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Hamza A, Schlembach D, Schild RL, Groten T, Wölfle J, Battefeld W, Kehl S, Schneider MO. Recommendations of the AGG (Working Group for Obstetrics, Department of Maternal Diseases) on How to Treat Thyroid Function Disorders in Pregnancy. Geburtshilfe Frauenheilkd 2023; 83:504-516. [PMID: 37152543 PMCID: PMC10159725 DOI: 10.1055/a-1967-1653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/23/2022] [Indexed: 03/11/2023] Open
Abstract
Abstract
Objective These recommendations from the AGG (Committee for Obstetrics, Department of Maternal Diseases) on how to treat thyroid function disorder during pregnancy aim to improve the diagnosis and management of thyroid anomalies during pregnancy.
Methods Based on the current literature, the task force members have developed the following recommendations and statements. These recommendations were adopted after a consensus by the members of the working group.
Recommendations The following manuscript gives an insight into physiological and pathophysiological thyroid changes during pregnancy, recommendations for clinical and subclinical hypo- and hyperthyroidism, as well as fetal and neonatal diagnostic and management strategies.
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Affiliation(s)
- Amr Hamza
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universität des Saarlandes, Homburg a. d. Saar, Germany
- Klinik für Geburtshilfe und Pränatalmedizin, Kantonspital Baden, Baden, Switzerland
| | | | - Ralf Lothar Schild
- Klinik für Geburtshilfe und Perinatalmedizin, Diakovere Perinatalzentrum Hannover, Hannover, Germany
| | - Tanja Groten
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Joachim Wölfle
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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Tochibora S, Hori T, Mori M, Matsumoto H, Otsuka H, Sasai H, Ito Y, Kasahara Y, Kawamoto N, Ohnishi H. Immediate postnatal central hypothyroidism caused by maternal Graves' disease: Importance of early screening. Clin Case Rep 2022; 10:e6061. [PMID: 35846938 PMCID: PMC9280755 DOI: 10.1002/ccr3.6061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/22/2022] [Accepted: 07/02/2022] [Indexed: 11/08/2022] Open
Abstract
This report illustrates a case of central hypothyroidism in a newborn immediately after birth caused by maternal Graves' disease. Infants from mothers with Graves' disease require careful examination without waiting for neonatal screening results, even though the mother's thyroid function is normal at birth or the newborn does not have goiter.
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Affiliation(s)
- Saho Tochibora
- Department of Pediatrics, Graduate School of MedicineGifu UniversityGifuJapan
- Division of Neonatal Intensive Care UnitGifu University HospitalGifuJapan
| | - Tomohiro Hori
- Department of Pediatrics, Graduate School of MedicineGifu UniversityGifuJapan
- Division of Neonatal Intensive Care UnitGifu University HospitalGifuJapan
- Clinical Genetics CenterGifu University HospitalGifuJapan
| | - Mai Mori
- Department of Pediatrics, Graduate School of MedicineGifu UniversityGifuJapan
- Division of Neonatal Intensive Care UnitGifu University HospitalGifuJapan
| | - Hideki Matsumoto
- Department of Pediatrics, Graduate School of MedicineGifu UniversityGifuJapan
- Division of Neonatal Intensive Care UnitGifu University HospitalGifuJapan
| | - Hiroki Otsuka
- Department of Pediatrics, Graduate School of MedicineGifu UniversityGifuJapan
- Division of Neonatal Intensive Care UnitGifu University HospitalGifuJapan
- Clinical Genetics CenterGifu University HospitalGifuJapan
| | - Hideo Sasai
- Department of Pediatrics, Graduate School of MedicineGifu UniversityGifuJapan
- Division of Neonatal Intensive Care UnitGifu University HospitalGifuJapan
- Clinical Genetics CenterGifu University HospitalGifuJapan
| | - Yuko Ito
- Department of Pediatrics, Graduate School of MedicineGifu UniversityGifuJapan
- Division of Neonatal Intensive Care UnitGifu University HospitalGifuJapan
| | - Yukiko Kasahara
- Department of Pediatrics, Graduate School of MedicineGifu UniversityGifuJapan
- Division of Neonatal Intensive Care UnitGifu University HospitalGifuJapan
- Department of PediatricsMatsunami General HospitalGifuJapan
| | - Norio Kawamoto
- Department of Pediatrics, Graduate School of MedicineGifu UniversityGifuJapan
- Division of Neonatal Intensive Care UnitGifu University HospitalGifuJapan
| | - Hidenori Ohnishi
