Loss of Integrity of Thyroid Morphology and Function in Children Born to Mothers with Inadequately Treated Graves’ Disease
Context: Central congenital hypothyroidism (CH-C) in neonates born to mothers with inadequately treated Graves’ disease usually needs T4 supplementation. The thyroid and its regulatory system have not yet been extensively studied after T4 withdrawal, until we observed disintegrated thyroid glands in...
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| Veröffentlicht in: | The journal of clinical endocrinology and metabolism 2007-08, Vol.92 (8), p.2984-2991 |
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| container_title | The journal of clinical endocrinology and metabolism |
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| creator | Kempers, Marlies J. E. van Trotsenburg, A. S. Paul van Rijn, Rick R. Smets, Anne M. J. B. Smit, Bert J. de Vijlder, Jan J. M. Vulsma, Thomas |
| description | Context: Central congenital hypothyroidism (CH-C) in neonates born to mothers with inadequately treated Graves’ disease usually needs T4 supplementation. The thyroid and its regulatory system have not yet been extensively studied after T4 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 T4-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in six children with CH-C born to inadequately treated mothers with Graves’ disease, in whom T4 supplementation was not withdrawn yet (group Ab) or never initiated (group Ac), in six euthyroid children born to adequately treated mothers with Graves’ disease (group B), and in 10 T4-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. |
| doi_str_mv | 10.1210/jc.2006-2042 |
| format | Article |
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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 T4-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 T4 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 T4-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.</description><identifier>ISSN: 0021-972X</identifier><identifier>EISSN: 1945-7197</identifier><identifier>DOI: 10.1210/jc.2006-2042</identifier><identifier>PMID: 17504907</identifier><identifier>CODEN: JCEMAZ</identifier><language>eng</language><publisher>Bethesda, MD: Endocrine Society</publisher><subject>Adult ; Biological and medical sciences ; Child ; Child, Preschool ; Children ; Congenital Hypothyroidism - diagnostic imaging ; Congenital Hypothyroidism - etiology ; Congenital Hypothyroidism - pathology ; Endocrinopathies ; Feeding. Feeding behavior ; Female ; Fetuses ; Fundamental and applied biological sciences. Psychology ; Graves disease ; Graves Disease - complications ; Graves Disease - drug therapy ; Graves Disease - pathology ; Humans ; Hypothyroidism ; Infant ; Infant, Newborn ; Maternal-Fetal Exchange ; Medical sciences ; Neonates ; Non tumoral diseases. Target tissue resistance. Benign neoplasms ; Pituitary ; Pituitary hormones ; Pituitary Hormones - deficiency ; Pregnancy ; Receptors, Thyrotropin - blood ; Supplements ; Thyroid Function Tests ; Thyroid gland ; Thyroid Gland - diagnostic imaging ; Thyroid Gland - pathology ; Thyroid Gland - physiology ; Thyroid-stimulating hormone ; Thyroid. Thyroid axis (diseases) ; Thyrotropin - blood ; Thyrotropin-releasing hormone ; Thyroxine ; Thyroxine - therapeutic use ; Ultrasonic imaging ; Ultrasonography ; Ultrasound ; Vertebrates: anatomy and physiology, studies on body, several organs or systems ; Vertebrates: endocrinology</subject><ispartof>The journal of clinical endocrinology and metabolism, 2007-08, Vol.92 (8), p.2984-2991</ispartof><rights>Copyright © 2007 by The Endocrine Society 2007</rights><rights>2007 INIST-CNRS</rights><rights>Copyright © 2007 by The Endocrine Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c461t-20963f8a49cb6f2c3f818c529f0977e19c3f453c1d5cb67835f092e916992133</citedby><cites>FETCH-LOGICAL-c461t-20963f8a49cb6f2c3f818c529f0977e19c3f453c1d5cb67835f092e916992133</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18997555$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17504907$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kempers, Marlies J. E.</creatorcontrib><creatorcontrib>van Trotsenburg, A. S. Paul</creatorcontrib><creatorcontrib>van Rijn, Rick R.</creatorcontrib><creatorcontrib>Smets, Anne M. J. B.</creatorcontrib><creatorcontrib>Smit, Bert J.</creatorcontrib><creatorcontrib>de Vijlder, Jan J. M.