scholarly journals A Case of Neonatal Thyrotoxicosis with Cardiac Insufficiency

2021 ◽  
Vol 28 (4) ◽  
pp. 161-166
Author(s):  
Ji Eun Jeong ◽  
So Hee Lee ◽  
Young Hyun Kim ◽  
Yoon Young Jang ◽  
Jin-Kyung Kim
Keyword(s):  
Male Infant ◽  
Cardiac Insufficiency ◽  
Careful Examination ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Normal Thyroid ◽  
Normal Thyroid Function ◽  
Maternal Thyroid ◽  
Blocking Antibodies ◽  
Neonatal Thyrotoxicosis

Neonatal thyrotoxicosis is rare and most of the cases are secondary to maternal Graves’ disease. It is usually transient, but can be associated with significant morbidity and mortality if not recognized promptly and treated adequately. Neonates born to mothers treated with antithyroid drugs or those who receive maternal thyroid blocking antibodies may exhibit normal thyroid function or even hypothyroidism at birth. Since there may not be any obvious symptoms of hyperthyroidism at birth, it may be overlooked. Therefore, such neonates should be evaluated properly and monitored regularly to prevent serious complications of hyperthyroidism. We report a case of a 21-day-old male infant who developed thyrotoxicosis with dyspnea, irritability, tachycardia, and cardiac insufficiency. He was born to a mother who was treated for Graves’ disease with antithyroid drugs during pregnancy. We have also discussed the importance of careful examination and monitoring to prevent the development of clinical hyperthyroidism.

scholarly journals Clinical course of euthyroid subjects with positive TSH receptor antibody: how often does Graves’ disease develop?

2021 ◽  
Author(s):  
Nami Suzuki ◽  
Akiko Kawaguchi ◽  
Jaeduk Yoshimura Noh ◽  
Ran Yoshimura ◽  
Kentaro Mikura ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Clinical Course ◽  
Tsh Receptor ◽  
Graves Disease ◽  
Normal Thyroid ◽  
Receptor Antibody ◽  
Female Patients ◽  
Tsh Receptor Antibody ◽  
Normal Thyroid Function ◽  
Positive Results

Abstract Background Thyroid stimulating hormone (TSH) receptor antibody (TRAb) is detected in the serum of patients with Graves’ disease (GD). This study aims to investigate the prevalence of euthyroid individuals showing positive results for TRAb and to clarify the clinical course of thyroid function and TRAb levels in these subjects. Objective Subjects were female patients who newly visited our hospital for a screening test prior to fertility treatment and showed normal thyroid function and volume without nodules between 2014 and 2017. After excluding subjects with a history of thyroid disease, 5,622 subjects were analyzed. Results Forty-seven of the 5,622 subjects showed positive results for TRAb (reference range, < 2.0 IU/L) at the initial visit. Median initial TRAb was 2.9 IU/L (range, 2.0 -14.7 IU/L) and median follow-up was 18.3 months (range, 0- 66.5 months). Six of the 47 subjects (12.8%) developed GD and median duration until development was 6.6 months (range, 1.2 -13.2 months). Median TRAb values initially and at diagnosisof GD for those 6 patients were 3.7 IU/L (range, 2.7 -5.1 IU/L) and 7.2 IU/L (range 3.6 -21.4 IU/L), respectively. TRAb results turned negative for 20 of the 47 subjects, but remained positive despite normal thyroid function in 13 of the 47 subjects. Conclusion GD developed over time in 12.8% of euthyroid young female patients showing positive TRAb within a median of 6.6 months. A positive result for TRAb itself did not mean development of GD, so other factors must be essential for the pathogenesis of GD.

Graves’ disease in a five-month-old boy with an unusual treatment course

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Svetlana Azova ◽  
Farrah Rajabi ◽  
Biren P. Modi ◽  
Laura Mansfield ◽  
Maureen M. Jonas ◽  
...  
Keyword(s):  
De Novo ◽  
Thyroid Autoimmunity ◽  
Mitochondrial Disorder ◽  
Male Infant ◽  
Left Ventricular ◽  
Definitive Treatment ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
First Line Therapy ◽  
Hpt Axis

