Outcome of Three Neonates Born to Two Goitrous Mothers with High Levels of Thyrotropin Receptor Blocking Antibodies at the Singapore General Hospital

  • Chiaw-Ling Chng Department of Endocrinology, Singapore General Hospital
  • Su Chin Ho Department of Endocrinology, Singapore General Hospital
  • Daphne Hsu Chin Khoo Department of Endocrinology, Singapore General Hospital

Abstract

Objective. We report the thyroid function of 3 neonates born to 2 goitrous mothers with high levels of thyroid binding inhibitory immunoglobulin (TBII) and TSH receptor blocking antibodies (TSBAb).

 

Methodology. A retrospective chart review of 3 neonates born to 2 goitrous mothers managed in a tertiary institution in Singapore.

 

Results. Patient A had a long-standing history of Graves’ disease (GD) but developed spontaneous hypothyroidism during pregnancy. At 32 weeks, she was found to have high levels of TBII and TSBAb. The neonate had mildly elevated TSH levels for 15 weeks but serum thyroxine levels (subclinical hypothyroidism) remained normal without treatment. The patient became pregnant again 3 years later. The second offspring had TBII with strong TSBAb activity during the perinatal period but remained euthyroid. Patient B was diagnosed with primary hypothyroidism at the age of 13. Subsequent tests revealed strong TBII and TSBAb activity. She became pregnant at age 27 and her TBII levels remained > 40IU/L throughout pregnancy. Her offspring was born with an elevated TBII level of 22.6 IU/L (NR 0-1.5) but normal thyroid function.

 

Conclusion. These cases illustrate that high levels of maternal TSBAb need not necessarily result in neonatal hypothyroidism and also suggest that the maternal and fetal thyroidal responses to these antibodies may not be identical

Downloads

Download data is not yet available.

References

Zakarija M, McKenzie JM. The spectrum and significance of autoantibodies reacting with the thyrotropin receptor. Endocrinol Metab Clin North Am 1987;16:343-63.

McGregor AM. Autoantibodies to the TSH receptor in patients with autoimmune thyroid disease. Clin Endocrinol (Oxf) 1990;33:683-5.

Rees Smith B, McLachlan SM, Furmaniak J. Autoantibodies to the thyrotropin receptor. Endocr Rev 1988;9:106-21.

Zakarija M, McKenzie JM, Eidson MS. Transient neonatal hypothyroidism: Characterization of maternal antibodies to the thyrotropin receptor. J Clin Endocrinol Metab 1990;70:1239-46.

Kung AW, Jones BM. A change from stimulatory to blocking antibody activity in Graves' disease during pregnancy. J Clin Endocrinol Metab 1998;83:514-8.

Kraiem Z, Lahat N, Glaser B, Baron E, Sadeh O, Sheinfeld M. Thyrotrophin receptor blocking antibodies: Incidence, characterization and in-vitro synthesis. Clin Endocrinol (Oxf) 1987;27:409-21.

Sato K, Okamura K, Yoshinari M et al. Goitrous hypothyroidism with blocking or stimulating thyrotropin binding inhibitor immunoglobulins. J Clin Endocrinol Metab 1990;71:855-60.

Gauna A, Segura G, Sartorio G, Soto R, Segal-Eiras A. Immunological aspects of Graves' disease patients in different clinical stages. J Endocrinol Invest 1989;12:671-7.

Tada H, Izumi Y, Watanabe Y et al. Blocking type anti-TSH receptor antibodies detected by radioreceptor assay in Graves' disease. Endocr J 2001;48:703-10.

Tada H, Mizuta I, Takano T et al. Blocking-type anti-TSH receptor antibodies and relation to responsiveness to antithyroid drug therapy and remission in Graves' disease. Clin Endocrinol (Oxf) 2003;58:403-8.

Kraiem Z, Baron E, Kahana L, Sadeh O, Sheinfeld M. Changes in stimulating and blocking TSH receptor antibodies in a patient undergoing three cycles of transition from hypo to hyper-thyroidism and back to hypothyroidism. Clin Endocrinol (Oxf) 1992;36:211-4.