- Department of Pediatrics, Graduate School of MedicineGifu UniversityGifuJapan
- Division of Neonatal Intensive Care UnitGifu University HospitalGifuJapan
- Clinical Genetics CenterGifu University HospitalGifuJapan
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Stern E, Schoenmakers N, Nicholas AK, Kassif E, Hamiel OP, Yeshayahu Y. A Novel Mutation in the Thyroglobulin Gene Resulting in Neonatal Goiter and Congenital Hypothyroidism in an Eritrean Infant. J Clin Res Pediatr Endocrinol 2022; 14:221-226. [PMID: 33832185 PMCID: PMC9176088 DOI: 10.4274/jcrpe.galenos.2021.2020.0278] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Congenital hypothyroidism (CH) due to dyshormonogenesis may occur due to mutations in any of the key genes involved in thyroid hormone biosynthesis (TG, TPO, DUOX2, DUOXA2, SLC5A5, IYD, SLC26A4 and SLC26A7). Mutations in the thyroglobulin gene (TG) are frequently associated with goiter, which may present fetally or neonatally, although a spectrum of phenotypes is reported. We present the case of a woman of Eritrean origin who presented in the third trimester of pregnancy in the early stages of labor. Ultrasound at presentation revealed a fetal neck swelling consistent with a goiter. Following delivery by Caesarian section with minimal respiratory support, the infant was found to be hypothyroid with undetectable serum levels of thyroglobulin. Sequencing of the TG revealed a homozygous donor splice site pathogenic variant (c.5686+1delG) not previously described in the literature. Levothyroxine treatment resulted in normal growth and psychomotor development. Goitrous CH with inappropriately low thyroglobulin has previously been reported in patients harbouring homozygous single nucleotide substitutions at the same TG donor splice site, which result in exon skipping and retention of malformed thyroglobulin by the endoplasmic reticulum. We conclude that the TG c.5686+1delG pathogenic variant is the likely basis for our patient’s fetal goiter and CH, and that the clinical phenotype associated with TG c.5686+1delG is comparable to that seen with single nucleotide substitutions at the same site.
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Affiliation(s)
- Eve Stern
- Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Pediatric Endocrine and Diabetes Unit, Ramat-Gan, Israel,* Address for Correspondence: Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Pediatric Endocrine and Diabetes Unit, Ramat-Gan, Israel Phone: +97235305015 E-mail:
| | - Nadia Schoenmakers
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Adeline K. Nicholas
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Eran Kassif
- Sheba Medical Center, Department of Obstetrics and Gynecology, Tel Hashomer, Israel,Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Orit Pinhas Hamiel
- Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Pediatric Endocrine and Diabetes Unit, Ramat-Gan, Israel,Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Yonatan Yeshayahu
- Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Pediatric Endocrine and Diabetes Unit, Ramat-Gan, Israel,Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Assuta Medical Center, Pediatric Endocrine and Diabetes Unit, Ashdod, Israel
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Puricelli MD, Danielsen BM, Van Beek-King J, Wraight CL, Stewart KS, Beninati M, Lobeck IN, Iruretagoyena JI. Taking the Natural Exit: Opportunities for Treatment Rightsizing in Fetal Head and Neck Mass. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fetal head and neck masses, when present, may cause neonatal airway obstruction at birth and associated morbidity and mortality. Escalated maternal treatment intensity such as surgical laryngoscopist/airway surgeon attended delivery and ex utero intrapartum treatment can mitigate the neonatal risk, however, increase maternal risk for complications. Accordingly, accurate prediction of the potential neonatal benefit and maternal risk is essential. Serial third-trimester sonographic features suggestive of more severe airway obstruction may justify more aggressive intervention in the right patient. This case study presents a 23-year-old G1P0 with a fetus predicted to have reduced perinatal airway risk based upon serial third-trimester ultrasound findings. Treatment was de-escalated, and the patient was successfully managed. Collaborative data collection aimed at treatment rightsizing across neonatal, maternal, and systematic domains will support ideal allocation.
