Cui Yiwen, Rijhsinghani Asha
Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Fetal Diagnosis Unit, University of Iowa, Iowa City, Iowa.
AJP Rep. 2019 Oct;9(4):e341-e345. doi: 10.1055/s-0039-1694035. Epub 2019 Nov 11.
To assess maternal thyroid-stimulating immunoglobulin (TSI) as a predictor of neonatal thyroid hyperthyroidism in pregnancies complicated by Graves' disease. This is a 10-year retrospective study of patients with a history of Graves' disease and elevated TSI activity level defined as 1.3 times the normal. All subjects underwent cordocentesis for ultrasound findings of suspected fetal thyrotoxicosis (fetal tachycardia, oligohydramnios, hydrops, and thyromegaly). Neonatal diagnosis was made based on neonatal thyroid function testing or symptoms. Fourteen patients were included in the study, seven with active Graves' disease requiring antithyroid drug ("ATD group") and seven with iatrogenic hypothyroidism on levothyroxine ("levothyroxine group"). Four cases (57%) of neonatal thyrotoxicosis were diagnosed in the levothyroxine group compared with two cases (28%) in the ATD group. The lowest maternal TSI level at which a neonate did not develop hyperthyroidism was 2.6 for the levothyroxine group and 2.5 for the ATD group. The odds ratio of a neonate from the levothyroxine group developing hyperthyroidism compared with one from the ATD group is 3.3 (95% confidence interval: 0.4-30.7). For patients with Graves' disease, those with iatrogenic hypothyroidism and TSI > 2.5 times the basal level are at the highest risk for neonatal thyrotoxicosis.
评估母体促甲状腺素免疫球蛋白（TSI）作为合并格雷夫斯病妊娠新生儿甲状腺功能亢进症预测指标的价值。 这是一项对有格雷夫斯病病史且TSI活性水平升高（定义为正常水平的1.3倍）患者的10年回顾性研究。所有受试者因超声检查发现疑似胎儿甲状腺毒症（胎儿心动过速、羊水过少、水肿和甲状腺肿大）而接受脐静脉穿刺术。新生儿诊断基于新生儿甲状腺功能检测或症状。 14名患者纳入研究，7例患有需要抗甲状腺药物治疗的活动性格雷夫斯病（“抗甲状腺药物组”），7例接受左甲状腺素治疗的医源性甲状腺功能减退患者（“左甲状腺素组”）。左甲状腺素组诊断出4例（57%）新生儿甲状腺毒症，而抗甲状腺药物组为2例（28%）。左甲状腺素组新生儿未发生甲状腺功能亢进症的最低母体TSI水平为2.6，抗甲状腺药物组为2.5。左甲状腺素组新生儿发生甲状腺功能亢进症的比值比与抗甲状腺药物组相比为3.3（95%置信区间：0.4 - 30.7）。 对于格雷夫斯病患者，医源性甲状腺功能减退且TSI＞基础水平2.5倍的患者发生新生儿甲状腺毒症的风险最高。
