Maternal TSH-receptor antibodies predict fetal/neonatal hyperthyroidism in pregnancies with a history of Graves disease
Authors' conclusion
Trimester-specific TRAb thresholds were higher than the universal ULN multipliers commonly applied in clinical practice, and differed by gestational age and disease status.
Study context
- Population
- Pregnant women with a history of or active Graves disease, tertiary and secondary care centres across the Netherlands, 2010–2023; TRAb measured with TRAK human assay on BRAHMS Kryptor Compact Plussecondary care centres 44
- Participants
- 500 vs 178
- Exposure
- History of Graves disease vs Active Graves
- History of Graves diseasen = 500
- Active Gravesn = 178
- Outcome
- Biochemically confirmed fetal/neonatal hyperthyroidism or hypothyroidism
Methodological detailsmulticentre, observational
- Multicentre
- Observational
Main finding
As reported in the abstract
Prediction of fetal/neonatal thyroid dysfunction by trimester-specific TRAb thresholds
| Group | Trimester-specific cutoffs (fold upper limit of normal (ULN)) | NPV | Sensitivity |
|---|---|---|---|
| History of Graves disease | 25-, 19-, and 6-fold | 100% | |
| Active Graves | 10-, 12-, and 10-fold | 89%, 86%, and 83% |
Trimester-specific cutoffs (fold upper limit of normal (ULN))
History of Graves disease25-, 19-, and 6-fold
Active Graves10-, 12-, and 10-fold
NPV
History of Graves disease100%
Active Graves— not stated in the abstract
Sensitivity
History of Graves disease— not stated in the abstract
Active Graves89%, 86%, and 83%
Observational data: associations, not effects.
Further findings
Neonatal hyperthyroidism with antithyroid drug treatment
- Neonatal hyperthyroidism occurred despite low or declining maternal TRAb levels in mothers treated with antithyroid drugs
Original publication
Maternal TSH-receptor antibodies predict fetal/neonatal hyperthyroidism in pregnancies with a history of Graves disease. J Clin Endocrinol Metab. Published 18 March 2026. doi:10.
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