Neonatal Hyperthyroidism: Neonatal Clinical Course of Two Brothers Born to a Mother with Graves-Basedow Disease, Before and After Total Thyroidectomy

Zuppa, Antonio Alberto; Sindico, Paola; Savarese, Immacolata; D’Andrea, Vito; Fracchiolla, Annalisa; Cota, Francesco; Romagnoli, Costantino

doi:10.1515/jpem.2007.20.4.535

Cited by 15 publications

(10 citation statements)

References 22 publications

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“…Less commonly, hyperthyroidism is (initially) treated with repeated doses of iodide instead of ATDs. 18,[69][70][71] In extremely ill newborns requiring admission to a NICU for respiratory or cardiac support, a short course of glucocorticoids, which inhibit thyroid hormone secretion and impair peripheral deiodination of T4 to T3, may be necessary.…”

Section: Question 6: What Clinical Indications Should Prompt Initiatimentioning

confidence: 99%

Management of Neonates Born to Mothers With Graves’ Disease

2016

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Neonates born to mothers with Graves’ disease are at risk for significant morbidity and mortality and need to be appropriately identified and managed. Because no consensus guidelines regarding the treatment of these newborns exist, we sought to generate a literature-based management algorithm. The suggestions include the following: (1) Base initial risk assessment on maternal thyroid stimulating hormone (TSH) receptor antibodies. If levels are negative, no specific neonatal follow-up is necessary; if unavailable or positive, regard the newborn as “at risk” for the development of hyperthyroidism. (2) Determine levels of TSH-receptor antibodies in cord blood, or as soon as possible thereafter, so that newborns with negative antibodies can be discharged from follow-up. (3) Measurement of cord TSH and fT4 levels is not indicated. (4) Perform fT4 and TSH levels at day 3 to 5 of life, repeat at day 10 to 14 of life and follow clinically until 2 to 3 months of life. (5) Use the same testing schedule in neonates born to mothers with treated or untreated Graves’ disease. (6) When warranted, use methimazole (MMI) as the treatment of choice; β-blockers can be added for sympathetic hyperactivity. In refractory cases, potassium iodide may be used in conjunction with MMI. The need for treatment of asymptomatic infants with biochemical hyperthyroidism is uncertain. (7) Assess the MMI-treated newborn on a weekly basis until stable, then every 1 to 2 weeks, with a decrease of MMI (and other medications) as tolerated. MMI treatment duration is most commonly 1 to 2 months. (8) Be cognizant that central or primary hypothyroidism can occur in these newborns.

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Section: Question 6: What Clinical Indications Should Prompt Initiatimentioning

confidence: 99%

Management of Neonates Born to Mothers With Graves’ Disease

2016

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“…Cardiac insufficiency is one of the major risks in these infants. Liver dysfunction (hepatitis and cholestatic jaundice), coagulopathy, pulmonary arterial hypertension, craniostenosis, microcephaly, and psychomotor disabilities may occur in severely affected infants (4,5,6,7). Fetal thyroid dysfunction precedes neonatal hyperthyroidism.…”

Section: Introductionmentioning

confidence: 99%

“…Optimal management of GD during pregnancy is crucial to prevent fetal death or permanent neurological impairments (8,9,10,11,12,13,14,15,16,17,18,19). Neonatal hyperthyroidism has been evaluated in several studies (2,3,7) but recent case reports (20,21,22) indicate that this transient disease is still overlooked by clinicians, leading to severe complications that could have been prevented. Better knowledge of predictors of neonatal hyperthyroidism would result in improved preventive and therapeutic management.…”

Section: Introductionmentioning

confidence: 99%

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

Besançon

Beltrand

Gac

et al. 2014

European Journal of Endocrinology

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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.

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“…five times the upper limit of the normal range [1,[20][21][22] or > 10 IU/L [15]. We therefore used 10 IU/L as the cut-off value for TRAb in the present study.…”

Section: Disclosurementioning

confidence: 99%

Kinetic analyses of changes in serum TSH receptor antibody values after total thyroidectomy in patients with Graves’ disease

Yoshioka

Miyauchi

et al. 2016

Endocr J

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Neonatal Hyperthyroidism: Neonatal Clinical Course of Two Brothers Born to a Mother with Graves-Basedow Disease, Before and After Total Thyroidectomy

Abstract: TRAb may persist after total thyroidectomy: clinical and instrumental follow-up of the newborn is recommended.

Cited by 15 publications

References 22 publications

Management of Neonates Born to Mothers With Graves’ Disease

Management of Neonates Born to Mothers With Graves’ Disease

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

Kinetic analyses of changes in serum TSH receptor antibody values after total thyroidectomy in patients with Graves’ disease

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Neonatal Hyperthyroidism: Neonatal Clinical Course of Two Brothers Born to a Mother with Graves-Basedow Disease, Before and After Total Thyroidectomy

Abstract: TRAb may persist after total thyroidectomy: clinical and instrumental follow-up of the newborn is recommended.

Cited by 15 publications

References 22 publications

Management of Neonates Born to Mothers With Graves’ Disease

Management of Neonates Born to Mothers With Graves’ Disease

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

Kinetic analyses of changes in serum TSH receptor antibody values after total thyroidectomy in patients with Graves&rsquo; disease

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Kinetic analyses of changes in serum TSH receptor antibody values after total thyroidectomy in patients with Graves’ disease