Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2024; 14(02): e176-e183
DOI: 10.1055/a-2317-9431
Case Report

Fetal Hyperthyroidism Secondary to Maternal Basedow–Graves' Disease

Julio Soto 
1   Department of Pediatrics, School of Medicine, Universidad de Concepcion, Concepcion, Chile
2   Division of Pediatric Endocrinology, Pediatrics Service, Hospital Las Higueras, Talcahuano, Chile
,
Bunio Weissglas
3   Department of Internal Medicine, School of Medicine, Universidad de Concepcion, Concepcion, Chile
,
Gustav von Plessing-Pierry 
3   Department of Internal Medicine, School of Medicine, Universidad de Concepcion, Concepcion, Chile
,
Maria Paz del Solar
4   Department of Clinical and Preclinical Sciences, School of Medicine, Universidad Catolica de la Santisima Concepcion, Concepcion, Chile
,
Carolina Peña-Villa
3   Department of Internal Medicine, School of Medicine, Universidad de Concepcion, Concepcion, Chile
5   Division of Endocrinology, Internal Medicine Service, Hospital Las Higueras, Talcahuano, Chile
,
Ximena Flores
6   Division of Obstetric and Gynecologic Ultrasound, Obstetrics and Gynecology Service, Hospital Las Higueras, Talcahuano, Chile
7   Department of Obstetrics and Ginecology, School of Medicine, Universidad de Concepcion, Concepcion, Chile
,
Monica Arancibia
2   Division of Pediatric Endocrinology, Pediatrics Service, Hospital Las Higueras, Talcahuano, Chile
,
Laura Campos
2   Division of Pediatric Endocrinology, Pediatrics Service, Hospital Las Higueras, Talcahuano, Chile
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Fetal hyperthyroidism is a rare prenatal disease and can be life-threatening. The diagnosis is based on ultrasound in mothers with a history of Basedow–Graves' disease and elevation of thyrotropin receptor antibodies (TRAbs) levels. The treatment consists of antithyroid drugs. We present a mother with Basedow–Graves' disease, treated with radioactive iodine 16 years ago. She had an unplanned pregnancy at the age of 29 years, and an elevation of TRAbs (21 U/L) was found at the sixth week of pregnancy. At 22 weeks of gestation, fetal ultrasound displayed tachycardia, goiter, exophthalmos, and suspicion of craniosynostosis, hence methimazole was started. Concomitantly, suppressed maternal thyroid-stimulating hormone (TSH) was found. Her daughter was born at 33 + 6 weeks showing clinical and laboratory findings of hyperthyroidism. Consequently, treatment with methimazole was prescribed. Normal thyroid function was documented in the mother after giving birth. Clear explanation has not been found for the alteration of maternal TSH during pregnancy.