AbstractObjectivesGraves’ disease (GD) is rare in children under age five years. Antithyroid drugs are typically first-line therapy but carry the risks of agranulocytosis and liver dysfunction.Case presentationA male infant with multiple congenital anomalies, left ventricular hypertrophy, and neurologic dysfunction developed GD at five months of life. The presence of chronic hepatitis complicated medical management. Potassium iodide was effective temporarily, but urgent thyroidectomy was required at nine months of age. Postoperatively, the patient developed a thyroid function pattern consistent with impaired pituitary sensitivity to thyroid hormone (TH) that responded to the addition of liothyronine. Exome sequencing revealed a heterozygous de novo duplication of the ATAD3 gene cluster, suggesting a possible mitochondrial disorder.ConclusionsThis case describes the youngest child to date to be diagnosed with endogenous GD and to successfully undergo definitive treatment with thyroidectomy. An underlying defect in mitochondrial function is suspected, suggesting a potential novel pathophysiologic link to early-onset thyroid autoimmunity. Additionally, this case illustrated the development of impaired pituitary sensitivity to TH following thyrotoxicosis of postnatal onset, which may contribute to our understanding of hypothalamic-pituitary-thyroid (HPT) axis development.

Thyroid hypoechogenic pattern at ultrasonography as a tool for predicting recurrence of hyperthyroidism after medical treatment in patients with Graves' disease

1992 ◽  
Vol 126 (2) ◽  
pp. 128-131 ◽  
Author(s):  
Paolo Vitti ◽  
Teresa Rago ◽  
Francesco Mancusi ◽  
Stefania Pallini ◽  
Massimo Tonacchera ◽  
...  
Keyword(s):  
Antithyroid Drugs ◽  
Graves Disease ◽  
Study Group ◽  
Thyrotropin Receptor ◽  
Thyroid Ultrasonography ◽  
Normal Thyroid ◽  
End Of Treatment ◽  
The Relationship ◽  
Prediction Of Relapse

An abnormal thyroid echographic pattern characterized by a diffuse low echogenicity has been described in Hashimoto's thyroiditis and Graves' disease. The aim of the present work was to study the relationship between thyroid hypoechogenicity and the outcome of treatment for hyperthyroidism with antithyroid drugs in patients with Graves' disease. The study group included 105 patients who underwent a course of methimazole treatment. Thyroid ultrasonography was carried out at diagnosis, and autoantibodies to thyrotropin receptor (TR-ab) were measured at the end of treatment. During the follow-up after methimazole treatment, 87/105 (83%) patients had relapse of hyperthyroidism and 18/105 (17%) were in remission. Recurrence of hyperthyroidism occurred in 71/76 (93%) patients with thyroid hypoechogenicity and in 16/29 (55%) of those with normal thyroid echogenicity (ϰ2= 19.0; p<0.0001). Positive TR-ab values at the end of methimazole treatment were found in 59/76 (78%) patients with thyroid hypoechogenicity and in 12/29 (41%) patients with normal thyroid echogenicity (ϰ2 = 10.9; p< 0.0001). Sixty-five/87 (74%) patients with relapse of hyperthyroidism and 6/18(3 3%) of those who remained euthyroid were TR-ab-positive at the end of methimazole treatment (ϰ2 = 9.8; p< 0.002). The finding of thyroid hypoechogenicity at diagnosis had higher specificity (0.81) and sensitivity (0.72) with respect to TR-ab positivity at the end of methimazole treatment (0.74 and 0.66 respectively) for the prediction of relapse of hyperthyroidism. Therefore, the evaluation of thyroid echographic pattern can be considered a useful prognostic tool in patients with Graves' disease.

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

2019 ◽  
Vol 09 (04) ◽  
pp. e341-e345 ◽  
Author(s):  
Yiwen Cui ◽  
Asha Rijhsinghani
Keyword(s):  
Antithyroid Drug ◽  
Activity Level ◽  
Graves Disease ◽  
Neonatal Diagnosis ◽  
Ultrasound Findings ◽  
Thyroid Function Testing ◽  
History Of ◽  
Neonatal Thyroid Function ◽  
Maternal Thyroid ◽  
Neonatal Thyrotoxicosis

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.

scholarly journals Management of Graves' hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy

2009 ◽  
Vol 160 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Peter Laurberg ◽  
Claire Bournaud ◽  
Jesper Karmisholt ◽  
Jacques Orgiazzi
Keyword(s):  
Drug Therapy ◽  
Thyroid Function ◽  
Antithyroid Drug ◽  
Autoimmune Disorder ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Limited Effect ◽  
Antithyroid Drug Therapy ◽  
Maternal Thyroid ◽  
In Pregnancy