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Affiliation(s)
- Michael D. Puricelli
- Division of Otolaryngology, University of Wisconsin–Madison School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Brodey Matthew Danielsen
- University of Wisconsin–Madison School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Jessica Van Beek-King
- Division of Otolaryngology, University of Wisconsin–Madison School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - C. Lydia Wraight
- Division of Neonatology, University of Wisconsin–Madison School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Katharina S. Stewart
- Division of Maternal-Fetal Medicine, University of Wisconsin–Madison School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Michael Beninati
- Division of Maternal-Fetal Medicine, University of Wisconsin–Madison School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
- Division of Acute Care and Regional General Surgery, University of Wisconsin–Madison School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Inna N. Lobeck
- Division of Pediatric Surgery, University of Wisconsin–Madison School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - J. Igor Iruretagoyena
- Division of Maternal-Fetal Medicine, University of Wisconsin–Madison School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
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Abstract
Fetal and neonatal dysfunctions include rare serious disorders involving abnormal thyroid function during the second half of gestation, which may persist throughout life, as for most congenital thyroid disorders, or be transient, resolving in the first few weeks of life, as in autoimmune hyperthyroidism or hypothyroidism and some cases of congenital hypothyroidism (CH) with the thyroid gland in situ. Primary CH is diagnosed by neonatal screening, which has been implemented for 40 years in developed countries and should be introduced worldwide, as early treatment prevents irreversible neurodevelopmental delay. Central CH is a rarer entity occurring mostly in association with multiple pituitary hormone deficiencies. Other rare disorders impair the action of thyroid hormones. Neonatal Graves' disease (GD) results from the passage of thyrotropin receptor antibodies (TRAbs) across the placenta, from mother to fetus. It may affect the fetuses and neonates of mothers with a history of current or past GD, but hyperthyroidism develops only in those with high levels of stimulatory TRAb activity. The presence of antibodies predominantly blocking thyroid-stimulating hormone receptors may result in transient hypothyroidism, possibly followed by neonatal hyperthyroidism, depending on the balance between the antibodies present. Antithyroid drugs taken by the mother cross the placenta, treating potential fetal hyperthyroidism, but they may also cause transient fetal and neonatal hypothyroidism. Early diagnosis and treatment are key to optimizing the child's prognosis. This review focuses on the diagnosis and management of these patients during the fetal and neonatal periods. It includes the description of a case of fetal and neonatal autoimmune hyperthyroidism.
