Antenatal management of recurrent fetal goitrous hyperthyroidism associated with fetal cardiac failure in a pregnant woman with persistent high levels of thyroidstimulating hormone receptor antibody after ablative therapy

Tadashi Matsumoto, Kei Miyakoshi, Yoshifumi Saisho, Tomohiro Ishii, Satoru Ikenoue, Yoshifumi Kasuga, Ikuko Kadohira, Seiji Sato, Naoko Momotani, Kazuhiro Minegishi, Yasunori Yoshimura

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Abstract

High titer of maternal thyroid-stimulating hormone receptor antibody (TRAb) in patients with Graves' disease could cause fetal hyperthyroidism during pregnancy. Clinical features of fetal hyperthyroidism include tachycardia, goiter, growth restriction, advanced bone maturation, cardiomegaly, and fetal death. The recognition and treatment of fetal hyperthyroidism are believed to be important to optimize growth and intellectual development in affected fetuses. We herein report a case of fetal treatment in two successive siblings showing in utero hyperthyroid status in a woman with a history of ablative treatment for Graves' disease. The fetuses were considered in hyperthyroid status based on high levels of maternal TRAb, a goiter, and persistent tachycardia. In particular, cardiac failure was observed in the second fetus. With intrauterine treatment using potassium iodine and propylthiouracil, fetal cardiac function improved. A high level of TRAb was detected in the both neonates. To the best of our knowledge, this is the first report on the changes of fetal cardiac function in response to fetal treatment in two siblings showing in utero hyperthyroid status. This case report illustrates the impact of prenatal medication via the maternal circulation for fetal hyperthyroidism and cardiac failure.

Original languageEnglish
Pages (from-to)1281-1287
Number of pages7
JournalEndocrine Journal
Volume60
Issue number12
DOIs
Publication statusPublished - 2013

Fingerprint

Hyperthyroidism
Pregnant Women
Heart Failure
Hormones
Antibodies
Thyrotropin Receptors
Fetus
Graves Disease
Mothers
Goiter
Tachycardia
Therapeutics
Siblings
Propylthiouracil
Fetal Death
Cardiomegaly
Growth and Development
Iodine
Potassium
Newborn Infant

Keywords

  • Fetal goiter
  • Fetal hyperthyroidism
  • Fetal therapy
  • Graves' disease
  • Prenatal diagnosis

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

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title = "Antenatal management of recurrent fetal goitrous hyperthyroidism associated with fetal cardiac failure in a pregnant woman with persistent high levels of thyroidstimulating hormone receptor antibody after ablative therapy",
abstract = "High titer of maternal thyroid-stimulating hormone receptor antibody (TRAb) in patients with Graves' disease could cause fetal hyperthyroidism during pregnancy. Clinical features of fetal hyperthyroidism include tachycardia, goiter, growth restriction, advanced bone maturation, cardiomegaly, and fetal death. The recognition and treatment of fetal hyperthyroidism are believed to be important to optimize growth and intellectual development in affected fetuses. We herein report a case of fetal treatment in two successive siblings showing in utero hyperthyroid status in a woman with a history of ablative treatment for Graves' disease. The fetuses were considered in hyperthyroid status based on high levels of maternal TRAb, a goiter, and persistent tachycardia. In particular, cardiac failure was observed in the second fetus. With intrauterine treatment using potassium iodine and propylthiouracil, fetal cardiac function improved. A high level of TRAb was detected in the both neonates. To the best of our knowledge, this is the first report on the changes of fetal cardiac function in response to fetal treatment in two siblings showing in utero hyperthyroid status. This case report illustrates the impact of prenatal medication via the maternal circulation for fetal hyperthyroidism and cardiac failure.",
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author = "Tadashi Matsumoto and Kei Miyakoshi and Yoshifumi Saisho and Tomohiro Ishii and Satoru Ikenoue and Yoshifumi Kasuga and Ikuko Kadohira and Seiji Sato and Naoko Momotani and Kazuhiro Minegishi and Yasunori Yoshimura",
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AU - Matsumoto, Tadashi

AU - Miyakoshi, Kei

AU - Saisho, Yoshifumi

AU - Ishii, Tomohiro

AU - Ikenoue, Satoru

AU - Kasuga, Yoshifumi

AU - Kadohira, Ikuko

AU - Sato, Seiji

AU - Momotani, Naoko

AU - Minegishi, Kazuhiro

AU - Yoshimura, Yasunori

PY - 2013

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