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Neonatal Graves disease with persistent hypoglycemia: A case report.

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Neonatal Graves disease can cause severe hypoglycemia in newborns. This case highlights transient neonatal hyperinsulinism as a potential cause, resolving by six months.

Keywords:
Neonatal Graves diseasehyperinsulinismhyperthyroidismhypoglycemia

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Area of Science:

  • Neonatalogy
  • Endocrinology
  • Pediatric Endocrinology

Background:

  • Neonatal Graves disease is the primary cause of hyperthyroidism in newborns.
  • Maternal Graves disease is linked to intrauterine growth restriction (IUGR), small for gestational age (SGA) infants, and neonatal Graves disease.
  • IUGR and SGA are associated with hypoglycemia and transient neonatal hyperinsulinism.

Observation:

  • A preterm infant (34 weeks, 3 days; 1.6 kg) born to a mother with recent Graves disease treatment presented with hyperthyroidism and persistent hypoglycemia.
  • The infant exhibited tachycardia, abnormal thyroid values, and severe hypoglycemia.
  • Potential contributing factors included maternal propranolol use, prematurity, IUGR, increased metabolism from neonatal Graves disease, and transient stress-induced hyperinsulinism.

Findings:

  • The infant received methimazole for hyperthyroidism, propranolol for tachycardia, and diazoxide for hypoglycemia.
  • Both hyperthyroidism and hypoglycemia resolved by six months of age.
  • This case suggests transient neonatal hyperinsulinism, induced by multiple stressors, as a likely cause of severe persistent hypoglycemia in neonatal Graves disease.

Implications:

  • This case expands the understanding of neonatal Graves disease complications.
  • It highlights the importance of considering transient neonatal hyperinsulinism in cases of persistent hypoglycemia associated with neonatal Graves disease.
  • Early diagnosis and management are crucial for favorable outcomes in affected infants.