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Affiliation(s)
- Juliane Léger
- Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Pediatric Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Paris, France
- Université de Paris; NeuroDiderot, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Clemence Delcour
- Université de Paris; NeuroDiderot, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
- Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Gynecology and Obstetric Department, Paris, France
| | - Jean-Claude Carel
- Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Pediatric Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Paris, France
- Université de Paris; NeuroDiderot, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
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Iwaki H, Ohba K, Okada E, Murakoshi T, Kashiwabara Y, Hayashi C, Matsushita A, Sasaki S, Suda T, Oki Y, Gemma R. Dose-Dependent Influence of Antithyroid Drugs on the Difference in Free Thyroxine Levels between Mothers with Graves' Hyperthyroidism and Their Neonates. Eur Thyroid J 2021; 10:372-381. [PMID: 34540707 PMCID: PMC8406247 DOI: 10.1159/000509324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Several guidelines have recommended that the use of the lowest effective dose of antithyroid drugs (ATDs) that maintains maternal serum free thyroxine (FT4) levels at or moderately above the upper limit of the reference range is appropriate for fetal euthyroid status. However, little is known about whether ATD dosage affects the difference in serum FT4 levels between the mother and neonate. We conducted a retrospective study at a tertiary hospital in Japan to investigate the dose-dependent influence of ATDs on both maternal and fetal thyroid hormone status. MATERIALS AND METHODS We retrospectively examined 62 pregnant women who delivered between 2007 and 2016 and were treated for Graves' hyperthyroidism with ATD at any stage during pregnancy. We selected individuals whose data on maternal FT4 level within 4 weeks of their deliveries and cord FT4 level of their infants at the time of delivery were available. Those with multiple pregnancies, iodine or glucocorticoid treatment, and fetal goiter detected by ultrasonography were excluded. RESULTS After the exclusion criteria were applied, we recruited 40 individuals. The cord FT4 levels were significantly lower than the maternal FT4 levels in patients treated with high-dosage ATDs (methimazole >5 mg daily or propylthiouracil >100 mg daily). However, there were no significant differences between maternal and cord FT4 levels in patients treated with low-dosage ATDs (methimazole ≤5 mg daily or propylthiouracil ≤100 mg daily). We selected 35 individuals whose data on maternal thyrotropin receptor-binding inhibitory immunoglobulin (TBII) level were available. Multiple linear regression analysis adjusted for ATD dosage, maternal TBII level, and gestational period found that ATD dosage was a significant predictor of the difference in serum FT4 levels between the mother and neonate. In terms of maternal complications, multiple logistic regression analysis identified maternal free triiodothyronine (FT3) level as a significant predictor of the incidence of preterm delivery. CONCLUSIONS We found a dose-dependent influence of ATDs on the difference in serum FT4 levels between mothers with Graves' hyperthyroidism and their neonates. Further studies to evaluate the optimal target FT4 and FT3 levels for the mother and neonate during pregnancy may improve the outcome of pregnant women with Graves' hyperthyroidism.
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Affiliation(s)
- Hiroyuki Iwaki
- Division of Endocrinology, Department of Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Kenji Ohba
- Medical Education Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
- *Kenji Ohba, Medical Education Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192 (Japan),
| | - Eisaku Okada
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takeshi Murakoshi
- Obstetrics and Gynecology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yumiko Kashiwabara
- Division of Endocrinology, Department of Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Chiga Hayashi
- Division of Endocrinology, Department of Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Akio Matsushita
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shigekazu Sasaki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yutaka Oki
- Department of Metabolism and Endocrinology, Hamamatsu-Kita Hospital, Hamamatsu, Japan
| | - Rieko Gemma
- Division of Endocrinology, Department of Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
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Schenke SA, Görges R, Seifert P, Zimny M, Kreissl MC. Update on diagnosis and treatment of hyperthyroidism: ultrasonography and functional imaging. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2021; 65:102-112. [PMID: 33494588 DOI: 10.23736/s1824-4785.21.03333-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Ultrasonography and radionuclide imaging using [99mTc]Pertechnetate or radioactive iodine isotopes are essential tools used during the diagnostic workup of hyperthyroidism with or without structural alterations of the thyroid. Color duplex sonography and ultrasound elastography may add important information to find the cause of the hormone excess. During the last few years, hybrid imaging using SPECT/-(CT) or PET-based methods, such as [124]Iodine-PET/CT or [124]Iodine-PET/ultrasound have been increasingly used, playing a role in the context of localizing ectopic thyroid tissue or in multinodular goiter. Recently, promising data has been published on the use of [99mTc]MIBI imaging in amiodarone induced hyperthyroidism.