Graves' disease is a common autoimmune disorder in women in fertile ages. The hyperthyroidism is causedby generation of TSH-receptor activating antibodies. In pregnancy both the antibodies and the antithyroid medication given to the mother pass the placenta and affect the foetal thyroid gland. Thyroid function should be controlled not only in the mother with Graves' hyperthyroidism but also in her foetus.The review includes two cases illustrating some of the problems in managing Graves' disease in pregnancy.Major threats to optimal foetal thyroid function are inadequate or over aggressive antithyroid drug therapy of the mother. It should be taken into account that antithyroid drugs tend to block the foetal thyroid function more effectively than the maternal thyroid function, and that levothyroxin (l-T4) given to the mother will have only a limited effect in the foetus.Surgical thyroidectomy of patients with Graves' hyperthyroidism does not lead to immediate remission of the autoimmune abnormality, and the combination thyroidectomy+withdrawal of antithyroid medication+l-T4 replacement of the mother involves a high risk of foetal hyperthyroidism.ConclusionAntithyroid drug therapy of pregnant women with Graves' hyperthyroidism should be balanced to control both maternal and foetal thyroid function. Surgical thyroidectomy of a pregnant woman with active disease may lead to isolated foetal hyperthyroidism.

scholarly journals Pregnancy in women heterozygous for MCT8 mutations: risk of maternal hypothyroxinemia and fetal care

2011 ◽  
Vol 164 (2) ◽  
pp. 309-314 ◽  
Author(s):  
Helton Estrela Ramos ◽  
Melina Morandini ◽  
Aurore Carré ◽  
Elodie Tron ◽  
Corinne Floch ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Thyroid Function ◽  
Direct Sequencing ◽  
Monocarboxylate Transporter ◽  
Function Evaluation ◽  
Compensatory Mechanisms ◽  
Neonatal Hypothyroidism ◽  
Normal Thyroid ◽  
Normal Thyroid Function ◽  
Maternal Thyroid

ContextMonocarboxylate transporter 8 (MCT8 or SLC16A2) mutations cause X-linked Allan–Herndon–Dudley syndrome. Heterozygous females are usually asymptomatic, but pregnancy may modify thyroid function and MCT8 is expressed in the placenta, suggesting that maternal and fetal abnormalities might develop even in the absence of MCT8 fetal mutation. Genetic counseling is so far based on X-linked transmission, and prenatal diagnosis is rarely performed.ObjectiveTo describe thyroid function and the prenatal diagnosis in pregnant mothers harboring heterozygous MCT8 mutations and management of the persistent maternal hypothyroxinemia.PatientsTwo women heterozygous for MCT8 mutations (c.1690G>A and c.1393-1G>C) were monitored throughout pregnancy.MethodsPrenatal diagnosis included sex determination, direct MCT8 sequencing, and familial linkage analysis. Ultrasonography and hormonal assays for maternal thyroid function evaluation were performed serially during pregnancy. Neonatal thyroid hormonal status was assessed.ResultsNone of the three fetuses (two males and one female) carried MCT8 mutations. One of the two heterozygous mothers revealed gestational hypothyroxinemia, prompting early levothyroxine (l-T4) therapy until delivery. The second heterozygous mother showed normal thyroid function but was preventively traited by l-T4 and all of the three neonates had normal thyroid hormone levels and thyroid gland at birth, suggesting advantages of prenatal care and/or compensatory mechanisms.ConclusionHeterozygous MCT8 women should be monitored for requirement of l-T4 therapy to prevent fetal and neonatal hypothyroidism and to avoid risk of potential cognitive delay due to gestational hypothyroxinemia. Moreover, when the disease-causing mutation is known and/or the first child is affected, prenatal diagnosis for male fetuses should be assessed early for MCT8 mutations by direct sequencing.

scholarly journals Management of severe Graves’ hyperthyroidism in pregnancy following immune reconstitution therapy in multiple sclerosis

2021 ◽  
Author(s):  
Sara Salehi Hammerstad ◽  
Elisabeth G Celius ◽  
Henrik Husby ◽  
Ingvild M Sørensen ◽  
Ingrid E Norheim
Keyword(s):  
Multiple Sclerosis ◽  
Hashimoto Thyroiditis ◽  
Newborn Baby ◽  
Graves Disease ◽  
Autoimmune Thyroid Diseases ◽  
Autoimmune Thyroid ◽  
Normal Thyroid Function ◽  
Increased Risk ◽  
Neonatal Thyrotoxicosis

