Neonates Born to Mothers with Graves’ Disease: 15 Year Experience of a Pediatric Endocrinology Department

Abstract

<jats:p>Introduction: Graves disease is characterized by the existence of autoantibodies directed to the thyrotropin receptor, which can have a stimulatory/inhibitory action, in women with the condition, their fetus or neonate. Our aim was to review the case series of these neonates in order to establish neonatal thyroid function predictors.Material and Methods: Retrospective cohort study of the database of the Department of Pediatric Endocrinology, including patients born to mothers with Graves’ disease, between 2002 and 2017. Clinical and biochemical data were collected from mothers and offspring.Results: Fifty newborns, from 46 women with a median of 3.5 years after diagnosis, were included. During all trimesters of pregnancy, more than half of women had positive autoantibodies directed to the thyrotropin receptor. Not every woman had a complete thyroid function evaluation every trimester. In 32 newborns, cord blood screening was done. During the neonatal period, there were three cases of hypothyroidism and two of hyperthyroidism. The mothers of these five newborns had higher levels of free thyroid hormones during the second trimester (p = 0.03). The level of antibodies directed to the thyrotropin receptor was significantly higher in the cord blood (p = 0.03) and in the first neonatal test (p = 0.03) of these dysthyroid newborns.Discussion: Our results reinforce the need for every pregnant woman with Graves’ disease to be subject to thyroid function and autoantibodies evaluation during every trimester, as well as the importance of evaluating these antibodies in cord blood.Conclusion: High levels of free thyroid hormones during the second trimester of pregnancy and antibodies directed to the thyrotropin receptor value in cord blood are predictors of dysthyroidism in neonates born from women with Grave’s disease.</jats:p>

Follow-Up of Thyroid Function in Children With Neonatal Hyperthyroidism

“…Our study indicates that tachycardia could be the sole clinical manifestation of hyperthyroidism in a newborn. Other symptoms, such as poor weight gain despite good appetite, irritability, hypertension, tachypnoe and ocular protrusion, have been reported in other studies ( 11 , 24 , 25 ).…”

“…The antithyroid drug (ATD) administration during pregnancy and previous definitive treatment of GD (radioactive iodine [RAI] therapy or thyroidectomy) in the mother could also impact the function of the fetal/neonatal thyroid ( 4 , 8 , 10 ). Autoimmune hyperthyroidism also occurs in children born to mothers who were treated for GD years ago, but still have detectable circulating TRAb ( 4 , 5 , 11 ).…”

Pregnancy and Graves’ Disease

“…These affected babies all had higher levels of TRAbs in their cord blood at delivery and in the follow-up tests. [67] Newborns of mothers with GD can present with hyperthyroidism but also with central or primary hypothyroidism. There are no clear guidelines as to how these neonates should be followed, but most authorities do recommend testing for TRAbs in the cord blood/blood with subsequent discharge of negative testing newborns.…”

Antithyroid Drugs in the Management of Graves' Disease: A Friend and Foe

“…The baby suffered neonatal thyrotoxicosis induced by the transplacental transmission of maternal TRAb. The risk of neonatal thyrotoxicosis is higher in patients such as our patient with persistently higher TRAb in the third trimester of pregnancy and those patients who continue to require ATD toward the end of pregnancy and therefore require close monitoring [ 17 , 18 ]. We could not undertake this as the patient did not attend the clinic from the first trimester of pregnancy till three months postpartum.…”