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Affiliation(s)
- Simone A Schenke
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany -
| | - Rainer Görges
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Philipp Seifert
- Clinic for Nuclear Medicine, University Hospital of Jena, Jena, Germany
| | | | - Michael C Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
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Rodrigues TMB, Silva MMDC, Freitas MM, Duarte ZMC, Frutuoso VS, Rodrigues MT, Rubio IGS. Case Report: Functional Analysis and Neuropsychological Evaluation of Dyshormonogenetic Fetal Goiter in Siblings Caused by Novel Compound Hyterozygous TPO Gene Mutations. Front Endocrinol (Lausanne) 2021; 12:671659. [PMID: 34220711 PMCID: PMC8251258 DOI: 10.3389/fendo.2021.671659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/21/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION It is rare for a euthyroid mother to carry a child with a fetal goiter. However, cases of congenital hypothyroidism (CH) caused by thyroid dyshormonogenesis have been reported. Even though gene mutations associated with fetal goiter have been reported in a few studies, the effects on intellectual development have not been investigated. This study aimed to characterize and investigate the underlying genetic mechanism of CH and neuropsychological development and growth of two siblings with CH-induced fetal goiters. CASE REPORT Two male siblings from a non-consanguineous marriage with CH and fetal goiter were diagnosed by ultrasonography at 32- and 26-weeks of gestation. This condition was confirmed by cordocentesis in the first pregnancy (TSH: 135 μIU/ml). The mother was euthyroid, and no intra-amniotic levothyroxine treatment was performed. Peripheral blood DNA was screened for TPO mutations. The new deletion p.Cys296Alafs*21 and the p.Arg665Trp mutation, inherited from heterozygous parents, were identified in both patients. Functional analysis showed both mutations reduced the TPO enzyme activity and impaired the membrane localization. The p.Cys296Alafs*21 mutation produces a protein product with a drastically reduced molecular weight. Additionally, a complete clinical and neuropsychological evaluation was also performed. The WISC IV test was employed to provide an overall measure of the siblings' cognitive and intellectual abilities. No growth retardation was detected in either child. In general, both children showed normal neuropsychological development; however, they exhibited slight reduction of Processing Speed Index scores, which are sensitive to neurological and attentional factors and motor maturation activity. Notably, the younger sibling obtained significantly low scores in the Operational Memory Index, a measure of attention capacity and psychoneurological immaturity. CONCLUSION We described a new TPO compound heterozygosity that severely impaired the TPO activity and membrane localization leading to severe CH and fetal goiter. This is the first report showing the neuropsychological evaluation in patients with dyshormonogenetic fetal goiter. More studies are needed to understand the neurodevelopmental outcomes of neonates with CH-induced fetal goiters.
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Affiliation(s)
| | - Marlon Messias da Conceição Silva
- Thyroid Molecular Science Laboratory, Department of Biological Sciences, Federal University of São Paulo, Federal University of São Paulo (UNIFESP), Diadema, Brazil
- Structural and Functional Biology Program, Federal University of São Paulo, UNIFESP, São Paulo, Brazil
| | - Magali Maciel Freitas
- Thyroid Molecular Science Laboratory, Department of Biological Sciences, Federal University of São Paulo, Federal University of São Paulo (UNIFESP), Diadema, Brazil
| | - Zélia Maria Costa Duarte
- Thyroid Molecular Science Laboratory, Department of Biological Sciences, Federal University of São Paulo, Federal University of São Paulo (UNIFESP), Diadema, Brazil
| | - Vitória Sousa Frutuoso
- Thyroid Molecular Science Laboratory, Department of Biological Sciences, Federal University of São Paulo, Federal University of São Paulo (UNIFESP), Diadema, Brazil
| | - Mariana Teixeira Rodrigues
- Thyroid Molecular Science Laboratory, Department of Biological Sciences, Federal University of São Paulo, Federal University of São Paulo (UNIFESP), Diadema, Brazil
- Structural and Functional Biology Program, Federal University of São Paulo, UNIFESP, São Paulo, Brazil
| | - Ileana Gabriela Sanchez Rubio
- Thyroid Molecular Science Laboratory, Department of Biological Sciences, Federal University of São Paulo, Federal University of São Paulo (UNIFESP), Diadema, Brazil
- Structural and Functional Biology Program, Federal University of São Paulo, UNIFESP, São Paulo, Brazil
- *Correspondence: Ileana Gabriela Sanchez Rubio,
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