Follow-up of infants born to mothers with Graves’ disease

Maximiano, Cristiana; Silva, Marta Ribeiro; Carvalho, Fábia; Almeida, Juliana; Gomes, Maria Miguel; Martins, Sofia; Marques, Olinda; Estrada, Alexandra; Pereira, Almerinda; Antunes, Ana

doi:10.1016/j.endien.2021.11.005

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…Neonatal hyperthyroidism (NH) is mainly related to the transplacental passage of maternal antithyrotropin receptor antibodies (TRAbs) (7)(8)(9). During pregnancy, TRAbs freely cross the placenta and either overstimulate the thyroid-stimulating antibody (TSAb) or block the thyroid blocking antibody (TBAb) in the fetal thyroid gland (10,11). This study retrospectively analyzed the clinical data of 19 infants diagnosed with hyperthyroidism in the neonatal period.…”

Section: Discussionmentioning

confidence: 99%

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Clinical features of neonatal hyperthyroidism: a retrospective analysis in southwestern China

Song,

Wei,

Cao

et al. 2024

Front. Pediatr.

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PurposeThis study aimed to explore the clinical characteristics and evaluate the different types of thyroid dysfunction in babies with neonatal hyperthyroidism.MethodsThe clinical data of 19 neonates with hyperthyroidism admitted to the Children's Hospital of Chongqing Medical University between January 2012 and April 2021 were retrospectively analyzed.ResultsFifteen (78.9%) infants were born to mothers with Graves’ disease. Eleven (57.9%) infants were premature; two babies were born at small for gestational age. The age at diagnosis ranged from 3 to 34 days, with a mean of 18.53 ± 6.85 days. The majority of the babies presented with goiter (84.2%) and tachycardia (94.7%) after birth. Nine (47.4%) of them presented with abnormal weight gain, seven (36.8%) presented with stare or ocular protrusion, six (31.6%) presented with hyperexcitability, four (21.1%) presented with jaundice and liver dysfunction, two (10.5%) presented with sweating, one (5.3%) presented with fever, and one case presented without any symptoms. Transient hyperthyroidism was the main thyroid dysfunction in our study. Overt hyperthyroidism was diagnosed in 13 (68.4%) neonates. Another three babies (15.8%) presented with hyperthyroidism with slightly elevated free triiodothyronine levels, normal thyroxine (T4) levels, and low thyroid-stimulating hormone (TSH) levels. Normal thyroid hormone levels with low TSH levels were observed in three (15.8%) neonates. Ten children were treated with antithyroid drugs. Eighteen children recovered normal thyroid function at 1–3 months of age; one baby in the study group required further levothyroxine supplementation due to primary hypothyroidism (HT). One child was found to have developmental delay at 2 years of age during follow-up.ConclusionsOur study highlights the need for prolonged monitoring of thyroid function in suspected patients. A single normal screening for hyperthyroidism or the absence of a maternal history of hyperthyroidism cannot exclude this disease.

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Section: Discussionmentioning

confidence: 99%

“…Thyroid function disturbances observed in newborns depend on the type and level of maternal antibodies. The administration of ATDs during pregnancy could also impact neonatal thyroid function ( 10 ). Due to different levels and clearance rates of maternal ATDs and TRAb, the typical biochemical changes of hyperthyroidism may be delayed.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of neonatal hyperthyroidism: a retrospective analysis in southwestern China

Song,

Wei,

Cao

et al. 2024

Front. Pediatr.

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“…Infants are not easily affected by excessive iodine, and the underlying cause might be immature self-regulation mechanisms, such as iodine inhibition, which are relatively weak compared with those of adults ( 51 ). Second, serum TRAb levels in pregnant women with GD often increase in the third trimester and pass through the placenta, which assists the thyroids of infants in resisting excess iodine until 2 to 3 months after birth ( 52 , 53 ). Nonetheless, the monitoring of thyroid function in infants is highly recommended during inorganic iodine therapy for lactating mothers with GD.…”

Section: Inorganic Iodine As a Drug In The Treatment Of Gdmentioning

confidence: 99%

Application of oral inorganic iodine in the treatment of Graves’ disease

Huang

et al. 2023

Front. Endocrinol.

