Neonatal thyrotoxicosis caused by maternal autoimmune hyperthyroidism

Correia, Miguel; María, Ana; Prado, Sara Noéme; Limbert, Catarina

doi:10.1136/bcr-2014-209283

Cited by 8 publications

(6 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study indicates that tachycardia could be the sole clinical manifestation of hyperthyroidism in a newborn. Other symptoms, such as poor weight gain despite good appetite, irritability, hypertension, tachypnoe and ocular protrusion, have been reported in other studies ( 11 , 24 , 25 ).…”

Section: Discussionsupporting

confidence: 69%

Follow-Up of Thyroid Function in Children With Neonatal Hyperthyroidism

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 69%

Follow-Up of Thyroid Function in Children With Neonatal Hyperthyroidism

et al. 2022

View full text Add to dashboard Cite

show abstract

“…3,4 Fetal tachycardia, if untreated can lead to heart failure, which is associated with a perinatal mortality rate of about 12% to 45%. 3,5 It is well known that despite receiving ablative therapy for GD, approximately 40% of patients are TRAb positive post 5 years of therapy, 6,7 hence TRAb levels must be checked early pregnancy. 1 This was not organised in our patient as she was based rurally and had missed early specialist review.…”

Section: Discussionmentioning

confidence: 99%

Management of fetal hyperthyroidism caused by persistent autoimmune antibodies in a case of previously treated maternal Graves’ disease

et al. 2022

View full text Add to dashboard Cite

Maternal Graves’ autoantibodies are well known to cause fetal and neonatal thyroid disturbances. Despite radioiodine therapy, Graves’ autoantibodies are known to persist, which can cross the placenta and cause hyperthyroidism in the fetus. We present the case of a 26-year-old woman in her first pregnancy, clinically and biochemically euthyroid with history of treated Graves’ disease, where the fetus showed signs of hyperthyroidism on antenatal scans. This was confirmed by amniotic fluid testing as fetal blood sampling was not feasible and successfully treated with maternal carbimazole whilst continuing thyroxine for the mother (block-replacement). We discuss the challenges in the diagnosis of fetal hyperthyroidism and treatment whilst maternal thyroid status is maintained on thyroxine.

show abstract

“…This underscores the importance of obtaining a proper and detailed history from the mother and thyroid function screening along with TRAB levels in a pregnant women with a previous history of Graves' disease even if treated. 2 Higher TRAB levels in the mother are associated with a greater risk of thyrotoxicosis in the fetus. The mother in our case developed hyperthyroidism despite a sub-total thyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of thyrotoxicosis during pregnancy is 0.1 to– 0.4% with 1 to 5% of infants of these mothers developing thyrotoxicosis, the manifestations of which can begin in utero. 2 Fetal thyrotoxicosis presents in several ways including tachycardia, intrauterine growth retardation, goiter, cardiac failure, intrauterine death, and non-immune hydrops. 1 3 We describe a neonate with thyrotoxicosis, who developed non-immune hydrops and severe tricuspid regurgitation in utero, both of which responded to maternal treatment initially and later neonatal treatment.…”

mentioning

confidence: 99%

Neonatal Thyrotoxicosis with Tricuspid Valve Regurgitation and Hydrops in a Preterm Infant Born to a Mother with Graves' Disease

Doucette

Tierney

Roggensack

et al. 2018

AJP Rep

View full text Add to dashboard Cite

Neonatal hyperthyroidism is rare disorder due to the passage of thyroid receptor antibodies (TRBs) from the mother to the fetus. Neonatal thyrotoxicosis can present in several ways and if unrecognized, can be fatal. We present a preterm neonate who developed fetal hydrops and tricuspid regurgitation in utero. The mother had a history of treated Grave's disease. The infant responded to maternal treatment antenatally and postnatal anti-thyroid treatment, with resolution of both the tricuspid regurgitation and hydrops. To our knowledge, this is the first case report of tricuspid regurgitation associated with fetal and neonatal thyrotoxicosis. Our case also highlights the importance of obtaining a detailed and accurate history in a mother with previous Grave's disease, even if treated.

show abstract

Neonatal thyrotoxicosis caused by maternal autoimmune hyperthyroidism

Cited by 8 publications

References 11 publications

Follow-Up of Thyroid Function in Children With Neonatal Hyperthyroidism

Follow-Up of Thyroid Function in Children With Neonatal Hyperthyroidism

Management of fetal hyperthyroidism caused by persistent autoimmune antibodies in a case of previously treated maternal Graves’ disease

Neonatal Thyrotoxicosis with Tricuspid Valve Regurgitation and Hydrops in a Preterm Infant Born to a Mother with Graves' Disease

Contact Info

Product

Resources

About