Human Reproduction Update, Vol.10, No.2 pp.95-105, 2004
© European Society of Human Reproduction and Embryology 2004; all rights reserved
Abnormal stimulation of the thyrotrophin receptor during gestation
1 Service d’Endocrinologie, 2 INSERM EMI U0018, 3 Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire d’Angers and 4 Université d’Angers, Angers, France 5 To whom correspondence should be addressed at Service d’Endocrinologie Centre Hospitalier Universitaire d‘Angers, 4 rue Larrey, 49033 Angers cedex 01, France. e-mail: PaRodien{at}chu-angers.fr
Pregnancy induces physiological alterations in thyroid function which may make difficult the interpretation of results of thyroid hormone measurement. A state of hyperstimulation of the thyroid gland is common in early pregnancy. In a few cases, thyroid hormone values will deviate from the normal range, which corresponds to the gestational transient thyrotoxicosis. This syndrome is closely associated with hyperemesis gravidarum. The relationship between the two syndromes, demonstrated by epidemiological studies, has been illustrated by an exceptional case of familial recurrent gestational thyrotoxicosis presenting as hyperemesis gravidarum due to hypersensitivity of the thyrotrophin receptor to hCG. However, the exact mechanisms of hyperemesis gravidarum have not yet been identified. Gestational transient thyrotoxicosis has to be distinguished from Graves’ disease, because the latter is associated with potential maternal and fetal complications when thyrotoxicosis is not controlled, whereas the former has usually a favourable outcome. The existence of other cases of thyroid hypersensitivity or hCG endowed with abnormal thyrotrophic activity is suspected. They may be identified only by assessment of the thyroid function in cases of hyperemesis gravidarum. The identification of these cases would be helpful to understand the mechanisms of specificity of glycoprotein hormone receptors.
Key words: hyperemesis gravidarum/pregnancy/thyrotoxicosis/thyrotrophin receptor
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