Weetman AP, McGregor AM. Autoimmune thyroid disease: Further developments in our understanding. Endocr Rev 1994;15:788-830.

Amino N, Kuro R, Tanizawa O et al. Changes of serum anti-thyroid antibodies during and after pregnancy in autoimmune thyroid diseases. Clin Exp Immunol 1978;31:30-7.

Hidaka Y, Tamaki H, Iwatani Y, Tada H, Mitsuda N, Amino N. Prediction of post-partum Graves' thyrotoxicosis by measurement of thyroid stimulating antibody in early pregnancy. Clin Endocrinol (Oxf) 1994;41:15-20.

Amino N, Izumi Y, Hidaka Y et al. No increase of blocking type anti-thyrotropin receptor antibodies during pregnancy in patients with Graves' disease. J Clin Endocrinol Metab 2003;88:5871-4.

Schwarz-Lauer L, Chazenbalk GD, McLachlan SM, Ochi Y, Nagayama Y, Rapoport B. Evidence for a simplified view of autoantibody interactions with the thyrotropin receptor. Thyroid 2002;12:115-20.

McKenzie JM, Zakarija M. Fetal and neonatal hyperthyroidism and hypothyroidism due to maternal TSH receptor antibodies. Thyroid 1992;2:155-9.

Matsuura N, Yamada Y, Nohara Y et al. Familial neonatal transient hypothyroidism due to maternal TSH-binding inhibitor immunoglobulins. N Engl J Med 1980;303:738-41.

Connors MH, Styne DM. Transient neonatal 'athyreosis' resulting from thyrotropin-binding inhibitory immunoglobulins. Pediatrics 1986;78:287-90.

Francis G, Riley W. Congenital familial transient hypothyroidism secondary to transplacental thyrotropin-blocking autoantibodies. Am J Dis Child 1987;141:1081-3.

Brown RS, Bellisario RL, Botero D et al. Incidence of transient congenital hypothyroidism due to maternal thyrotropin receptor-blocking antibodies in over one million babies. J Clin Endocrinol Metab 1996;81:1147-51.

Beierwaltes WH, Dodson VN, Wheeler AH. Thyroid autoantibodies in the families of cretins. J Clin Endocrinol Metab 1959;19:179-82.

Evans C, Jordan NJ, Owens G, Bradley D, Ludgate M, John R. Potent thyrotrophin receptor-blocking antibodies: A cause of transient congenital hypothyroidism and delayed thyroid development. Eur J Endocrinol 2004;150:265-8.

Goldsmith RE, McAdams AJ, Larsen PR, McKenzie M, Hess E. Familial autoimmune thyroiditis: maternal-fetal relationship and the role of generalized autoimmunity. J Clin Endocrinol Metab 1973;37:265-75.

Brown RS, Bellisario RL, Mitchell E, Keating P, Botero D. Detection of thyrotropin binding inhibitory activity in neonatal blood spots. J Clin Endocrinol Metab 1993;77:1005-8.

Kohler B, Schnabel D, Biebermann H, Gruters A. Transient congenital hypothyroidism and hyperthyrotropinemia: Normal thyroid function and physical development at the ages of 6-14 years. J Clin Endocrinol Metab 1996;81:1563-7.

Radunovic N, Dumez Y, Nastic D, Mandelbrot L, Dommergues M. Thyroid function in fetus and mother during the second half of normal pregnancy. Biol Neonate 1991;59:139-48.

Ballabio M, Nicolini U, Jowett T, Ruiz de Elvira MC, Ekins RP, Rodeck CH. Maturation of thyroid function in normal human foetuses. Clin Endocrinol (Oxf) 1989;31:565-71.

Published
2014-05-22
How to Cite
Chng, C.-L., Ho, S. C., & Chin Khoo, D. H. (2014). Outcome of Three Neonates Born to Two Goitrous Mothers with High Levels of Thyrotropin Receptor Blocking Antibodies at the Singapore General Hospital. Journal of the ASEAN Federation of Endocrine Societies, 27(1), 92. Retrieved from https://asean-endocrinejournal.org/index.php/JAFES/article/view/20
Section
Case Reports