Predictive value of maternal second-generation thyroid-binding inhibitory immunoglobulin assay for neonatal autoimmune hyperthyroidism
Abstract
Context: Hyperthyroidism occurs in 1% of neonates born to mothers with active or past Graves' disease (GD). Current guidelines for the management of GD during pregnancy were based on studies conducted with first-generation thyroid-binding inhibitory immunoglobulin (TBII) assays. Objective: This retrospective study was conducted in order to specify the second-generation TBII threshold predictive of fetal and neonatal hyperthyroidism, and to identify other factors that may be helpful in predicting neonatal hyperthyroidism. Methods: We included 47 neonates born in the Lyon area to 42 mothers harboring measurable levels of TBII during pregnancy. TBII measurements were carried out in all mothers; bioassays were carried out in 20 cases. Results: Nine neonates were born with hyperthyroidism, including five with severe hyperthyroidism requiring treatment. Three neonates were born with hypothyroidism. All hyperthyroid neonates were born to mothers with TBII levels >5 IU/l in the second trimester (sensitivity, 100% and specificity, 43%). No mother with TSH receptor-stimulating antibodies (TSAb measured by bioassay) below 400% gave birth to a hyperthyroid neonate. Among mothers of hyperthyroid neonates, who required antithyroid drugs during pregnancy, none could stop treatment before delivery. Analysis of TBII evolution showed six unexpected cases of increasing TBII values during pregnancy. Conclusion: Maternal TBII value over 5 IU/l indicates a risk of neonatal hyperthyroidism. Among these mothers, a TSAb measurement contributes to identify more specifically those who require a close fetal thyroid ultrasound follow-up. These results should be confirmed in a larger series.
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In a recent study of 47 newborns to mothers who were TRAb positive in pregnancy, nine had neonatal biochemical hyperthyroidism, and five of these (9% of all) needed ATD therapy.
“In a recent study of 47 newborns to mothers who were TRAb positive in pregnancy, nine of the children had neonatal biochemical hyperthyroidism, and five of these (9% of all) needed ATD therapy.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [504]
All hyperthyroid neonates were born to mothers with TRAb levels ≥5 IU/L (>3 times upper reference for the assay) in the second trimester (sensitivity 100%, specificity 43%).
“All hyperthyroid neonates were born to mothers with TRAb levels ‡5 IU/L (>3 times upper reference for the assay) in the second trimester (sensitivity 100%, specificity 43%).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [504]
All mothers who gave birth to hyperthyroid newborns required ATD therapy in late pregnancy.
“All mothers who gave birth to hyperthyroid newborns required ATD therapy in late pregnancy (504).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [504]
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- Authors
- Abeillon-du Payrat, J., Chikh, K., Bossard, N., Bretones, P., Gaucherand, P., Claris, O., Charrié, A., Raverot, V., Orgiazzi, J., Borson-Chazot, F., & Bournaud, C.
- Affiliations
- Inserm (FR)
- Lyon 1 Université (FR)
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-10
- Volume
- 171
- Issue
- 4
- Pages
- 451-460
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2137096201
- Cited by
- 107
- References
- 45
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 5 · 2023: 8 · 2022: 12 · 2021: 12 · 2020: 12 · 2019: 8 · 2018: 17 · 2017: 10 · 2016: 10 · 2015: 3 · 2012: 1
- FWCI
- 6.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- neonatal hyperthyroidism, neonatal hypothyroidism
- MeSH terms
- Adult, Female, France, Graves Disease, Humans, Infant, Newborn, Infant, Newborn, Diseases, Male, Predictive Value of Tests, Pregnancy, Pregnancy Complications, Prenatal Exposure Delayed Effects, Retrospective Studies, Thyroid Gland, Biomarkers, Immunoglobulins, Thyroid-Stimulating
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