyroidism in rat dams on the neurons development of different brain regions of their offspring at several postnatal weeks in relation to changes in the oxidative stress and antioxidant defense system. The adult female rats were administered methimazole (MMI) in drinking water (0.02% w/v) from gestation day 1 to lactation day 21 to induce hypothyroidism and exogenous thyroxine (T4) in drinking water (0.002% w/v) beside intragastric incubation of 50––200 T4μg/kg body weight (b. wt.) to induce hyperthyroidism. In normal female rats, the sera total thyroxine (TT4) and total triiodothyronine (TT3) levels were detectably increased at day 10 post-partum than those at day 10 of pregnancy. Free thyroxine (FT4), free triiodothyronine (FT3), thyrotropin (TSH) and growth hormone (GH) concentrations in normal offspring were elevated at first, second and third postnatal weeks in an age-dependent manner. In hypothyroid group, a marked depression was observed in sera of dam TT3 and TT4 as well as offspring FT3, FT4 and GH, while there was a significant increase in TSH level with the age progress. The reverse pattern to latter state was recorded in hyperthyroid group. Concomitantly, in control offspring, the rate of neuron development in both cerebellar and cerebral cortex was increased in its density and complexity with age progress. This development may depend, largely, on THs state. Both maternal hypothyroidism and hyperthyroidism caused severe growth retardation in neurons of these regions of their offspring from the first to third weeks. Additionally, in normal offspring, seven antioxidant enzymes, four non-enzymatic antioxidants and one oxidative stress marker (lipid peroxidation, LPO) followed a synchronized course of alterations in cerebrum, cerebellum and medulla oblongata. In both thyroid states, the oxidative damage has been demonstrated by the increased LPO and inhibition of enzymatic and non-enzymatic antioxidants in most examined ages and brain regions. These disturbances in the antioxidant defense system led to deterioration in the neuronal maturation and development. In conclusion, it can be suggested that the maldevelopment of neurons and dendrites in different brain regions of offspring of hypothyroid and hyperthyroid mother rat dams may be attributed, at least in part, to the excess oxidative stress and deteriorated antioxidant defense system in such conditions.

Thyroid aplasia in male sibling of heterozygotic twins born to the hyperthyroid mother treated with propylthiouracil during pregnancy (case report)

A30-year-old pregnant female was diagnosed to have thyrotoxicosis (TSH= 0.005 µU/ml) at 13th week of gestation. Propylthiouracil (PTU; 200 mg daily) was prescribed to her and four weekly follow ups by the endocrinologist and obstetrician were ensured. At each examination TSH, FT4 and FT3 levels were normal and she became symptom free. Repeated ultrasound examination throughout the pregnancy did not reveal any fetal abnormality. The lady normally delivered heterozygotic twins. Umbilical cord blood of the baby boy twin showed ahigh TSH (541 µU/ml; reference range 0.270 - 4.20 μU/ml). He was started on thyroxine therapy (50 µg once daily). Ultrasound reported the absence of the thyroid gland. One month later TSH was within normal range and thyroxine dose was adjusted to 25 µg once daily. Repeated ultrasound confirmed the absence of thyroid gland. TSH was repeatedly normal. The boy is currently doing well on thyroxine replacement therapy. The other non-identical twin was ahealthy girl with normal thyroid function tests and always thereafter. This case report suggested that PTU could be ahazardous drug to the fetus, since the mother gave birth to ababy with thyroid aplasia. PTU, Thyroid aplasia, Thyrotoxicosis, TSH.

Maternal Thyroid Autoantibodies Predict Poor Perinatal Outcomes

Endocrinology| July 01 2009 Maternal Thyroid Autoantibodies Predict Poor Perinatal Outcomes AAP Grand Rounds (2009) 22 (1): 5. https://doi.org/10.1542/gr.22-1-5 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Maternal Thyroid Autoantibodies Predict Poor Perinatal Outcomes. AAP Grand Rounds July 2009; 22 (1): 5. https://doi.org/10.1542/gr.22-1-5 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: perinatal period, thyroid autoantibodies, thyroid diseases, antibodies Source: Männistö T, Vääräsmäki M, Pouta A, et al. Perinatal outcome of children born to mothers with thyroid dysfunction or antibodies: a prospective population-based cohort study. J Clin Endocrinol Metab. 2009;94(3):772–779; doi:10.1210/jc.2008-1520 Investigators from Finland and the UK prospectively evaluated the effect of maternal thyroid dysfunction and autoimmunity on perinatal outcomes. Data on 9,247 pregnant Finnish women and their singleton births from the Northern Finland Birth Cohort were analyzed. Blood samples from a subset of mothers during the first trimester were analyzed for serum free T4 (fT4), thyroid stimulating hormone (TSH), thyroid-peroxidase antibody (TPO-Ab), and thyroglobulin antibody (TG-Ab). The study participants were divided into four groups based on thyroid studies: 1) clinical hypothyroidism (high TSH, low fT4); 2) subclinical hypothyroidism (high TSH, normal fT4); 3) subclinical hyperthyroidism (low TSH, normal fT4); and 4) clinical hyperthyroidism (low TSH, high fT4). Blood samples were available from 5,805 mothers. Approximately 1% (n=54) had clinical hypothyroidism, 4% (n=224) subclinical hypothyroidism, 4% (n=204) subclinical hyperthyroidism, and 1.5% (n=77) clinical hyperthyroidism. Approximately 5% had TPO-Ab or TG-Ab positivity. Infants born to clinically hyperthyroid mothers were more likely to be large for gestational age (6.6% vs 2.5%) although this effect disappeared after correction for maternal age and parity. Infants born to TPO-Ab positive but not TG-Ab positive mothers were more likely to have low birth weight or be large for gestational age. The adjusted odds ratio of perinatal death among children born to TPO-Ab positive mothers was 3.2 (95% CI, 1.4–7.1) and 2.5 (95% CI, 1.1–5.9) for children born to TG-Ab positive mothers. More than half the deaths among children born to thyroid autoantibody positive mothers occurred in infants born at less than 28 weeks gestation. The authors conclude that positive maternal thyroid autoantibody but not thyroid hormone status is a risk factor for perinatal death. Dr Varma has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. This large Finnish study sheds new light on the relationship of maternal thyroid disease and perinatal outcomes, an issue that has been addressed in previous studies.1,–3 Prior investigations suggested that thyroid dysfunction is associated with spontaneous abortions, fetal death, premature births, microcephaly, low birth weight, and impaired psychological development.4,5 The strengths of this current study are its large size and relatively complete collection of data on this cohort. The data support the authors’ conclusion that maternal thyroid autoantibodies detected during the first trimester are independently associated with risk for perinatal mortality, most likely through a higher incidence of pre-term delivery. However, the authors also acknowledge that, even with this large cohort, perinatal mortality was a rare event and thus the actual risk may be different from that seen in this study. In addition, because the Finnish population is 99% Caucasian the study needs to be replicated in more ethnic groups before its results are applied to a diverse populace such as that of... You do not currently have access to this content.

