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September 1992, Vol 146, No. 9 >
Article | September 1992

Elimination Kinetics of Maternally Derived Thyrotropin Receptor–Blocking Antibodies in a Newborn With Significant Thyrotropin Elevation FREE

Anton-Lewis Usala, MD; Isaiah Wexler, MD; Amy Posch; Manjula K. Gupta, PhD
[+] Author Affiliations

Accepted for publication May 26, 1992.

Presented in part at the 72nd Endocrine Society Meeting, Atlanta, Ga, June 20, 1990.

Reprint requests to Section of Pediatric Endocrinology, East Carolina University School of Medicine, Brody Building 3E133, Greenville, NC 27858-4354 (Dr Usala).


Am J Dis Child. 1992;146(9):1074-1077. doi:10.1001/archpedi.1992.02160210076025.
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• Objective.  —To determine the course of maternally derived elevations in thyrotropin-binding inhibitory immunoglobulins in a neonate.

Design.  —Case report.

Setting.  —University pediatric endocrinology clinic and endocrine immunology laboratory in Ohio.

Participants.  —An infant with elevated thyrotropin levels but near-normal total thyroxine levels, and her mother.

Interventions.  —None.

Measurements/Main Results.  —Thyroid hormone, thyrotropin, and thyrotropin-blocking immunoglobulin concentrations were serially measured in a woman and her infant, who was found to have elevated thyrotropin levels (234 mU/L) and borderline low thyroxine levels (95 nmol/L). As infant thyroxine concentrations remained normal (125 to 145 nmol/L), no thyroxine supplementation was given. Thyrotropin levels decreased concomitantly with thyrotropin-blocking inhibitory immunoglobulin levels, and normalized by day 56 of life. The apparent elimination half-life of thyrotropin-blocking immunoglobulins was 7.5 days.

Conclusions.  —The observed parallel elimination kinetics suggest that the thyrotropin receptor antibody acts as a thyrotropin antagonist, resulting in compensatory thyrotropin elevations. The duration of such elevations may be predicted on the basis of such elimination.(AJDC. 1992;146:1074-1077)

