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Background Elevated serum thyrotropin receptor antibody (TRAb) levels often return to baseline one year post RAI therapy but can sometimes take a few years to normalize. Remission rates of TRAb autoimmunity in GD is higher in patients taking antithyroid medications and who have undergone a thyroidectomy compared to RAI(1). The incidence of neonatal hyperthyroidism in mothers treated with RAI is estimated to be 3.6% 18-24 months post RAI.(2) Clinical case A 31-year-old female G4A1L3 diagnosed with GD at 24 years old treated with RAI at age 25 and remained on L-thyroxine replacement for hypothyroidism. First pregnancy (P1) age 24: terminated at 11wks gestation. P2 (age 28): Spontaneous vaginal delivery (SVD) induced at 38+4wks due to vaginal bleeding, birth weight (BW) 3750g, APGARS 9/9. Baby had NG and was admitted to NICU. On day 3, her heart rate (HR) was greater than140bpmin and she has lost 9.5% weight below her BW. Blood work showed TSH 64.0pmol/L (N: 13.5-41.3), FreeT3 40.4pmol/L (no neonatal reference range), TRAb 206U/L (90pmol/L(N: 12.4-72.4), FT3 23.7pmol/L, TRAb 25.9IU/L(N: 90 pmol/L(N: 12.4-72.4), FT3 19.5pmol/l. TRAB 21.9IU/L(N Conclusion Women with GD who were previously treated with RAI need to be closely monitored for TRAb activity throughout pregnancy. When TRAb Ab levels remain elevated in the T3, close monitoring and assessment of the fetus is critical. Obstetricians and neonatologists need to be involved in the management of these women. References 1. Laurberg P, Wallin G, Tallstedt L, Abraham-Nordling M, Lundell G, Tørring O. TSH-receptor autoimmunity in Graves’ disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study. European Journal of Endocrinology. 2008-01-01 2008;158(1): 69-75. 2. Yoshihara A, Iwaku K, Noh JY, Watanabe N, Kunii Y, Ohye H, et al. Incidence of neonatal hyperthyroidism among newborns of graves’ disease patients treated with radioiodine therapy. Thyroid. 2019;29(1): 128-34. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m. |
