Jankovski Lucia, Grosek Štefan, Žerjav Mojca Tanšek, Šimic Marijana Vidmar, Zaletel Katja
Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
Neonatology Section, Department of Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Children (Basel). 2024 Aug 11;11(8):968. doi: 10.3390/children11080968.
Fetal and neonatal thyrotoxicosis occurs in up to 5% of pregnancies in mothers with Graves' disease (GD). This condition is caused by stimulating antibodies against the thyrotropin receptor (TRAbs) that cross the placenta and may stimulate the fetal thyroid, typically in the second half of pregnancy. GD is often treated with radioiodine, resulting in hypothyroidism in most patients, but TRAbs can persist for several years. Even if a pregnant mother is hypothyroid after radioiodine therapy or surgery, her TRAbs can still, although rarely, induce fetal hyperthyroidism. In this review, we first present two cases of neonatal hyperthyroidism in mothers with GD who became hypothyroid after prior radioiodine therapy, identified through a 10-year analysis of the National Perinatal System in Slovenia. Based on these cases, we provide an overview of existing data on this rare clinical condition in neonates. We also discuss the underlying mechanisms and clinical outcomes based on currently available data. In conclusion, our review highlights the importance of careful monitoring during pregnancy in all women with GD, even in those well managed after radioiodine therapy or surgery.
患有格雷夫斯病（GD）的母亲中，高达5%的妊娠会出现胎儿及新生儿甲状腺毒症。这种情况是由针对促甲状腺素受体（TRAbs）的刺激性抗体引起的，这些抗体可穿过胎盘并刺激胎儿甲状腺，通常发生在妊娠后半期。GD通常采用放射性碘治疗，多数患者会导致甲状腺功能减退，但TRAbs可能会持续数年。即使怀孕母亲在放射性碘治疗或手术后出现甲状腺功能减退，其TRAbs尽管很少见，但仍可诱发胎儿甲状腺功能亢进。在本综述中，我们首先介绍两例患有GD的母亲在先前放射性碘治疗后出现甲状腺功能减退，但其新生儿出现甲状腺功能亢进的病例，这些病例是通过对斯洛文尼亚国家围产期系统进行10年分析确定的。基于这些病例，我们概述了关于新生儿这种罕见临床病症的现有数据。我们还根据目前可得的数据讨论了潜在机制和临床结果。总之，我们的综述强调了对所有患有GD的女性在孕期进行仔细监测的重要性，即使是那些在放射性碘治疗或手术后病情得到良好控制的女性。
