Management of neonates born to women with Graves' disease: a cohort study

Abstract

Objective: Hyperthyroidism in neonates born to mothers with Graves' disease (GD) can be associated with significant morbidity and mortality, but is still overlooked by clinicians. Management of neonatal hyperthyroidism would be improved by a better understanding of the predictive factors involved. The aim of this study was to evaluate the course of thyroid function and clinical outcomes during the first postnatal month in babies born to mothers with GD. Design: Prospective observational study. Methods: Sixty-eight neonates born to mothers with GD were managed from birth and divided into three groups based on thyrotropin receptor antibody (TRAb) and anti-thyroid drug (ATD) status in the mother: TRAb /ATDCve neonates, 24 (72.7%) had positive TRAb on cord blood assays, and seven of these developed neonatal hyperthyroidism. FT 4 elevation between days 3 and 7 but not at birth was predictive of the development of hyperthyroidism. Conclusions: TRAb status should be checked in the third trimester in mothers with GD and on cord blood in their neonates; if positive, it indicates a high risk of neonatal hyperthyroidism. FT 4 measurement at birth should be repeated between days 3 and 5 (and by day 7 at the latest); rapid FT 4 elevation during the first postnatal week is predictive of hyperthyroidism and warrants ATD therapy.

Predictive value of maternal second-generation thyroid-binding inhibitory immunoglobulin assay for neonatal autoimmune hyperthyroidism

“…As in the recent report of Besançon et al (37), we found an increased risk of neonatal hyperthyroidism when neonatal TBII levels were elevated at birth, with a cutoff value of 6 IU/l, higher than that found by Skuza et al (38) on a smaller series of 14 neonates with first-generation TBII determination. Despite its high sensitivity, the clinical usefulness of this threshold may be questionable as results are often delayed.…”

“…Individual cases are shown in Table 2. The median age of the women at the beginning of pregnancy was 31 years (range, [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Twenty mothers of 21 neonates (one twin pregnancy) had a past history of GD.…”

ENDOCRINOLOGY IN PREGNANCY: Pregnancy and the incidence, diagnosing and therapy of Graves’ disease

“…Graves' disease and pregnancy (95,96)). Another consideration is the risk of GD relapse post-partum in women who experienced remission of GD in late pregnancy, and women who were in remission already before the pregnancy after previous ATD therapy.…”

Antithyroid drugs and congenital heart defects: ventricular septal defect is part of the methimazole/carbimazole embryopathy

“…In a new publication by Besancon et al (1), the authors focused on the thyroid function and clinical outcomes of 68 neonates born to mothers with past or present Graves' disease. The study draws important conclusions on the management of neonatal thyroid function at birth and in the postnatal period, and it emphazises the role of maternal TSH receptor antibodies (TRAb) status in late pregnancy (1). Thus, focus must be on both the mother and the child in the management of pregnant women with Graves' disease (2).…”

“…Echocardiography was performed in 60 of the 68 neonates, and four cases of congenital heart defects (CHDs) compatible with a diagnosis of birth defect according to the 10th revision of the International Classification of Disease (ICD-10) were reported including two atrial septal defects (ASD), one ventricular septal defect (VSD) and one tetralogy of Fallot (1). In addition to this, one case of congenital pulmonary airway malformation and one case of aplasia cutis were described, but it is not clear how and when non-cardiac birth defects were diagnosed.…”