Thyroid Disorders of Neonates Born to Mothers with Graves' Disease

Maternal hyperthyroidism implies the risk of thyroid abnormalities in the newborn. We describe retrospectively the clinical presentation, treatment and follow up of 28 children born of hyperthyroid mothers. Patients were subdivided as follows: Group A (neonatal hyperthyroidism) (n=9): born from eight hyperthyroid mothers and one thyroidectomized mother. Children born from untreated mothers consulted between 1 and 7 days of life, while those born from treated mothers consulted between 8 and 17 days. Eight needed treatment. All remitted completely. Group B (primary hypothyroidism) (n=14): born from treated mothers, detected by neonatal screening. Eleven had transient hypothyroidism and three needed treatment. Group C (hypothalamic-pituitary hypothyroidism) (n=5): born from uncontrolled hyperthyroid mothers and found during follow up (age 9-28 days). The infants were treated with thyroid hormone, and recovered before 8 months of life. Every child born from a mother with autoimmune thyroid disease needs paediatric endocrinological assessment for detection of possible thyroid disorders.

Congenital segmental dilatation of the small bowel

Antenatal ultrasonographic examination at 30 weeks' gestation of a hyperthyroid mother, revealed a large sonolucent lesion 2.6 × 3.5 cm (Fig 1) on the right side of the abdomen of a male fetus. It was thought to be either a choledochal cyst or an enteric duplication cyst, and in the absence of significant increase in size or polyhydramnios on follow-up, it was decided to manage the condition after a normal term delivery. At 3 hours of age, progressive abdominal distension developed with respiratory distress that required intubation and ventilatory support. Plain film of the chest and abdomen (Fig 2) showed a radiolucent cystic lesion occupying the entire right side of the abdomen and crossing the midline. The neonate also showed dysmorphic features (low set ears, focal dermal hypoplasia of scalp, hypoplastic nipples and nails, and left-sided choanal atresia) and chromosomal analysis revealed 46,XY, (15p+). Exploratory laparotomy revealed isolated segmental dilatation and hypertrophy of the distal jejunum 10 cm in length, requiring excision; end-to-end anastomosis was also done. The neonate made an uneventful recovery and histopathology of the resected bowel showed no abnormality.

Hyperthyroidism and production of precocious involution in the mammary glands of lactating rats

This study investigated the influence of chronic hyperthyroidism on mammary function in lactating rats and the effects on their pups. Thyroxine-treated (10 microg per 100 g body weight per day; hyperthyroid (HT)) or vehicle-treated rats were mated 2 weeks after the start of treatment and killed with their litters on days 7, 14 and 21 of lactation. Serum concentrations of triiodothyronine (T(3)) and tetraiodothyronine (T(4)) increased in thyroxine-treated rats. In HT mothers, serum prolactin decreased on day 7 and day 14 of lactation, whereas insulin-like growth factor I (IGF-I) and progesterone concentrations decreased, and corticosterone increased on day 7 of lactation. In HT pups, T(4) concentration increased on day 7 and day 14 of lactation, whereas T(3) increased only on day 14 of lactation, and growth hormone increased on day 7 of lactation. Mammary prolactin binding sites did not vary, but there was an increase in the binding sites in the liver on day 14 of lactation in thyroxine-treated rats. In an acute suckling experiment, thyroxine-treated rats released less oxytocin, growth hormone and prolactin and excreted less milk than did control rats. Mammary casein, lactose and total lipid concentrations in thyroxine-treated rats were similar to those of control rats on day 14 of lactation. Histological studies of the mammary glands showed an increased proportion of alveoli showing reduced or no lumina and cells with condensed nuclei on day 14 and day 21 of lactation; the TdT-mediated dUTP nick-end labelling (TUNEL) test revealed an increase in apoptosis in alveolar cells on day 21 of lactation in thyroxine-treated rats. Expression of SGP-2, a gene expressed during mammary involution, increased in thyroxine-treated rats on day 14 and day 21 of lactation, whereas expression of insulin-like growth factor binding protein 5, a proapoptotic signal, was unchanged. Bcl-2, which promotes survival of mammary gland epithelial cells was unchanged, whereas expression of IGF-I, which also promotes survival of mammary gland epithelial cells, increased on day 21 of lactation in thyroxine-treated rats. These results indicate that thyroxine treatment produces some milk stasis as a result of impairments in suckling induced release of oxytocin that may initiate the first stage of mammary involution, increasing apoptosis in a gland that is otherwise actively producing and secreting milk.