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Iodine is a crucial trace element for the human body and the basic raw material for the synthesis of thyroid hormones. Oral inorganic iodine includes dietary iodine and therapeutic iodine, both of which are closely associated with thyroid immunity and metabolism. Graves’ disease (GD), also known as diffuse toxic goiter, is characterized by hyperthyroidism and high iodine metabolism. Clinically, patients diagnosed with GD are often asked to limit iodine intake or even avoid iodine in their diet. The latest research has demonstrated that the interference of dietary iodine with antithyroid drugs (ATDs) treatment may be overestimated. In addition, as a medication for GD treatment, the administration of inorganic iodine has shown positive results in patients with mild hyperthyroidism, a low thyroid autoantibody concentration, a small thyroid volume, a high iodine diet and so on. Inorganic iodine may also be used as an alternative when patients experience side effects with traditional ATDs and for those who still prefer conservative treatment. Due to its low teratogenicity, blood toxicity and bone marrow toxicity, inorganic iodine plays a unique role in special populations, such as pregnant or lactating patients and patients receiving tumor radiotherapy or chemotherapy. In this review, the research progress, biological function, doses and effects, applicable populations and specific applications of dietary iodine and therapeutic iodine are summarized to provide references for the diagnosis and treatment of GD, thus improving the quality of life of GD patients.

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“…Thyroid function disturbances observed in the fetus/newborn depend not only on the type of maternal antibodies, but also on their levels. The antithyroid drug (ATD) administration during pregnancy and previous definitive treatment of GD (radioactive iodine [RAI] therapy or thyroidectomy) in the mother could also impact the function of the fetal/neonatal thyroid ( 4 , 8 , 10 ). Autoimmune hyperthyroidism also occurs in children born to mothers who were treated for GD years ago, but still have detectable circulating TRAb ( 4 , 5 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

“…Fetal hyperthyroidism can cause goiter, heart failure with non-immune hydrops, advanced bone maturation, intrauterine growth retardation, preterm birth and even fetal death ( 1 , 5 , 6 , 8 ). Therefore, a mother with a history of GD should be closely followed up during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Follow-Up of Thyroid Function in Children With Neonatal Hyperthyroidism

et al. 2022

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IntroductionNeonatal hyperthyroidism mainly occurring in the children born to mothers with Graves’ disease (GD). The influence of maternal GD on the newborn’s thyroid function includes not only hyperthyroidism, but also various forms of hypothyroidism. Maternally transferred thyrotropin receptor antibodies (TRAb), the antithyroid drug (ATD) administration during pregnancy and previous definitive treatment of GD (radioactive iodine therapy or thyroidectomy) in the mother impact the function of the fetal/neonatal thyroid. Some newborns born to mothers with GD may present central hypothyroidism (CeH) due to impaired regulation of the fetal hypothalamic-pituitary-thyroid axis. The aim of this study was to evaluate different types of thyroid dysfunction in babies with neonatal hyperthyroidism.Materials and MethodsMedical records of 14 infants with neonatal hyperthyroidism (13 born to mothers with GD, and one born to mother with Hashimoto thyroiditis) were analyzed.ResultsTransient hyperthyroidism was the main thyroid dysfunction in our study group. Overt hyperthyroidism with highly increased TRAb levels (mean 13.0 ± 7.0 IU/L) was diagnosed in 6 (43%) neonates. Another 6 (43%) babies presented hyperthyroidism with slightly increased fT4 and/or fT3 levels and TSH levels in the lower limit of the normal range coinciding with positive TRAb levels (mean 3.8 ± 1.6 IU/L). Normal thyroid hormone levels with TSH levels below the lower limit of the range were observed in 2 (14%) neonates. Four babies in the study group (28.5%) required further levothyroxine (L-T4) supplementation due to CeH or, in one case, due to primary hypothyroidism.ConclusionOur study highlights the need for prolonged monitoring of thyroid function in children born to mothers with GD. Diagnosis of CeH could be delayed due to its masking by transient hyperthyroidism. Prolonged thyroid-stimulating hormone suppression after TRAb elimination should be considered as a signal announcing CeH.

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Follow-up of infants born to mothers with Graves’ disease

Cited by 4 publications

References 17 publications

Clinical features of neonatal hyperthyroidism: a retrospective analysis in southwestern China

Clinical features of neonatal hyperthyroidism: a retrospective analysis in southwestern China

Application of oral inorganic iodine in the treatment of Graves’ disease

Follow-Up of Thyroid Function in Children With Neonatal Hyperthyroidism

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