Abstract Context Alemtuzumab (ALZ), a CD52 monoclonal antibody, is highly efficacious in multiple sclerosis; however, side effects are common. Autoimmune thyroid diseases (Graves’ disease and Hashimoto thyroiditis) is a well-known complication of ALZ. Treatment of ALZ induced Graves’ disease can be challenging, and even more difficult during pregnancy. Case description We present a case of severe ALZ induced Graves’ disease with a rapid increase in TSH receptor antibodies (TRAb 240 IU/L) and thyrotoxicosis in early pregnancy. Treatment with high doses of anti-thyroid medication was needed. There was high risk of both fetal and neonatal thyrotoxicosis. Serial fetal sonography showed normal development. The newborn baby presented high levels of TRAb (240 IU/L) and developed neonatal thyrotoxicosis on day eight. Adequate monitoring, treatment, and follow up of the newborn baby ensured normal thyroid function until disappearance of TRAb, 6 weeks after birth. Conclusion MS patients treated with ALZ may develop severe Graves’ disease with an increased risk of both fetal and neonatal thyrotoxicosis. Close follow up with a multidisciplinary approach is needed to ensure a healthy outcome.

Graves'-Basedow disease in pregnancy

2015 ◽  
Vol 54 (03) ◽  
pp. 106-111 ◽  
Author(s):  
S. L. Andersen ◽  
P. Laurberg
Keyword(s):  
Side Effects ◽  
Birth Defects ◽  
Thyroid Dysfunction ◽  
National Study ◽  
Antithyroid Drugs ◽  
Upper Limit ◽  
Special Concern ◽  
Maternal Thyroid ◽  
Toxic Reactions ◽  
Serum Tsh

SummaryThyroid hormones are essential development factors and maternal thyroid dysfunction may cause pregnancy complications and diseases in the fetus/child. In the present review we discuss new data on the incidence of Graves'-Basedow disease (GBD) in and around pregnancy, and how hyperthyroidism may affect the risk of spontaneous abortion and stillbirth.A special concern in pregnant women is the potential side effects from the use of antithyroid drugs (ATDs). One type of side effects is the allergic/toxic reactions to the drugs, which seem to be similar in and outside pregnancy, and another is that ATDs tend to over treat the fetus when the mother with GBD is made euthyroid. To avoid fetal hypothyroidism, the lowest possible ATD dose should be used to keep maternal thyroid function at the upper limit of normality with low serum TSH. Birth defects after the use of methimazole (MMI) (or its prodrug carbimazole) have been considered to be very rare, and no risk has previously been associated with the use of propylthiouracil (PTU). However, a recent Danish national study found that 1/30 of children exposed to MMI in early pregnancy had birth defects associated with this, and many defects were severe. PTU exposure was associated with defects in 1/40, and these defects were less severe. Proposals are given on how to reduce the risk of ATD associated birth defects.

Guideline for radioiodine therapy for benign thyroid diseases (version 3)

2004 ◽  
Vol 43 (06) ◽  
pp. 217-220 ◽  
Author(s):  
J. Dressler ◽  
F. Grünwald ◽  
B. Leisner ◽  
E. Moser ◽  
Chr. Reiners ◽  
...  
Keyword(s):  
Radioiodine Therapy ◽  
Thyroid Volume ◽  
Thyroid Diseases ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Co Morbidity ◽  
History Of ◽  
Individual Decisions ◽  
Prophylactic Use ◽  
Benign Thyroid

SummaryThe version 3 of the guideline for radioiodine therapy for benign thyroid diseases presents first of all a revision of the version 2. The chapter indication for radioiodine therapy, surgical treatment or antithyroid drugs bases on an interdisciplinary consensus. The manifold criteria for decision making consider the entity of thyroid disease (autonomy, Graves’ disease, goitre, goitre recurrence), the thyroid volume, suspicion of malignancy, cystic nodules, risk of surgery and co-morbidity, history of subtotal thyroidectomy, persistent or recurrent thyrotoxicosis caused by Graves’ disease including known risk factors for relapse, compression of the trachea caused by goitre, requirement of direct therapeutic effect as well as the patient’s preference. Because often some of these criteria are relevant, the guideline offers the necessary flexibility for individual decisions. Further topics are patients’ preparation, counseling, dosage concepts, procedural details, results, side effects and follow-up care. The prophylactic use of glucocorticoids during radioiodine therapy in patients without preexisting ophthalmopathy as well as dosage and duration of glucocorticoid medication in patients with preexisting ophthalmopathy need to be clarified in further studies. The pragmatic recommendations for the combined use of radioiodine and glucocorticoids remained unchanged in the 3rd version.

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