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

Anton-Lewis Usala, MD; Isaiah Wexler, MD; Amy Posch; Manjula K. Gupta, PhD
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)

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