Graves Disease With Thyroid-Stimulating Hormone Receptor–Blocking Autoantibodies During Pregnancy
Authors: Brigitte Decallonne, Pieter-Jan Martens, Annick Van den Bruel, Christine Vanhole, George J. Kahaly
Journal: Annals of Internal Medicine (2020)

Letters2 June 2020Graves Disease With Thyroid-Stimulating Hormone Receptor–Blocking Autoantibodies During PregnancyBrigitte Decallonne, MD, PhD, Pieter-Jan Martens, MD, Annick Van den Bruel, MD, Christine Vanhole, MD, PhD, and George J. Kahaly, MD, PhDBrigitte Decallonne, MD, PhDUniversity Hospitals Leuven, Leuven, Belgium (B.D., P.M., C.V.), Pieter-Jan Martens, MDUniversity Hospitals Leuven, Leuven, Belgium (B.D., P.M., C.V.), Annick Van den Bruel, MDHospital St Jan, Bruges, Belgium (A.V.), Christine Vanhole, MD, PhDUniversity Hospitals Leuven, Leuven, Belgium (B.D., P.M., C.V.), and George J. Kahaly, MD, PhDJohannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0818 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Graves disease is an autoimmune disease caused by thyroid-stimulating hormone receptor antibodies (TSH-R-Ab), which can be stimulating (TSAb), neutral, or blocking (TBAb). The net antibody activity determines the clinical phenotype. Typically, TSAbs dominate, resulting in hyperthyroidism. Rarely, TBAbs prevail, resulting in hypothyroidism (1). The conventional TSH-R-Ab binding assay used in clinical practice does not differentiate among antibody types. This limitation is relevant in women with Graves disease who are taking L-thyroxine (L-T4) and become pregnant because TSH-R-Abs cross the placenta and affect the fetal thyroid gland.Objective: To remind clinicians of the importance of early detection, close monitoring, and ...References1. Smith TJ, Hegedüs L. Graves' disease. N Engl J Med. 2016;375:1552-65. [PMID: 27797318] CrossrefMedlineGoogle Scholar2. Diana T, Li Y, Olivo PD, et al. Analytical performance and validation of a bioassay for thyroid-blocking antibodies. Thyroid. 2016;26:734-40. [PMID: 26956921] doi:10.1089/thy.2015.0447 CrossrefMedlineGoogle Scholar3. Brown RS, Alter CA, Sadeghi-Nejad A. Severe unsuspected maternal hypothyroidism discovered after the diagnosis of thyrotropin receptor-blocking antibody-induced congenital hypothyroidism in the neonate: failure to recognize and implications to the fetus. Horm Res Paediatr. 2015;83:132-5. [PMID: 25427793] CrossrefMedlineGoogle Scholar4. Kahaly GJ, Bartalena L, Hegedüs L, et al. 2018 European Thyroid Association guideline for the management of Graves' hyperthyroidism. Eur Thyroid J. 2018;7:167-86. [PMID: 30283735] doi:10.1159/000490384 CrossrefMedlineGoogle Scholar5. Muller I, Moran C, Lecumberri B, et al. 2019 European Thyroid Association guidelines on the management of thyroid dysfunction following immune reconstitution therapy. Eur Thyroid J. 2019;8:173-85. [PMID: 31602359] doi:10.1159/000500881 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University Hospitals Leuven, Leuven, Belgium (B.D., P.M., C.V.)Hospital St Jan, Bruges, Belgium (A.V.)Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.)Acknowledgment: The authors thank Miss Tanja Diana, PhD, MSc (Johannes Gutenberg University Thyroid Lab, Mainz, Germany), for being responsible for all sequential functional TSH-R-Ab measurements.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0818.This article was published at Annals.org on 24 March 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMaternal HyperthyroidismIdentification of Two Different Phenotypes of Patients with Amiodarone-Induced Thyrotoxicosis and Positive Thyrotropin Receptor Antibody TestsManagement of Graves Thyroidal and Extrathyroidal Disease: An UpdateStrong Correlation between HLA and Clinical Course of Subacute Thyroiditis—A Report of the Three Siblings 2 June 2020Volume 172, Issue 11Page: 767-769KeywordsAntibodiesAutoimmune diseasesDrugsHyperthyroidismHypothyroidismPlacentaPregnancyThyroidThyroid diseasesThyroid-stimulating hormone ePublished: 24 March 2020 Issue Published: 2 June 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...