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[Neonatal hyperthyroidism in a premature infant born to a mother with Grave's disease]
1Service de pédiatrie et néonatologie, CHU Nord, chemin des Bourrelys, Marseille, France.
Insights
Maternal Graves' disease can cause neonatal thyrotoxicosis. However, a bioassay of thyrotropin receptor antibodies (TRAb) may not reliably predict this risk, necessitating thyroid function monitoring in all at-risk neonates.
Area of Science:
- Endocrinology
- Neonatal Medicine
- Immunology
Background:
- Neonatal thyrotoxicosis typically results from maternal thyroid-stimulating hormone receptor antibodies (TRAb) crossing the placenta.
- Thyrotropin receptor antibody (TRAb) bioassays are used to assess the risk of neonatal hyperthyroidism.
Observation:
- A premature infant born to a mother with Graves' disease developed thyrotoxicosis despite having low TRAb levels detected by bioassay.
- The infant received carbimazole treatment for two months until TRAb levels became undetectable.
Findings:
- Thyrotropin receptor antibody (TRAb) bioassay results may not consistently predict neonatal hyperthyroidism in infants of mothers with Graves' disease.
- The case highlights a potential limitation of bioassay in assessing neonatal hyperthyroid risk.
Implications:
- Clinical monitoring of neonatal thyroid function is crucial for all infants born to mothers with Graves' disease, irrespective of TRAb bioassay results.
- This underscores the need for comprehensive assessment beyond antibody levels for managing neonatal hyperthyroidism.
- Further research may be warranted to refine predictive markers for neonatal thyrotoxicosis.
Background:
Neonatal thyrotoxicosis is most commonly due to transplacental transfer of maternal thyroid-stimulating hormone receptor antibodies (TRAb). Bioassay of thyrotropin receptor antibodies may help to determine the risk for neonatal hyperthyroidism.
Case Report:
Thyrotoxicosis developed in a premature infant born to a mother with Graves' disease, with a low level of TRAb by bioassay. The infant was treated with carbimazole for two months, until TRAb had disappeared.
Conclusion:
Bioassay TRAb is not always reliable for predicting the development of neonatal hyperthyroidism in infants born to mothers with Graves' disease. Thyroid function should be measured in all these neonates.