1 Service d'Endocrinologie - Diabète - Nutrition Reims, Centre Hospitalier Universitaire de Reims, Champagne-Ardenne, France.
2 Université de Reims Champagne-Ardenne UFR de Médecine, Reims, France.
Thyroid. 2019 May;29(5):743-747. doi: 10.1089/thy.2018.0098.
Thyroid-stimulating hormone (TSH) receptor (TSHR) antibodies (TRAb) can be present in chronic autoimmune thyroiditis. Transplacental TRAb transfer can lead to fetal thyroid dysfunction and serious complications. We report the case of a woman with autoimmune hypothyroidism and extremely high TRAb levels, with blocking and stimulating activities (biological activities characterized with Chinese hamster ovary cells expressing TSHR). At week 22 of her first pregnancy, sonography detected fetal growth retardation and cardiac abnormalities (extreme tachycardia, right ventricular dilatation, pericardial effusion). The mother's TRAb level, assayed later, was 4030 IU/L ( < 10). Delivered via caesarean section gestational week 30, the newborn girl had several malformations, signs of malnutrition, goiter and hyperthyroidism associated with elevated TRAb (1200 IU/L). The newborn died 26 days after delivery. Faced with persistently high TRAb levels and a desire to become pregnant again, the woman was treated with three consecutive 740-MBq activities of iodine-131, which resulted in a decrease in TRAb to 640 IU/L. The patient had two subsequent pregnancies 16 and 72 months after the radioiodine administration. During the close follow-ups, fetal development was normal, and initial TRAb levels during the two pregnancies were 680 and 260 IU/L, respectively, which initially decreased but then increased in late pregnancy. In both cases, labor was induced at 34 weeks. The newborns, mildly hyperthyroid at birth, required carbimazole treatment at days 5 and 2, respectively. The mild hyperthyroidism despite high TRAb levels was likely due to the concomitant presence of stimulating and blocking TRAb. The two girls, now aged 12 and 8 years, are in good health. The mother has no detectable thyroid gland tissue and is euthyroid on levothyroxine (175 μg/d). Her TRAb level gradually decreased to 136 IU/L. This remarkable case illustrates the severe consequences of untreated fetal hyperthyroidism and the need to assay and follow-up TRAb levels in women of reproductive age with autoimmune thyroiditis.
甲状腺刺激激素（TSH）受体（TSHR）抗体（TRAb）可存在于慢性自身免疫性甲状腺炎中。TRAb 可通过胎盘转移导致胎儿甲状腺功能障碍和严重并发症。我们报告了一例自身免疫性甲状腺功能减退症和极高 TRAb 水平的妇女的病例，该妇女具有阻断和刺激活性（用表达 TSHR 的中国仓鼠卵巢细胞鉴定的生物学活性）。在她第一次怀孕的第 22 周，超声检查发现胎儿生长迟缓和心脏异常（极度心动过速、右心室扩张、心包积液）。后来检测到母亲的 TRAb 水平为 4030 IU/L（<10）。第 30 周经剖宫产分娩的新生儿女孩有多种畸形、营养不良迹象、甲状腺肿和与 TRAb 升高相关的甲状腺功能亢进（1200 IU/L）。新生儿在出生后 26 天死亡。由于持续的 TRAb 水平高且有再次怀孕的愿望，该妇女接受了三次连续的 740-MBq 碘-131 治疗，导致 TRAb 降至 640 IU/L。在放射性碘治疗后 16 和 72 个月，该患者又经历了两次怀孕。在密切随访期间，胎儿发育正常，两次妊娠初期的 TRAb 水平分别为 680 和 260 IU/L，随后在妊娠晚期逐渐下降，但又升高。在这两种情况下，均在 34 周时引产。新生儿出生时轻度甲状腺功能亢进，分别在第 5 天和第 2 天接受了卡比马唑治疗。尽管 TRAb 水平较高，但轻度甲状腺功能亢进可能是由于同时存在刺激和阻断性 TRAb。这两个女孩现在分别为 12 岁和 8 岁，身体健康。母亲没有检测到甲状腺组织，在服用左甲状腺素（175μg/d）时甲状腺功能正常。她的 TRAb 水平逐渐降至 136 IU/L。这个显著的病例说明了未经治疗的胎儿甲状腺功能亢进的严重后果，以及需要对患有自身免疫性甲状腺炎的育龄妇女进行 TRAb 水平检测和随访。
