title: One case of fetal and neonatal variable thyroid dysfunction in the context of Graves' disease.
abstract: Cases of maternal thyroid dysfunction are not always clearly identified during pregnancy. We report here the case of a 36-year-old patient with a history of treated Graves' disease whose child successively presented with a hypo- and hyperthyroid dysfunction that was difficult to treat despite the administration of synthetic antithyroid drugs and beta-blockers. The patient's thyroid hormone levels were normal during pregnancy, while still secreting anti-TSH-receptor autoantibodies. With time, these antibodies went from an inhibiting to a stimulating activity. Fetal monitoring using only ultrasonography had been proposed to the patient. With such a follow-up associated with fetal blood sampling it would have been possible to treat already in utero the thyroid dysfunction. The management of such patients is not limited to the follow-up of the maternal thyroid hormones, but should also evaluate the activity of the anti-TSH-receptor autoantibodies around the 28th week of amenorrhea and their effect on fetal blood. Fetal and neonatal thyroid dysfunctions have a major impact, but they can be detected and treated in utero. The clinical, laboratory and ultrasound follow-up makes it possible to monitor patients who are at risk and to propose a therapeutic and obstetrical management.
authors.affiliation: Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, Strasbourg, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Brand
authors.forename: Philippe
authors.initials: P
authors.lastname: Liégeois
authors.forename: Bruno
authors.initials: B
authors.lastname: Langer
mesh_terms: D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000209:etiology*; D006111:Graves Disease / Q000150:complications* / Q000628:therapy; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology*; D007037:Hypothyroidism / Q000209:etiology*; D007231:Infant, Newborn; D008499:Medical Records; D011247:Pregnancy; D011248:Pregnancy Complications