Fetal pituitary negative feedback at early gestational age.
We describe an early prenatal diagnosis and the successful treatment of fetal Graves' disease from transplacental transfer of maternal thyroid stimulating autoantibodies (TSAb). The diagnosis of fetal thyrotoxicosis was made by umbilical cord sampling (UBS) at 20 weeks gestation, based on suppressed TSH with elevated FT4 levels. Therapy with propylthiouracil (PTU) improved fetal thyroid function tests as well as the clinical signs of fetal Graves' disease. Three more UBS were conducted before delivery indicating persisting mild fetal hyperthyroidism. Undetectable concentrations of thyrotrophin in fetal serum in the presence of markedly elevated FT4, suggests pituitary negative feedback at as early as 20 weeks gestation. Amniotic fluid thyrotrophin levels were measured at 20,24 and 26 weeks and were shown to correlate better with (elevated) maternal rather than (suppressed) fetal TSH values; therefore, we believe that amniotic fluid thyrotrophin measurement is unreliable for prediction of fetal thyroid status. Our observation is the first documentation of an intact feedback mechanism so early in fetal development and it suggests that pituitary maturation occurs earlier than previously believed.
Rakover
Y
Y
Paediatric Endocrine Unit, Ha'Emek Medical Centre, Afula, affiliated to the Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Weiner
E
E
Mosh
N
N
Shalev
E
E
D000328:Adult; D000653:Amniotic Fluid / Q000737:chemistry; D005246:Feedback; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005315:Fetal Diseases / Q000175:diagnosis / Q000196:embryology* / Q000378:metabolism; D005865:Gestational Age; D006111:Graves Disease / Q000175:diagnosis / Q000196:embryology* / Q000378:metabolism; D006801:Humans; D010902:Pituitary Gland / Q000196:embryology* / Q000378:metabolism; D011296:Prenatal Diagnosis / Q000379:methods; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood
D013972:Thyrotropin; D013974:Thyroxine