TY - JOUR
T1 - Loss of integrity of thyroid morphology and function in children born to mothers with inadequately treated Graves' disease
AU - Kempers, Marlies J. E.
AU - van Trotsenburg, A. S. Paul
AU - van Rijn, Rick R.
AU - Smets, Anne M. J. B.
AU - Smit, Bert J.
AU - de Vijlder, Jan J. M.
AU - Vulsma, Thomas
PY - 2007
Y1 - 2007
N2 - Context: Central congenital hypothyroidism (CH-C) in neonates born to mothers with inadequately treated Graves' disease usually needs T-4 supplementation. The thyroid and its regulatory system have not yet been extensively studied after T-4 withdrawal, until we observed disintegrated thyroid glands in some patients. Objective: The aim was to study the occurrence and pathogenesis of disintegrated thyroid glands in CH-C patients. Design, Setting, Patients, Participants: Thyroid function was measured and thyroid ultrasound imaging was performed in 13 children with CH-C due to inadequately treated maternal Graves' disease after T-4-supplementation withdrawal (group Aa). In addition, thyroid ultrasound imaging was performed in six children with CH-C born to inadequately treated mothers with Graves' disease, in whom T-4 supplementation was not withdrawn yet (group Ab) or never initiated (group Ac), in six euthyroid children born to adequately treated mothers with Graves' disease (group B), and in 10 T-4-supplemented children with CH-C as part of multiple pituitary hormone deficiency (group C). Main Outcome Measures: Thyroid function and aspect (volume, echogenicity, echotexture)were measured. Results: In group A, five children had developed thyroidal hypothyroidism characterized by persistently elevated TSH concentrations and exaggerated TSH responses after TRH stimulation. In the majority of patients in groups A and C, thyroid echogenicity and volume were decreased, and echotexture was inhomogeneous. Thyroid ultrasound imaging was normal in group B children. Conclusions: Inadequately treated maternal Graves' disease not only may lead to CH-C but also carries an, until now, unrecognized risk of thyroid disintegration in the offspring as well. We speculate that insufficient TSH secretion due to excessive maternal-fetal thyroid hormone transfer inhibits physiological growth and development of the child's thyroid
AB - Context: Central congenital hypothyroidism (CH-C) in neonates born to mothers with inadequately treated Graves' disease usually needs T-4 supplementation. The thyroid and its regulatory system have not yet been extensively studied after T-4 withdrawal, until we observed disintegrated thyroid glands in some patients. Objective: The aim was to study the occurrence and pathogenesis of disintegrated thyroid glands in CH-C patients. Design, Setting, Patients, Participants: Thyroid function was measured and thyroid ultrasound imaging was performed in 13 children with CH-C due to inadequately treated maternal Graves' disease after T-4-supplementation withdrawal (group Aa). In addition, thyroid ultrasound imaging was performed in six children with CH-C born to inadequately treated mothers with Graves' disease, in whom T-4 supplementation was not withdrawn yet (group Ab) or never initiated (group Ac), in six euthyroid children born to adequately treated mothers with Graves' disease (group B), and in 10 T-4-supplemented children with CH-C as part of multiple pituitary hormone deficiency (group C). Main Outcome Measures: Thyroid function and aspect (volume, echogenicity, echotexture)were measured. Results: In group A, five children had developed thyroidal hypothyroidism characterized by persistently elevated TSH concentrations and exaggerated TSH responses after TRH stimulation. In the majority of patients in groups A and C, thyroid echogenicity and volume were decreased, and echotexture was inhomogeneous. Thyroid ultrasound imaging was normal in group B children. Conclusions: Inadequately treated maternal Graves' disease not only may lead to CH-C but also carries an, until now, unrecognized risk of thyroid disintegration in the offspring as well. We speculate that insufficient TSH secretion due to excessive maternal-fetal thyroid hormone transfer inhibits physiological growth and development of the child's thyroid
U2 - https://doi.org/10.1210/jc.2006-2042
DO - https://doi.org/10.1210/jc.2006-2042
M3 - Article
C2 - 17504907
SN - 0021-972X
VL - 92
SP - 2984
EP - 2991
JO - Journal of clinical endocrinology and metabolism
JF - Journal of clinical endocrinology and metabolism
IS - 8
ER -