Keywords

fetal hyperthyroidism - Graves' disease - hyperthyroidism - fetal


Publication History

Received: 12 October 2022

Accepted: 10 April 2024

Accepted Manuscript online:
02 May 2024

Article published online:
31 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Eng L, Lam L. Thyroid function during the fetal and neonatal periods. Neoreviews 2020; 21 (01) e30-e36
    CrossrefPubMedSearch in Google Scholar
  • 2 Polak M, Legac I, Vuillard E, Guibourdenche J, Castanet M, Luton D. Congenital hyperthyroidism: the fetus as a patient. Horm Res 2006; 65 (05) 235-242
    PubMedSearch in Google Scholar
  • 3 Léger J, Carel JC. Diagnosis and management of hyperthyroidism from prenatal life to adolescence. Best Pract Res Clin Endocrinol Metab 2018; 32 (04) 373-386
    CrossrefPubMedSearch in Google Scholar
  • 4 Léger J. Management of fetal and neonatal Graves' disease. Horm Res Paediatr 2017; 87 (01) 1-6
    CrossrefPubMedSearch in Google Scholar
  • 5 Luton D, Le Gac I, Vuillard E. et al. Management of Graves' disease during pregnancy: the key role of fetal thyroid gland monitoring. J Clin Endocrinol Metab 2005; 90 (11) 6093-6098
    CrossrefPubMedSearch in Google Scholar
  • 6 León MC. Hipertiroidismo en el embarazo. Recién nacido hijo de madre con Enfermedad de Graves Hyperthyroidism in pregnancy. Newborn of mother with Graves disease. Rev Española Endocrinol Pediatr 2013; 5 (02) 35-40
    PubMedSearch in Google Scholar
  • 7 Kurtoğlu S, Özdemir A. Fetal neonatal hyperthyroidism: diagnostic and therapeutic approachment. Turk Pediatri Ars 2017; 52 (01) 1-9
    CrossrefPubMedSearch in Google Scholar
  • 8 Spoke C, Martin C. Maternal Graves disease and abnormal CYP2D6 genotype with fetal hyperthyroidism. AACE Clin Case Rep 2020; 6 (04) e161-e164
    CrossrefPubMedSearch in Google Scholar
  • 9 Alexander EK, Pearce EN, Brent GA. et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017; 27 (03) 315-389
    CrossrefPubMedSearch in Google Scholar
  • 10 Laurberg P, Wallin G, Tallstedt L, Abraham-Nordling M, Lundell G, Tørring O. TSH-receptor autoimmunity in Graves' disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study. Eur J Endocrinol 2008; 158 (01) 69-75
    CrossrefPubMedSearch in Google Scholar
  • 11 Srisupundit K, Sirichotiyakul S, Tongprasert F, Luewan S, Tongsong T. Fetal therapy in fetal thyrotoxicosis: a case report. Fetal Diagn Ther 2008; 23 (02) 114-116
    CrossrefPubMedSearch in Google Scholar
  • 12 Lembet A, Eroglu D, Kinik ST, Gurakan B, Kuscu E. Non-invasive management of fetal goiter during maternal treatment of hyperthyroidism in Grave's disease. Fetal Diagn Ther 2005; 20 (04) 254-257
    CrossrefPubMedSearch in Google Scholar
  • 13 Luton D, Fried D, Sibony O. et al Assessment of fetal thyroid function by colored Doppler echography. Fetal Diagn Ther 1997; 12 (01) 24-27
    CrossrefPubMedSearch in Google Scholar
  • 14 Donnelly MA, Wood C, Casey B, Hobbins J, Barbour LA. Early severe fetal Graves disease in a mother after thyroid ablation and thyroidectomy. Obstet Gynecol 2015; 125 (05) 1059-1062
    CrossrefPubMedSearch in Google Scholar
  • 15 Kazakou P, Theodora M, Kanaka-Gantenbein C. et al Fetal hyperthyroidism associated with maternal thyroid autoantibodies: A case report. Case Rep Womens Health 2018; 20: e00081
    CrossrefPubMedSearch in Google Scholar
  • 16 Wallace C, Couch R, Ginsberg J. Fetal thyrotoxicosis: a case report and recommendations for prediction, diagnosis, and treatment. Thyroid 1995; 5 (02) 125-128
    CrossrefPubMedSearch in Google Scholar
  • 17 Wenstrom KD, Weiner CP, Williamson RA, Grant SS. Prenatal diagnosis of fetal hyperthyroidism using funipuncture. Obstet Gynecol 1990; 76 (3 Pt 2): 513-517
    PubMedSearch in Google Scholar
  • 18 Hadi HA, Strickland D. Prenatal diagnosis and management of fetal goiter caused by maternal Grave's disease. Am J Perinatol 1995; 12 (04) 240-242
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Porreco RP, Bloch CA. Fetal blood sampling in the management of intrauterine thyrotoxicosis. Obstet Gynecol 1990; 76 (3 Pt 2): 509-512
    PubMedSearch in Google Scholar
  • 20 Vali A, Wiles P, Thomas NB, Ludlam A. Relapse of maternal thyrotoxicosis presenting as a second-trimester fetal goiter. Ultrasound Obstet Gynecol 1993; 3 (06) 429-431
    CrossrefPubMedSearch in Google Scholar
  • 21 Belfar HL, Foley Jr TP, Hill LM, Kislak S. Sonographic findings in maternal hyperthyroidism. Fetal hyperthyroidism/fetal goiter. J Ultrasound Med 1991; 10 (05) 281-284
    CrossrefPubMedSearch in Google Scholar
  • 22 Pekonen F, Teramo K, Mäkinen T, Ikonen E, Osterlund K, Lamberg BA. Prenatal diagnosis and treatment of fetal thyrotoxicosis. Am J Obstet Gynecol 1984; 150 (07) 893-894
    CrossrefPubMedSearch in Google Scholar
  • 23 Hatjis CG. Diagnosis and successful treatment of fetal goitrous hyperthyroidism caused by maternal Graves disease. Obstet Gynecol 1993; 81 (5( Pt 2)): 837-839
    PubMedSearch in Google Scholar
  • 24 Heckel S, Favre R, Schlienger JL, Soskin P. Diagnosis and successful in utero treatment of a fetal goitrous hyperthyroidism caused by maternal Graves' disease. A case report. Fetal Diagn Ther 1997; 12 (01) 54-58 .11-18
    CrossrefPubMedSearch in Google Scholar
  • 25 Tongsong T, Wanapirak C, Kunavikatikul C, Sirirchotiyakul S, Piyamongkol W, Chanprapaph P. Fetal loss rate associated with cordocentesis at midgestation. Am J Obstet Gynecol 2001; 184 (04) 719-723
    CrossrefPubMedSearch in Google Scholar
  • 26 Somers EC. Pregnancy and autoimmune diseases. Best Pract Res Clin Obstet Gynaecol 2020; 64: 3-10
    CrossrefPubMedSearch in Google Scholar
  • 27 Kobaly K, Mandel SJ. Hyperthyroidism and pregnancy. Endocrinol Metab Clin North Am 2019; 48 (03) 533-545
    CrossrefPubMedSearch in Google Scholar
  • 28 Cooper DS, Laurberg P. Hyperthyroidism in pregnancy. Lancet Diabetes Endocrinol 2013; 1 (03) 238-249
    CrossrefPubMedSearch in Google Scholar
  • 29 James SR, Franklyn JA, Kilby MD. Placental transport of thyroid hormone. Best Pract Res Clin Endocrinol Metab 2007; 21 (02) 253-264
    CrossrefPubMedSearch in Google Scholar
  • 30 Blackburn S. Maternal-fetal thyroid interactions. J Perinat Neonatal Nurs 2009; 23 (04) 312-313
    CrossrefPubMedSearch in Google Scholar
  • 31 Banovac K, Ryan EA, O'Sullivan MJ. Triiodothyronine (T3) nuclear binding sites in human placenta and decidua. Placenta 1986; 7 (06) 543-549
    CrossrefPubMedSearch in Google Scholar
  • 32 Schmidt RL, LoPresti JS, McDermott MT, Zick SM, Straseski JA. Does reverse triiodothyronine testing have clinical utility? An analysis of practice variation based on order data from a national reference laboratory. Thyroid 2018; 28 (07) 842-848
    CrossrefPubMedSearch in Google Scholar