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Developmental delay and failure to thrive in a 7-month-old baby boy with spontaneous transient Graves'
Shuichi Yatsuga1, Tomoko Saikusa2, Takako Sasaki2
1Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan. yatsuga_shyuuichi@kurume-u.ac.jp.
Insights
Transient Graves
Area of Science:
- Pediatric Endocrinology
- Neonatal Medicine
Background:
- Thyroid dysfunction in infancy can cause developmental delay and failure to thrive.
- Congenital hypothyroidism is a common cause, while hyperthyroidism is rare.
Observation:
- A 7-month-old infant presented with developmental delay and failure to thrive.
- Blood tests revealed suppressed thyroid-stimulating hormone and elevated free thyroxine, indicative of hyperthyroidism.
- Thyrotropin receptor antibody was slightly elevated, suggesting Graves' disease.
Findings:
- The infant exhibited hyperthyroidism, likely due to transient Graves' disease.
- Thyroid scintigraphy showed increased technetium uptake.
- Observation was chosen over anti-thyroid medication due to the transient nature of the condition.
Implications:
- Spontaneous transient Graves' thyrotoxicosis should be considered in infants with developmental delay and failure to thrive.
- Early diagnosis and appropriate management are crucial for infant development.
- This case highlights the importance of considering rare causes of neonatal thyroid dysfunction.
Background:
Thyroid dysfunction can induce developmental delay and failure to thrive in infancy. Congenital hypothyroidism is one of the common causes of these symptoms in infancy. By contrast, hyperthyroidism is a rare cause of these symptoms in infancy.
Case Presentation:
A 7-month-old Japanese baby boy was examined for developmental delay and failure to thrive. Blood tests were performed, which showed low levels of thyroid-stimulating hormone (<0.01 μU/mL) and high levels of free thyroxine (2.14 pg/mL). He was referred to our hospital at 8 months of age. His height was 64 cm (-2.7 standard deviation) and his weight was 6085 g (-2.5 standard deviation). No goiter was detected on examination. His thyrotropin receptor antibody was slightly high (3.9 IU/L), whereas thyroid stimulating antibody, anti-thyroglobulin antibody, and thyroid peroxidase antibody were within normal range. These blood findings indicated hyperthyroidism, most likely Graves' disease. His free thyroxine level decreased in the first month after our examination. No increased vascularity of his thyroid gland was noted. The technetium uptake of his thyroid gland in scintigraphy was relatively increased compared to the intake of his salivary gland. We elected to observe rather than treat with anti-thyroid medications.
Conclusion:
We have to rule out spontaneous transient Graves' thyrotoxicosis when babies have symptoms of developmental delay and fail to thrive.
