Topical Iodine-Induced Thyrotoxicosis in a Newborn with a Giant Omphalocele

Area of Science:

• Neonatal endocrinology
• Pediatric surgery
• Dermatology

Background:

• Neonatal thyrotoxicosis, often linked to maternal Graves' disease, poses significant neurological risks.
• While iodine-induced hypothyroidism is documented in neonates, hyperthyroidism from topical iodine is rare.
• Giant omphalocele management requires careful consideration of potential systemic effects from treatments.

Observation:

• A neonate with a giant omphalocele received topical povidone-iodine dressings.
• Early in life, the infant developed suppressed thyroid-stimulating hormone, elevated free thyroxine, and cardiovascular signs of thyrotoxicosis.
• Symptoms resolved after discontinuing povidone-iodine and switching to silver sulfadiazine dressings.

Findings:

• Topical povidone-iodine application led to severe neonatal hyperthyroidism.
• Thyroid function normalized after cessation of iodine exposure.
• This case highlights a novel cause of neonatal hyperthyroidism.

Implications:

• Clinicians must be vigilant for thyroid dysfunction in neonates exposed to topical iodine.
• Iodine-based antiseptics should be used cautiously in neonates, especially those with large surface area wounds.
• This finding expands the spectrum of thyroid dysfunction associated with topical iodine in neonates.