</creatorcontrib><creatorcontrib>Vulsma, Thomas</creatorcontrib><title>Loss of Integrity of Thyroid Morphology and Function in Children Born to Mothers with Inadequately Treated Graves’ Disease</title><title>The journal of clinical endocrinology and metabolism</title><addtitle>J Clin Endocrinol Metab</addtitle><description>Context: Central congenital hypothyroidism (CH-C) in neonates born to mothers with inadequately treated Graves’ disease usually needs T4 supplementation. The thyroid and its regulatory system have not yet been extensively studied after T4 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 T4-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 T4 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 T4-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.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Congenital Hypothyroidism - diagnostic imaging</subject><subject>Congenital Hypothyroidism - etiology</subject><subject>Congenital Hypothyroidism - pathology</subject><subject>Endocrinopathies</subject><subject>Feeding. Feeding behavior</subject><subject>Female</subject><subject>Fetuses</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Graves disease</subject><subject>Graves Disease - complications</subject><subject>Graves Disease - drug therapy</subject><subject>Graves Disease - pathology</subject><subject>Humans</subject><subject>Hypothyroidism</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Maternal-Fetal Exchange</subject><subject>Medical sciences</subject><subject>Neonates</subject><subject>Non tumoral diseases. Target tissue resistance. Benign neoplasms</subject><subject>Pituitary</subject><subject>Pituitary hormones</subject><subject>Pituitary Hormones - deficiency</subject><subject>Pregnancy</subject><subject>Receptors, Thyrotropin - blood</subject><subject>Supplements</subject><subject>Thyroid Function Tests</subject><subject>Thyroid gland</subject><subject>Thyroid Gland - diagnostic imaging</subject><subject>Thyroid Gland - pathology</subject><subject>Thyroid Gland - physiology</subject><subject>Thyroid-stimulating hormone</subject><subject>Thyroid. Thyroid axis (diseases)</subject><subject>Thyrotropin - blood</subject><subject>Thyrotropin-releasing hormone</subject><subject>Thyroxine</subject><subject>Thyroxine - therapeutic use</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography</subject><subject>Ultrasound</subject><subject>Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><subject>Vertebrates: endocrinology</subject><issn>0021-972X</issn><issn>1945-7197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU-L1DAYxoMo7rh68ywBUS92zZ-maY7r6K4LI17m4K1k07fbDJ2km6RKwYNfw6_nJzHDFAZEIZA3yY_nfZ88CD2n5IIySt7tzAUjpCoYKdkDtKKqFIWkSj5EK0IYLZRkX8_Qkxh3hNCyFPwxOqNSkFIRuUI_Nj5G7Dt84xLcBZvmw2Hbz8HbFn_2Yez94O9mrF2LryZnkvUOW4fXvR3aAA6_98Hh5DObeggRf7epz2q6hftJJxhmvA2QixZfB_0N4u-fv_AHG0FHeIoedXqI8GzZz9H26uN2_anYfLm-WV9uClNWNGVnquJdrUtlbquOmVzT2gimOqKkBKryTfZlaCsyIGsu8gMDRSulGOX8HL0-yo7B308QU7O30cAwaAd-ik1VU16SWmbw5V_gzk_B5dEaTquS13mRTL09UibkvwvQNWOwex3mhpLmEEmzM80hkuYQScZfLKLT7R7aE7xkkIFXC6Cj0UMXtDM2nrhaKSmEyNybI-en8X8ti6UlP5LgWm-CdTAGiPHk5p-D_gEYn7Dw</recordid><startdate>20070801</startdate><enddate>20070801</enddate><creator>Kempers, Marlies J. E.</creator><creator>van Trotsenburg, A. S. Paul</creator><creator>van Rijn, Rick R.</creator><creator>Smets, Anne M. J. B.</creator><creator>Smit, Bert J.</creator><creator>de Vijlder, Jan J. M.</creator><creator>Vulsma, Thomas</creator><general>Endocrine Society</general><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7TM</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20070801</creationdate><title>Loss of Integrity of Thyroid Morphology and Function in Children Born to Mothers with Inadequately Treated Graves’ Disease</title><author>Kempers, Marlies J. E. ; van Trotsenburg, A. S. Paul ; van Rijn, Rick R. ; Smets, Anne M. J. B. ; Smit, Bert J. ; de Vijlder, Jan J. M. ; Vulsma, Thomas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c461t-20963f8a49cb6f2c3f818c529f0977e19c3f453c1d5cb67835f092e916992133</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Congenital Hypothyroidism - diagnostic imaging</topic><topic>Congenital Hypothyroidism - etiology</topic><topic>Congenital Hypothyroidism - pathology</topic><topic>Endocrinopathies</topic><topic>Feeding. Feeding behavior</topic><topic>Female</topic><topic>Fetuses</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Graves disease</topic><topic>Graves Disease - complications</topic><topic>Graves