Neonatal Graves disease with persistent hypoglycemia: A case report.

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.