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Central congenital hypothyroidism due to gestational hyperthyroidism: detection where prevention failed
Marlies J E Kempers1, David A van Tijn, A S Paul van Trotsenburg
1Academic Medical Center, Emma Children's Hospital, Department of Pediatric Endocrinology, University of Amsterdam, 1100 DE Amsterdam, The Netherlands. m.j.kempers@amc.uva.nl
The Journal of Clinical Endocrinology and Metabolism
|December 13, 2003
Summary
Maternal Graves' disease can cause central congenital hypothyroidism (CCH) in infants due to impaired pituitary development. Preserving maternal thyroid health during pregnancy is crucial for preventing this condition.
Area of Science:
- Endocrinology
- Neonatal Health
- Reproductive Medicine
Background:
- Maternal Graves' disease is known to affect fetal thyroid function.
- Adverse effects on offspring pituitary function, leading to central congenital hypothyroidism (CCH), are less reported.
Purpose of the Study:
- To investigate thyroid hormone determinants in infants with CCH born to mothers with Graves' disease.
- To understand the impact of maternal Graves' disease on fetal pituitary development.
Main Methods:
- Studied 18 children with CCH and their mothers with Graves' disease.
- Analyzed neonatal screening data, maternal treatment history, and thyroid hormone levels.
- Conducted thyrotropin-releasing hormone (TRH) tests to assess pituitary function.
Main Results:
- All studied neonates exhibited decreased plasma free thyroxine (T4) levels.
- Pituitary dysfunction was confirmed via TRH tests.
- Seventeen out of 18 children required thyroxine (T4) supplementation.
Conclusions:
- Insufficient maternal treatment during pregnancy may lead to a hyperthyroid fetal environment, impairing hypothalamic-pituitary-thyroid axis maturation.
- The estimated incidence of this CCH type (1:35000) necessitates early detection and treatment.
- Maintaining maternal euthyroidism throughout pregnancy is the optimal strategy to prevent CCH associated with Graves' disease.