title: Impact of thyrotropin receptor antibody levels on fetal development in two successive pregnancies in a woman with Graves' disease.
abstract: BACKGROUND
  Treatment with radioiodine for Graves' disease regularly increases the level of antithyroid antibodies, and transplacental passage of stimulating thyrotropin receptor antibodies (TRAb) may cause fetal hyperthyroidism.
  
  
  METHODS
  A 21-year-old woman with Graves' disease received radioiodine treatment to avoid use of antithyroid drugs in pregnancy. She became pregnant 4 months later and was euthyroid during pregnancy. In gestational week (GW) 33, she was admitted with an increased fetal heart rate of 176-180 beats/min. Fetal echocardiography indicated cardiac decompensation. The neonate had severe hyperthyroidism (free thyroxine >100 pmol/l, nv 12.0-22.0), cardiac insufficiency, insufficient weight gain, goiter and considerably accelerated skeletal age. In the mother and neonate, TRAb was >40 IU/l (nv <1.0), indicating transplacental passage of stimulating antibodies. After delivery, TRAb remained >40 IU/l in the woman, and 18 months later she underwent total thyroidectomy with subsequent decline in TRAb. In her next pregnancy, TRAb fluctuated between 38 and 17 IU/l, and repeated fetal ultrasound showed no goiter or sign of hyperthyroidism. In cord blood, TRAb was 10.9 IU/l, and the neonate had normal thyroid hormone levels.
  
  
  CONCLUSIONS
  This case report illustrates the impact of maternal TRAb level for neonatal outcome in two successive pregnancies.
authors.affiliation: Department of Endocrinology, Children's and Women's Health, St. Olavs University Hospital, Trondheim, Norway. marit.bjorgaas@ntnu.no
authors.forename: Marit R
authors.initials: MR
authors.lastname: Bjørgaas
authors.forename: Hanne
authors.initials: H
authors.lastname: Farstad
authors.forename: Sverre C
authors.initials: SC
authors.lastname: Christiansen
authors.forename: Harm-Gerd K
authors.initials: HG
authors.lastname: Blaas
mesh_terms: D000906:Antibodies / Q000097:blood / Q000502:physiology*; D005260:Female; D047109:Fetal Development / Q000276:immunology / Q000502:physiology*; D005315:Fetal Diseases / Q000453:epidemiology; D006111:Graves Disease / Q000276:immunology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D006980:Hyperthyroidism / Q000453:epidemiology; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology / Q000503:physiopathology* / Q000628:therapy; D011256:Pregnancy Outcome; D011989:Receptors, Thyrotropin / Q000276:immunology*; D012307:Risk Factors; D013965:Thyroidectomy; D013972:Thyrotropin / Q000097:blood; D055815:Young Adult
chemical_list: D000906:Antibodies; D007457:Iodine Radioisotopes; D011989:Receptors, Thyrotropin; D013972:Thyrotropin