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Prediction of neonatal hyperthyroidism in infants born to mothers with Graves disease
K A Skuza1, I N Sills, M Stene
1Department of Pediatrics, University of Medicine and Dentistry-New Jersey Medical School, Newark, USA.
Insights
Thyrotropin-receptor antibody (TRAb) levels in newborns can predict hyperthyroidism in infants born to mothers with Graves disease. TRAb levels below 0.15 indicate euthyroid status, while levels above 0.25 suggest developing hyperthyroidism.
Area of Science:
- Endocrinology
- Neonatal Medicine
- Immunology
Background:
- Graves disease in mothers can lead to neonatal hyperthyroidism.
- Thyrotropin-receptor antibodies (TRAb) play a role in Graves disease pathogenesis.
- Predicting neonatal hyperthyroidism is crucial for timely intervention.
Purpose of the Study:
- To assess the predictive value of neonatal thyrotropin-receptor antibody (TRAb) levels for hyperthyroidism.
- To determine if TRAb levels can identify infants at risk for neonatal hyperthyroidism.
- To evaluate TRAb levels in managing neonatal hyperthyroidism treatment.
Main Methods:
- Measured TRAb levels in sera of 14 infants born to mothers with Graves disease.
- Monitored TRAb levels sequentially in infants with hyperthyroidism during treatment.
- Assessed clinical and biochemical signs of hyperthyroidism.
Main Results:
- Infants with initial TRAb < 0.15 remained euthyroid.
- Infants with initial TRAb > 0.25 (0.48-0.88) developed neonatal hyperthyroidism.
- Treated infants with TRAb < 0.20 at discontinuation of antithyroid medication were symptom-free.
Conclusions:
- Neonatal TRAb levels effectively predict hyperthyroidism in infants of mothers with Graves disease.
- TRAb values > 0.25 are strongly associated with the development of neonatal hyperthyroidism.
- TRAb levels < 0.20 may guide the withdrawal of antithyroid medication in treated infants.
Objective:
To determine whether determinations of thyrotropin-receptor antibody (TRAb) levels in newborn infants of women with Graves disease would predict which infants will have hyperthyroidism.
Methods:
The TRAb levels, assayed in the sera of 14 infants born to 14 women with Graves disease, were measured sequentially in the infants with hyperthyroidism during the course of antithyroid medication therapy.
Results:
Seven infants had TRAb values less than 0.15 and remained euthyroid. In seven infants whose initial TRAb values were more than 0.25 (range, 0.48 to 0.88), clinical and biochemical signs of hyperthyroidism developed. The infants were treated with antithyroid medication until day 57 to day 123 of life. Therapy was discontinued when the infants were free of symptoms and when serum thyroxine and triiodothyronine and free thyroxine levels remained normal during therapy with decreasing doses of antithyroid medication. When the medication was discontinued, TRAb values were less than 0.20.
Conclusions:
Infants born to mothers with Graves disease with initial TRAb values less than 0.15 remained euthyroid. The TRAb values greater than 0.25 were associated with the development of neonatal hyperthyroidism. During treatment of neonatal hyperthyroidism, TRAb values less than 0.20 may be helpful in deciding when to withdraw antithyroid medication.