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Banigé M, Estellat C, Biran V, Desfrere L, Champion V, Benachi A, Ville Y, Dommergues M, Jarreau PH, Mokhtari M, Boithias C, Brioude F, Mandelbrot L, Ceccaldi PF, Mitanchez D, Polak M, Luton D. Study of the Factors Leading to Fetal and Neonatal Dysthyroidism in Children of Patients With Graves Disease. J Endocr Soc 2017; 1:751-761. [PMID: 29130077 PMCID: PMC5677510 DOI: 10.1210/js.2017-00189] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/20/2017] [Indexed: 12/27/2022] Open
Abstract
CONTEXT Neonatal hyperthyroidism was first described in 1912 and in 1964 was shown to be linked to transplacental passage of maternal antibodies. Few multicenter studies have described the perinatal factors leading to fetal and neonatal dysthyroidism. OBJECTIVE To show how fetal dysthyroidism (FD) and neonatal dysthyroidism (ND) can be predicted from perinatal variables, in particular, the levels of anti-thyrotropin receptor antibodies (TRAbs) circulating in the mother and child. DESIGN AND PATIENTS This was a retrospective multicenter study of data from the medical records of all patients monitored for pregnancy from 2007 to 2014. SETTING Among 280,000 births, the medical records of 2288 women with thyroid dysfunction were selected and screened, and 417 women with Graves disease and positive for TRAbs during pregnancy were included. RESULTS Using the maternal TRAb levels, the cutoff value of 2.5 IU/L best predicted for FD, with a sensitivity of 100% and specificity of 64%. Using the newborn TRAb levels, the cutoff value of 6.8 IU/L best predicted for ND, with a sensitivity of 100% and a specificity of 94%. In our study, 65% of women with a history of Graves disease did not receive antithyroid drugs during pregnancy but still had infants at risk of ND. CONCLUSIONS In pregnant women with TRAb levels ≥2.5 IU/L, fetal ultrasound monitoring is essential until delivery. All newborns with TRAb levels ≥6.8 IU/L should be examined by a pediatrician with special attention for thyroid dysfunction and treated, if necessary.
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Affiliation(s)
- Maïa Banigé
- Department of Neonatology, Obstetrics and Gynecology, University Hospitals Paris Nord Val de Seine, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy 92118, France
| | - Candice Estellat
- Department of Epidemiology and Clinical Research, Assistance Publique Hôpitaux de Paris, Bichat Hospital, University Hospitals Paris Nord Val de Seine, UMR 1123 ECEVE/CIC-EC 1425, Inserm, Paris 75184, France
| | - Valerie Biran
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Robert Debré Hospital, Paris Diderot University, Paris 75013, France
| | - Luc Desfrere
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Louis Mourier Hospital, University Hospitals Paris Nord Val de Seine, Colombes 92700, France
| | - Valerie Champion
- Department of Neonatal Pediatrics, Assistance Publique Hôpitaux de Paris, Armand Trousseau Hospital, Pierre and Marie Curie University (UPMC), Paris 75005, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Paris, Antoine Béclère Hospital, Paris-Sud University, Clamart 92140, France
| | - Yves Ville
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Paris, Necker-Enfants Malades, Paris Descartes University, Paris 75006, France
| | - Marc Dommergues
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Pierre and Marie Curie University (UPMC), Paris 75005, France
| | - Pierre-Henri Jarreau
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Port-Royal Hospital, Paris Descartes University, Paris 75006, France
| | - Mostafa Mokhtari
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Kremlin Bicêtre Hospital, Bicêtre 94270, France
| | - Claire Boithias
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Kremlin Bicêtre Hospital, Bicêtre 94270, France
| | - Frederic Brioude
- Department of Endocrinology Pediatrics, Assistance Publique Hôpitaux de Paris, Armand Trousseau Hospital, Paris 75012, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Paris, Louis Mourier Hospital, University Hospitals Paris Nord Val de Seine, Colombes 92700, France
| | - Pierre-François Ceccaldi
- Department of Neonatology, Obstetrics and Gynecology, University Hospitals Paris Nord Val de Seine, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy 92118, France
| | - Delphine Mitanchez
- Department of Neonatal Pediatrics, Assistance Publique Hôpitaux de Paris, Armand Trousseau Hospital, Pierre and Marie Curie University (UPMC), Paris 75005, France
| | - Michel Polak
- Department of Paediatric Endocrinology (APHP), Necker-Enfants Malades, Paris Descartes University, Paris 75006, France
| | - Dominique Luton
- Department of Neonatology, Obstetrics and Gynecology, University Hospitals Paris Nord Val de Seine, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy 92118, France
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Alonso Quintela P, Mata Zubillaga D, Gautreaux-Minaya S, Regueras Santos L, Rodríguez Blanco S, Oulego Erroz I. Hipertiroidismo neonatal e hipertensión pulmonar. An Pediatr (Barc) 2014; 80:e69-70. [DOI: 10.1016/j.anpedi.2013.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 06/17/2013] [Accepted: 06/23/2013] [Indexed: 11/29/2022] Open
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