REFERENCES

1 +
Matsuura N, Yamada Y, Nohara Y, et al.  Familial neonatal transient hypothyroidism due to maternal TSH-binding inhibitor immunoglobins . N Engl J Med . 1980;;303:738-741.
2 +
Ritzer RM, Mahler H, Alnery A.  Transitory congenital hypothyroidism and maternal thyroiditis . Acta Paediatr Scand . 1981;;70:765-767.
3 +
Francis C, Riley W.  Congenital familial transient hypothyroidism secondary to transplacental thyrotropin-blocking autoantibodies . AJDC . 1987;; 141:1081-1083.
4 +
Iseki M, Shjimizu M, Oikawa T, et al.  Sequential serum measurements of thyrotropin binding inhibitor immunoglobulin G in transient familial neonatal hypothyroidism . J Clin Endocrinol Metab . 1983;;57:384-387.
5 +
Zakarija M, McKenzie JM, Eidson MS.  Transient neonatal hypothyroidism: characterization of maternal antibodies to the thyrotropin receptor . J Clin Endocrinol Metab . 1990;;70:239-246.
6 +
Southgate K, Creagl F, Teece M.  A receptor assay for the measurement of TSH receptor antibodies in unextracted serum . Clin Endocrinol . 1984;;20: 539-548.
7 +
Gupta MK, Johnson C, Schumacher OP.  Use of FRTL-5 rat thyroid cell line for measurement of human thyroid-stimulating immunoglobin (TSI): comparison with TSH-binding inhibition immunoglobulin (TBII) . In: Medeiros-Neto G, Gaitan E, eds. Frontiers in Thyroidology . New York, NY: Plenum Medical Book Co; 1987;;2:1441-1446.
8 +
Vitti P, Rotella CM, Valente WA, et al.  Characterization of optimal stimulating effects of Graves' monoclonal and serum immunoglobulin G on adenosine 3'5'monophosphate production in FRTL-5 thyroid cells: a potential clinical assay . J Clin Endocrinol Metab . 1983;;57:782-791.
9 +
Kasagi K, Konishi J, Iida Y, et al.  A sensitive and practical assay for thyroid stimulating antibodies using FRTL-5 thyroid cells . Acta Endocrinol . 1987;;115:30-36.
10 +
Kessler SW.  Use of protein A-bearing staphylococci for the immunoprecipitation and isolation of antigens from cells . Methods Enzymol . 1981;; 73:442-459.
11 +
Jain VK, Gupta MK, Seifarth K, Clough J.  Monoclonal antibody based-enzyme immunoassays for IgG subclasses using biotin strepavidin system . Fed Proc . 1987;;45:73-79.
12 +
Zar JH.  Comparing simple linear regression equations . In: Biostatistical analysis . Englewood Cliffs, NJ: Prentice Hall International Inc; 1984;:292-305.
13 +
Holztman NA, Leonard CO, Medici FN, et al.  Newborn screening for congenital hypothyroidism: recommended guidelines . Pediatrics . 1987;;80: 745-749.
14 +
Miyanchi A, Amino N, Tamaki H, Kuma K.  Coexistence of thyroid stimulating and thyroid blocking antibodies in a patient with Graves' disease who had transient hypothyroidism . Am J Med . 1988;;85:418-420.
15 +
Klein RZ, Arnold MB, Bapat V, et al.  Elementary school performance of children with congenital hypothyroidism . J Pediatr . 1990;;116:27-32.
16 +
Fisher DA, Foley BL.  Early treatment of congenital hypothyroidism . Pediatrics . 1989;;83:785-789.
17 +
Hoffman WL, Goldberg MS, Smiley D.  Immunoglobulin G3 subclass production by rheumatoid synovial tissue cultures . J Clin Invest . 1982;;69: 136-144.
18 +
Karpatkin S, Schur PH, Strick N, Siskind GW.  Heavy chain subclass of human anti-platelet antibodies . Clin Immunopathol . 1973;;2:1-8.
19 +
Zakarija M.  The thyroid-stimulating antibody of Graves' disease: evidence for restricted heterogeneity . Horm Res . 1980;;13:1-15.
20 +
Hollingsworth DR, Mabry CC, Eckerd JM.  Hereditary aspects of Graves' disease in infancy and childhood . J Pediatr . 1982;;81:446-459.
21 +
Rovet JF, Ehrlich RM, Sorbara DL.  Effect of thyroid hormone level on temperament in infants with congenital hypothyroidism detected by screening of neonates . J Pediatr . 1989;;114:63-68.
22 +
Rovet JF, Donner E, Ehrlich R. Long-term outcome in children with congenital hypothyroidism (CH) identified by newborn screening: initial severity versus treatment adequacy. Presented at the 9th National Neonatal Screening Symposium; April 8, 1992; Raleigh, NC.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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References

