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Inicio Medicina Clínica (English Edition) Maternal autoimmune thyroid disease: Relevance for the newborn
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Vol. 144. Issue 7.
Pages 297-303 (April 2015)
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Vol. 144. Issue 7.
Pages 297-303 (April 2015)
Original article
DOI: 10.1016/j.medcle.2013.10.002
Maternal autoimmune thyroid disease: Relevance for the newborn
Enfermedad tiroidea autoinmunitaria materna: repercusión en el recién nacido
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M. Carmen Temboury Molinaa,
Corresponding author
carmentemboury@hotmail.com

Corresponding author.
, M. José Rivero Martínb, Jesús de Juan Ruizc, Susana Ares Segurad
a Servicio de Pediatría, Hospital del Sureste, Arganda del Rey, Madrid, Spain
b Servicio de Pediatría, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Spain
c Cátedra de Estadística, Escuela Superior de Ingenieros Industriales de Madrid, Madrid, Spain
d Servicio de Neonatología, Hospital Infantil La Paz, Madrid, Spain
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Tables (5)
Table 1. Description of the characteristics of mothers and children (No.=81).
Table 2. Serum thyroid function in the newborns.
Table 3. Description of the 7 children with verified serum thyroid-stimulating hormone >9.5.
Table 4. Free thyroxine of the child: differences according to the mother diagnosis.
Table 5. Multiple regression: variables that affect the thyrotropin value. Model that explains the 19% of the thyroid-stimulating hormone logarithm value.
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Abstract
Background and objective

Autoimmune thyroid disease is amongst the most frequent endocrine disorders during pregnancy. It is associated with an increase in perinatal morbidity, congenital defects, neurological damage, foetal and neonatal thyroid dysfunction. Maternal thyroid hormones play a key role in child neurodevelopment. We aimed to evaluate the thyroid function and the clinical course of neonates born from mothers with autoimmune thyroid disease during the first months of life in order to define the follow-up.

Patients and method

We monitored thyroid function and clinical status during the first months in 81 newborns of mothers with autoimmune thyroid disease; 16 had Graves disease and 65 autoimmune thyroiditis.

Results

A percentage of 4.93 newborns had congenital defects, and 8.64% neonates showed an increase in thyrotropin (TSH) (>9.5μUI/mL 2 times) and required thyroxin within the first month of life. A 85.7% of these showed a negative newborn screening (due to a later increase of TSH). A higher TSH value in the newborn was related to an older age of the mother, higher levels of thyroid peroxidase (TPO) antibody during pregnancy and lower birth weight. A higher free thyroxine (FT4) value in the newborn was related to fewer days of life and mothers with Graves disease.

Conclusions

We recommend the evaluation of TSH, T4 and TPO antibodies before 10 weeks in all pregnant women with follow-up if maternal thyroid autoimmunity or disorders is detected. It is also recommended to test children's serum TSH and FT4 at 48h of life in newborns of mothers with autoimmune thyroid disease and repeat them between the 2nd and 4th week in children with TSH>6μUI/mL. Careful endocrine follow-up is advised in pregnant women and children if hyperthyroidism is detected.

Keywords:
Children born from mothers with autoimmune thyroid disease
Pregnancy in Graves disease
Thyroid autoimmunity in pregnancy
Hypothyroidism
Resumen
Fundamento y objetivo

La enfermedad tiroidea autoinmunitaria es uno de los problemas endocrinológicos más frecuentes del embarazo. Se asocia a mayor morbilidad perinatal, malformaciones, daño neurológico y disfunción tiroidea neonatal. Las hormonas tiroideas maternas son claves en el neurodesarrollo fetal. Evaluamos la función tiroidea, en los primeros meses, de los hijos de mujeres con enfermedad tiroidea autoinmunitaria, para intentar establecer el seguimiento óptimo.

Pacientes y método

Se controló la función tiroidea, durante los primeros meses, en 81 hijos de mujeres con enfermedad tiroidea autoinmunitaria (16 casos de hipertiroidismo y 65 de tiroiditis autoinmunitaria).

Resultados

El 4,93% de los neonatos presentaron malformaciones, y el 8,64% recibieron tiroxina por un valor de tirotropina (TSH) comprobada mayor de 9,5μUI/ml en el primer mes. En el 85,7% de estos, el cribado neonatal fue negativo, por un aumento tardío de la TSH. Se asoció a TSH elevada en el niño: menor peso al nacimiento, mayor edad materna y mayor título de anticuerpos antiperoxidasa tiroidea (anti-TPO) en la gestación. Se asoció a una tiroxina libre (T4L) más alta en el niño: tener menos edad y que la madre tuviera hipertiroidismo.

Conclusiones

Se recomienda determinar en todas las gestantes los valores de TSH, T4 y anticuerpos anti-TPO antes de la semana 10, y seguimiento o tratamiento si hubiera alteraciones. Asimismo, se recomienda controlar a las 48h de vida la TSH y la T4L en hijos de mujeres con enfermedad tiroidea autoinmunitaria y, si la TSH fuera mayor de 6μUI/l, repetir el control entre las semanas 2-4. Es recomendable efectuar un control cuidadoso de la gestante con hipertiroidismo y de su hijo.

Palabras clave:
Hijo de mujer con enfermedad tiroidea autoinmunitaria
Enfermedad de Graves en el embarazo
Autoinmunidad tiroidea materna
Hipotiroidismo

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