Short-Term Hyperthyroidism Followed by Transient Pituitary Hypothyroidism in a Very Low Birth Weight Infant Born to a Mother With Uncontrolled Graves' Disease

• Ryuzo Higuchi

  1 From the Department of Perinatal Medicine, Wakayama Medical College, Wakayama City, 641-0012, Japan.

• Takeshi Kumagai

  1 From the Department of Perinatal Medicine, Wakayama Medical College, Wakayama City, 641-0012, Japan.

• Masakazu Kobayashi

  1 From the Department of Perinatal Medicine, Wakayama Medical College, Wakayama City, 641-0012, Japan.

• Takaomi Minami

  1 From the Department of Perinatal Medicine, Wakayama Medical College, Wakayama City, 641-0012, Japan.

• Hirofumi Koyama

  1 From the Department of Perinatal Medicine, Wakayama Medical College, Wakayama City, 641-0012, Japan.

• Yuki Ishii

  1 From the Department of Perinatal Medicine, Wakayama Medical College, Wakayama City, 641-0012, Japan.

抄録

Transient hypothyroxinemia in infants born to mothers with poorly controlled Graves' disease was first reported in 1988. We report that short-term hyperthyroidism followed by hypothyroidism with low basal thyroid-stimulating hormone (TSH) levels developed in a very low birth weight infant born at 27 weeks of gestation to a noncompliant mother with thyrotoxicosis attributable to Graves' disease. We performed serial thyrotropin-releasing hormone (TRH) tests in this infant and demonstrated that TSH unresponsiveness to TRH disappeared at 6.5 months of age. The maternal thyroid function was free triiodothyronine (FT3), 21.1 pg/mL; free thyroxine (FT4), 8.1 ng/dL; TSH, <0.03 μU/mL; thyroid-stimulating hormone receptor antibody, 52% (normal: <15%); thyroid-stimulating antibody, 294% (normal: <180%); and thyroid-stimulation blocking antibody, 9% (normal: <25%) on the day of delivery. A nonstress test revealed fetal tachycardia >200 beats per minute, and a male infant weighing 1152 g was born by emergency cesarean section. Thyroid-stimulating hormone receptor antibody was 16% and thyroid-stimulating antibody was 370% in the cord blood. We administered 10 mg/kg per day of oral propylthiouracil from day 1. Tachycardia along with elevated FT4 and FT3 levels in the infant decreased from 200/minute to 170/minute, 4.7 ng/dL to 2.9 ng/dL, 7.0 pg/mL to 4.8 pg/mL, respectively, in the first 33 hours. At 5 days, FT4and FT3 were 1.1 ng/dL and 2.9 pg/mL, respectively, and we stopped propylthiouracil administration. Although FT4decreased to 0.4 ng/dL, TSH was quite low and did not respond to intravenous TRH by 14 days of age. We began daily levothyroxine 5-μ/kg supplementation. The responsiveness of TSH to TRH did not become significant until 4 months old and normalized at 6.5 months old. At this time, levothyroxine was stopped. We conclude that placental transfer of thyroid hormones may cause hyperthyroidism in the fetal and early neonatal periods and lead to transient pituitary hypothyroidism in an infant born to a mother with uncontrolled Graves' disease.

収録刊行物

• Pediatrics

  Pediatrics 107 (4), e57-e57, 2001-04-01

  American Academy of Pediatrics (AAP)

キーワード

• Pediatrics, Perinatology and Child Health

詳細情報

• CRID: 1361418520372792704
• NII論文ID: 30012915546
• NII書誌ID: AA00770295
• DOI: 10.1542/peds.107.4.e57
• ISSN: 10984275
• ISSN: 00314005
• ISSN: http://id.crossref.org/issn/00314005
• Web Site: https://publications.aap.org/pediatrics/article-pdf/107/4/e57/843036/e57.pdf
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