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Khaled et al., from the
Federal University of Parana, Curitiba, Brazil, reported on the
occurrence of neonatal hyperthyroidism in three infants. The
accepted prevalence of this thyroid disorder is about 1:50,000
newborns and it may occur in 1–2% of all newborns from
mothers with Graves’ disease, in whom placental transfer of
stimulatory (and blocking) auto-antibodies occurs. These
stimulatory auto-antibodies (IgG) will act on the fetal thyroid
TSH-receptor with subsequent generation of cellular events
related to growth and increased synthesis and release of thyroid
hormone. The classical clinical course of neonatal
hyperthyroidism was present including low birth weight,
tachycardia, warm and moist skin, tremor and hyperkinesia. Two
infants also developed respiratory distress, pulmonary
hypertension and prolonged jaundice. Treatment consisted of
propranolol, lugol drops and methimazole. The thyroid tests
confirmed the diagnosis of hyperthyroidism (table 2).
Serum TSH was below 0.03 µU/ml. All three cases had positive anti-TPO auto-antibodies. This report illustrates the severity of the neonatal hyperthyroidism and the need for prompt recognition and immediate treatment in an intensive care unit. Table 2: The results were the following:
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