1 +
Matsuura N, Yamada Y, Nohara Y, et al.  Familial neonatal transient hypothyroidism due to maternal TSH-binding inhibitor immunoglobins . N Engl J Med . 1980;;303:738-741.
2 +
Ritzer RM, Mahler H, Alnery A.  Transitory congenital hypothyroidism and maternal thyroiditis . Acta Paediatr Scand . 1981;;70:765-767.
3 +
Francis C, Riley W.  Congenital familial transient hypothyroidism secondary to transplacental thyrotropin-blocking autoantibodies . AJDC . 1987;; 141:1081-1083.
4 +
Iseki M, Shjimizu M, Oikawa T, et al.  Sequential serum measurements of thyrotropin binding inhibitor immunoglobulin G in transient familial neonatal hypothyroidism . J Clin Endocrinol Metab . 1983;;57:384-387.
5 +
Zakarija M, McKenzie JM, Eidson MS.  Transient neonatal hypothyroidism: characterization of maternal antibodies to the thyrotropin receptor . J Clin Endocrinol Metab . 1990;;70:239-246.
6 +
Southgate K, Creagl F, Teece M.  A receptor assay for the measurement of TSH receptor antibodies in unextracted serum . Clin Endocrinol . 1984;;20: 539-548.
7 +
Gupta MK, Johnson C, Schumacher OP.  Use of FRTL-5 rat thyroid cell line for measurement of human thyroid-stimulating immunoglobin (TSI): comparison with TSH-binding inhibition immunoglobulin (TBII) . In: Medeiros-Neto G, Gaitan E, eds. Frontiers in Thyroidology . New York, NY: Plenum Medical Book Co; 1987;;2:1441-1446.
8 +
Vitti P, Rotella CM, Valente WA, et al.  Characterization of optimal stimulating effects of Graves' monoclonal and serum immunoglobulin G on adenosine 3'5'monophosphate production in FRTL-5 thyroid cells: a potential clinical assay . J Clin Endocrinol Metab . 1983;;57:782-791.
9 +
Kasagi K, Konishi J, Iida Y, et al.  A sensitive and practical assay for thyroid stimulating antibodies using FRTL-5 thyroid cells . Acta Endocrinol . 1987;;115:30-36.
10 +
Kessler SW.  Use of protein A-bearing staphylococci for the immunoprecipitation and isolation of antigens from cells . Methods Enzymol . 1981;; 73:442-459.
11 +
Jain VK, Gupta MK, Seifarth K, Clough J.  Monoclonal antibody based-enzyme immunoassays for IgG subclasses using biotin strepavidin system . Fed Proc . 1987;;45:73-79.
12 +
Zar JH.  Comparing simple linear regression equations . In: Biostatistical analysis . Englewood Cliffs, NJ: Prentice Hall International Inc; 1984;:292-305.
13 +
Holztman NA, Leonard CO, Medici FN, et al.  Newborn screening for congenital hypothyroidism: recommended guidelines . Pediatrics . 1987;;80: 745-749.
14 +
Miyanchi A, Amino N, Tamaki H, Kuma K.  Coexistence of thyroid stimulating and thyroid blocking antibodies in a patient with Graves' disease who had transient hypothyroidism . Am J Med . 1988;;85:418-420.
15 +
Klein RZ, Arnold MB, Bapat V, et al.  Elementary school performance of children with congenital hypothyroidism . J Pediatr . 1990;;116:27-32.
16 +
Fisher DA, Foley BL.  Early treatment of congenital hypothyroidism . Pediatrics . 1989;;83:785-789.
17 +
Hoffman WL, Goldberg MS, Smiley D.  Immunoglobulin G3 subclass production by rheumatoid synovial tissue cultures . J Clin Invest . 1982;;69: 136-144.
18 +
Karpatkin S, Schur PH, Strick N, Siskind GW.  Heavy chain subclass of human anti-platelet antibodies . Clin Immunopathol . 1973;;2:1-8.
19 +
Zakarija M.  The thyroid-stimulating antibody of Graves' disease: evidence for restricted heterogeneity . Horm Res . 1980;;13:1-15.
20 +
Hollingsworth DR, Mabry CC, Eckerd JM.  Hereditary aspects of Graves' disease in infancy and childhood . J Pediatr . 1982;;81:446-459.
21 +
Rovet JF, Ehrlich RM, Sorbara DL.  Effect of thyroid hormone level on temperament in infants with congenital hypothyroidism detected by screening of neonates . J Pediatr . 1989;;114:63-68.
22 +
Rovet JF, Donner E, Ehrlich R. Long-term outcome in children with congenital hypothyroidism (CH) identified by newborn screening: initial severity versus treatment adequacy. Presented at the 9th National Neonatal Screening Symposium; April 8, 1992; Raleigh, NC.

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