[Show abstract][Hide abstract] ABSTRACT: Context: In adult women, Anti-Müllerian hormone (AMH) is produced by small growing follicles, and circulating levels of AMH reflect the number of antral follicles as well as primordial follicles. Whether AMH reflects follicle numbers in healthy girls remains to be elucidated. Objective: To evaluate if serum levels of AMH reflects ovarian morphology in healthy girls. Design: Population-based cohort study. Setting: General community. Participants: 121 healthy girls aged 9.8 - 14.7 years. Main outcome measures: Clinical examination, including pubertal breast stage (Tanner´s classification B1 - 5). Ovarian volume as well as the number and size of antral follicles were assessed by two independent modalities: A) Magnetic resonance imaging (MRI): Ellipsoid volume, follicles ≥ 2mm, and B) Transabdominal ultrasound (TAUS): Ellipsoid- and 3D volume, follicles ≥ 1mm. Circulating levels of AMH, inhibin B, estradiol, FSH and LH were assessed by immunoassays; testosterone and androstenedione by LC-MS/MS. Results: AMH reflected the number of small (MRI 2 - 3mm) and medium (4 - 6mm) follicles (Pearson´s Rho (r) = 0.531 and r = 0.512, p<0.001) but not large follicles (≥ 7mm) (r = 0.109, p=0.323). In multiple regression analysis, small and medium follicles (MRI ≤ 6mm) remained the main contributors to circulating AMH (Beta 0.501, p<0.001) whereas the correlation between AMH and estradiol was negative (Beta -0.318, p=0.005). In early puberty (B1 - B3), the number of AMH-producing follicles (2 - 6mm) correlated positively with pubertal stages (r=0.453, p=0.001), whereas AMH levels were unaffected (-0.183, p=0.118). Conclusions: Similarly to adult women, small and medium antral follicles (≤ 6mm) were the main contributors to circulating levels of AMH in girls.
[Show abstract][Hide abstract] ABSTRACT: Maternal overtreatment with antithyroid drugs can induce fetal goitrous hypothyroidism. This condition can have a critical effect on pregnancy outcome, as well as on fetal growth and neurological development. The purpose of this Review is to clarify if and how fetal goitrous hypothyroidism can be prevented, and how to react when prevention has failed. Understanding the importance of pregnancy-related changes in maternal thyroid status when treating a pregnant woman is crucial to preventing fetal goitrous hypothyroidism. Maternal levels of free T(4) are the most consistent indication of maternal and fetal thyroid status. In patients with fetal goitrous hypothyroidism, intra-amniotic levothyroxine injections improve fetal outcome. The best way to avoid maternal overtreatment with antithyroid drugs is to monitor closely the maternal thyroid status, especially estimates of free T(4) levels.
[Show abstract][Hide abstract] ABSTRACT: Treatment of Graves' disease during pregnancy with antithyroid drugs (ATDs) poses a risk of inducing hypothyroidism and, thus, development of a goiter to the fetus.
We report two patients referred to our department after discovery of a fetal goiter by ultrasound examination in the second trimester of pregnancy. The women receiving 400 mg/day propylthiouracil and 10 mg/day thiamizole, respectively, had thyrotropin and total thyroxine values within the normal reference range but a lowered free thyroxine level. Fetal blood sampling by cordocentesis revealed severe fetal hypothyroidism as the cause of goiter development. Reduction of maternal ATD dose and injection of levothyroxine intra-amniotically quickly reduced the goiter size, and both babies were born euthyroid and without goiters.
Two pregnant women with Graves' disease were overtreated with ATDs inducing iatrogenic goiter in the fetuses. Successful treatment with intra-amniotic levothyroxine injections rendered the babies euthyroid and nongoitrous at birth.
Correct interpretation of thyroid function tests during pregnancy in general--and during ATD therapy of Graves' disease in particular--is difficult. Awareness of pregnancy-related changes in maternal thyroid status, and a close teamwork among endocrinologists, obstetricians, and experts in fetal medicine, is pivotal in ensuring normal growth and development of the unborn child of these patients.
Thyroid: official journal of the American Thyroid Association 01/2011; 21(1):75-81. · 2.60 Impact Factor