Fetal Heart Rate as an Indirect Indicator of Treatment Response in Fetal Hyperthyroidism Secondary to Transplacental Passage of Maternal Thyrotropin Receptor Antibodies
Bibliographic record
Abstract
Maternal hyperthyroidism is prevalent in 0.2-0.4% of pregnancies. Graves’ disease accounts for 85% of these cases. Approximately 1-5% of neonates born to these mothers develop hyperthyroidism. Transplacental passage of thyrotropin receptor antibodies (TRAbs) are considered to be the likely cause of transient fetal and neonatal hyperthyroidism. An 18-year-old G1P0 with a history of Graves’ disease treated by radioactive ablation presented with persistent fetal tachycardia at 23 weeks gestational age. TRAb was elevated and fetal hyperthyroidism secondary to transplacental crossing of maternal TRAb was suspected. There was no evidence of overt fetal hyperthyroidism or goiter on ultrasound examination. Oral methimazole was initiated and the fetal tachycardia resolved. Upon decrease of the methimazole dosage, the fetal tachycardia returned. Methimazole dosing was again increased and stabilized at a higher dose and the fetal tachycardia remained resolved. At birth at 40 weeks gestation, the neonate was tachycardic with elevated TRAb. She was initiated on methimazole. At 1 month of life, the methimazole dose was halved. At 2 months of life, all medication was held. On further testing, the thyroid function test remained normal. In our patient who did not display evidence of fetal hyperthyroidism on ultrasound examination, as there were no abnormal fetal markers on ultrasound to evaluate treatment response, fetal heart rate on non-stress testing was successfully used as an indirect indicator of fetal thyroid status and guided appropriate titration of methimazole. J Clin Gynecol Obstet. 2019;8(3):91-96 doi: https://doi.org/10.14740/jcgo564
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".