{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:26:10Z","timestamp":1793157970867,"version":"4.5.0"},"reference-count":12,"publisher":"The Endocrine Society","issue":"9","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Vereniging Academische Ziekenhuizen"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Transplacental transfer of thyrotropin receptor antibodies (TRAbs) during pregnancy may cause fetal\/neonatal thyroid dysfunction. Current guidelines recommend a universal TRAb titer threshold, irrespective of gestational age or assay platform. However, evidence supporting trimester-specific and assay-specific thresholds is lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This work aimed to determine whether trimester-specific TRAb levels predict fetal\/neonatal thyroid dysfunction and to establish assay-specific cutoff values for clinical risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective, multicenter, observational cohort study (2010-2023), maternal TRAb titers were measured using the TRAK human assay on the BRAHMS Kryptor Compact Plus analyzer. Settings were tertiary and secondary care centers (n = 44) across the Netherlands. Patients included women with a history of (n = 500) or active (n = 178) Graves disease. Main outcome measures included biochemically confirmed fetal\/neonatal hyperthyroidism or hypothyroidism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Trimester-specific TRAb titer thresholds predicted risk with high accuracy. In women with a history of Graves disease (n = 500), trimester-specific cutoffs of 25-, 19-, and 6-fold the upper limit of normal (ULN) showed a negative predictive value of 100%. In women with active Graves (n = 178), cutoffs of 10-, 12-, and 10-fold the ULN showed sensitivities of 89%, 86%, and 83%. Neonatal hyperthyroidism occurred despite low or declining maternal TRAb levels in mothers treated with antithyroid drugs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Trimester-specific TRAb thresholds were higher than the universal ULN multipliers commonly applied in clinical practice, and differed by gestational age and disease status. Application of a single ULN-based threshold titer across different TRAb assays may result in misclassification (ie, overestimation of fetal and neonatal Graves disease) and consequently in unnecessary and resource-intensive fetal surveillance. This indicates that TRAb thresholds are assay specific and require platform-specific clinical validation, even when assays are calibrated against a common international standard.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgag118","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T08:21:57Z","timestamp":1773822117000},"page":"e2161-e2170","source":"Crossref","is-referenced-by-count":3,"title":["Maternal TSH-receptor antibodies predict fetal\/neonatal hyperthyroidism in pregnancies with a history of Graves disease"],"prefix":"10.1210","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6219-3109","authenticated-orcid":false,"given":"Langeza","family":"Saleh","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Center Rotterdam , 3015 CN Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco W J","family":"Schreurs","sequence":"additional","affiliation":[{"name":"Department of Immunology, Laboratory Medical Immunology, Erasmus Medical Center Rotterdam , 3015 CN Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Boersma","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Thorax Center, Erasmus Medical Center Rotterdam , 3015 CN Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemmo A","family":"Drexhage","sequence":"additional","affiliation":[{"name":"Department of Immunology, Erasmus Medical Center Rotterdam , 3015 CN Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine M P F","family":"de Muinck Keizer-Schrama","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sophia Children's Hospital, Erasmus Medical Center , 3015 CN Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willy","family":"Visser","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus Medical Center Rotterdam , 3015 CN Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"issue":"2","key":"2026081219564871600_dgag118-B1","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1089\/thy.1992.2.155","article-title":"Fetal and neonatal hyperthyroidism and hypothyroidism due to maternal TSH receptor 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