Disease - drug therapy</topic><topic>Graves Disease - pathology</topic><topic>Humans</topic><topic>Hypothyroidism</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Maternal-Fetal Exchange</topic><topic>Medical sciences</topic><topic>Neonates</topic><topic>Non tumoral diseases. Target tissue resistance. Benign neoplasms</topic><topic>Pituitary</topic><topic>Pituitary hormones</topic><topic>Pituitary Hormones - deficiency</topic><topic>Pregnancy</topic><topic>Receptors, Thyrotropin - blood</topic><topic>Supplements</topic><topic>Thyroid Function Tests</topic><topic>Thyroid gland</topic><topic>Thyroid Gland - diagnostic imaging</topic><topic>Thyroid Gland - pathology</topic><topic>Thyroid Gland - physiology</topic><topic>Thyroid-stimulating hormone</topic><topic>Thyroid. Thyroid axis (diseases)</topic><topic>Thyrotropin - blood</topic><topic>Thyrotropin-releasing hormone</topic><topic>Thyroxine</topic><topic>Thyroxine - therapeutic use</topic><topic>Ultrasonic imaging</topic><topic>Ultrasonography</topic><topic>Ultrasound</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><topic>Vertebrates: endocrinology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kempers, Marlies J. E.</creatorcontrib><creatorcontrib>van Trotsenburg, A. S. Paul</creatorcontrib><creatorcontrib>van Rijn, Rick R.</creatorcontrib><creatorcontrib>Smets, Anne M. J. B.</creatorcontrib><creatorcontrib>Smit, Bert J.</creatorcontrib><creatorcontrib>de Vijlder, Jan J. M.</creatorcontrib><creatorcontrib>Vulsma, Thomas</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of clinical endocrinology and metabolism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kempers, Marlies J. E.</au><au>van Trotsenburg, A. S. Paul</au><au>van Rijn, Rick R.</au><au>Smets, Anne M. J. B.</au><au>Smit, Bert J.</au><au>de Vijlder, Jan J. M.</au><au>Vulsma, Thomas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Loss of Integrity of Thyroid Morphology and Function in Children Born to Mothers with Inadequately Treated Graves’ Disease</atitle><jtitle>The journal of clinical endocrinology and metabolism</jtitle><addtitle>J Clin Endocrinol Metab</addtitle><date>2007-08-01</date><risdate>2007</risdate><volume>92</volume><issue>8</issue><spage>2984</spage><epage>2991</epage><pages>2984-2991</pages><issn>0021-972X</issn><eissn>1945-7197</eissn><coden>JCEMAZ</coden><abstract>Context: Central congenital hypothyroidism (CH-C) in neonates born to mothers with inadequately treated Graves’ disease usually needs T4 supplementation. The thyroid and its regulatory system have not yet been extensively studied after T4 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 T4-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 T4 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 T4-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.</abstract><cop>Bethesda, MD</cop><pub>Endocrine Society</pub><pmid>17504907</pmid><doi>10.1210/jc.2006-2042</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The journal of clinical endocrinology and metabolism, 2007-08, Vol.92 (8), p.2984-2991 |
| issn | 0021-972X 1945-7197 |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Biological and medical sciences Child Child, Preschool Children Congenital Hypothyroidism - diagnostic imaging Congenital Hypothyroidism - etiology Congenital Hypothyroidism - pathology Endocrinopathies Feeding. Feeding behavior Female Fetuses Fundamental and applied biological sciences. Psychology Graves disease Graves Disease - complications Graves Disease - drug therapy Graves Disease - pathology Humans Hypothyroidism Infant Infant, Newborn Maternal-Fetal Exchange Medical sciences Neonates Non tumoral diseases. Target tissue resistance. Benign neoplasms Pituitary Pituitary hormones Pituitary Hormones - deficiency Pregnancy Receptors, Thyrotropin - blood Supplements Thyroid Function Tests Thyroid gland Thyroid Gland - diagnostic imaging Thyroid Gland - pathology Thyroid Gland - physiology Thyroid-stimulating hormone Thyroid. Thyroid axis (diseases) Thyrotropin - blood Thyrotropin-releasing hormone Thyroxine Thyroxine - therapeutic use Ultrasonic imaging Ultrasonography Ultrasound Vertebrates: anatomy and physiology, studies on body, several organs or systems Vertebrates: endocrinology |
| title | Loss of Integrity of Thyroid Morphology and Function in Children Born to Mothers with Inadequately Treated Graves’ Disease |
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