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Fetal and neonatal thyroid function in relation to maternal Graves' disease
Michel Polak1, Isabelle Le Gac, Edith Vuillard
1Department of Paediatric Endocrinology and Diabetes, and INSERM EMI 0363, Necker-Enfants Malades Teaching Hospital, 149 rue de Sèvres, 75015 Paris, France. michel.polak@nck.ap-hop-paris.fr
Summary
Maternal Graves' disease can affect fetal thyroid health. This study highlights the importance of expert fetal ultrasound to detect and manage fetal goiter, hypothyroidism, and hyperthyroidism, ensuring better outcomes.
Area of Science:
- Endocrinology
- Maternal-Fetal Medicine
- Obstetrics
Background:
- Published data on neonatal effects of maternal Graves' disease (GD) is abundant, yet fetal effects are less understood.
- Graves' disease in pregnant women poses risks to fetal thyroid function.
Purpose of the Study:
- To prospectively investigate fetal effects in pregnancies complicated by maternal Graves' disease.
- To assess the utility of fetal ultrasonography in diagnosing and differentiating fetal thyroid dysfunction.
Main Methods:
- Prospective study of 72 pregnant women with a history of Graves' disease.
- Fetal ultrasonography performed at 22 and 32 weeks gestation.
- Analysis of ultrasound findings, fetal heart rate, maternal antibodies, and antithyroid drug status.
Main Results:
- Fetal goiter detected in 11 of 41 fetuses (32 weeks) from mothers with positive TSH-receptor antibodies and/or antithyroid treatment.
- Ultrasound and clinical data differentiated fetal hypothyroidism (n=7) from hyperthyroidism (n=4) in affected fetuses.
- One fetus with hyperthyroidism experienced intrauterine fetal demise; ten fetuses were successfully treated. One fetus without goiter had hypothyroidism at birth.
Conclusions:
- Expert fetal thyroid scrutiny via ultrasonography is crucial in pregnant women with Graves' disease.
- Multidisciplinary collaboration among ultrasonographists, obstetricians, and pediatric endocrinologists is essential for accurate diagnosis and management.
- Fetal hyperthyroidism is a significant concern requiring prompt and aggressive treatment.