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Cholestasis and Pulmonary Hypertension in Neonatal Thyrotoxicosis: A Case Report. DR. SULAIMAN AL HABIB MEDICAL JOURNAL 2022. [DOI: 10.1007/s44229-022-00019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AbstractNeonatal thyrotoxicosis is mostly caused by the transplacental passage of maternal thyroid stimulating hormone (TSH) receptor antibodies (TRAb) to the fetus. Although rare and transient, this condition may be associated with significant morbidity and mortality if not diagnosed and treated in an appropriate and timely manner. Anti-thyroid drugs are the main therapy. Here, we report a preterm newborn that presented with two uncommon presentations of neonatal thyrotoxicosis, cholestasis and pulmonary hypertension that significantly improved following the administration of anti-thyroid medications.
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Yeliosof O, Marshall I. Severe hyperthyroidism without symptoms due to nonthyroidal illness in a child with acute hepatitis: case report and literature review. Ann N Y Acad Sci 2020; 1487:5-11. [PMID: 32965700 DOI: 10.1111/nyas.14493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/10/2020] [Accepted: 08/22/2020] [Indexed: 12/28/2022]
Abstract
While liver enzyme changes are frequently reported in hyperthyroidism, liver dysfunction itself can lead to alterations in thyroid hormone metabolism. However, the exact relationship between hyperthyroidism and liver dysfunction is unclear. We report an 11-year-old boy presenting with acute hepatitis of unknown etiology, who was incidentally found to have asymptomatic biochemical hyperthyroidism. Despite significant total and free T4 elevation, clinical evidence of thyrotoxicosis was absent. Thyroid I-123 uptake was also reduced. Additional testing revealed slight T3 elevation and significant rT3 elevation. Graves' and Hashimoto's thyroiditis testing was negative. We hypothesize that the biochemical hyperthyroidism was due to transient thyroiditis. Although an etiology for the boy's hepatitis was never determined, and an undiagnosed infectious etiology causing subacute thyroiditis was considered, subsequent testing showing positive thyroid peroxidase antibodies, suggesting autoimmune Hashimoto's thyroiditis as the likely cause of the hyperthyroidism. We believe, furthermore, that the absence of symptoms was the result of concurrent nonthyroidal illness resulting in the biochemical findings of slight T3 elevation and significant rT3 increase despite significant T4 elevation.
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Affiliation(s)
- Olga Yeliosof
- Division of Pediatric Endocrinology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ian Marshall
- Division of Pediatric Endocrinology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Carpenter RM, Wongward J. Graves’ disease presenting as severe postpartum pruritus. BMJ Case Rep 2018; 2018:bcr-2018-225347. [DOI: 10.1136/bcr-2018-225347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Akangire G, Cuna A, Lachica C, Fischer R, Raman S, Sampath V. Neonatal Graves' Disease with Maternal Hypothyroidism. AJP Rep 2017; 7:e181-e184. [PMID: 28948062 PMCID: PMC5610045 DOI: 10.1055/s-0037-1606365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/30/2017] [Indexed: 11/12/2022] Open
Abstract
Neonatal Graves' disease presenting as conjugated hyperbilirubinemia is a diagnostic challenge because the differential includes a gamut of liver and systemic diseases. We present a unique case of neonatal Graves' disease in a premature infant with conjugated hyperbilirubinemia born to a mother with hypothyroidism during pregnancy and remote history of Graves' disease. Infant was treated with a combination of methimazole, propranolol, and potassium iodide for 4 weeks. Thyroid function improved after 8 weeks of treatment with full recovery of thyroid function, disappearance of thyroid-stimulating antibodies, and resolution of failure to thrive and conjugated hyperbilirubinemia. This case provides several clinical vignettes as it is a rare, severe, presentation of an uncommon neonatal disease, signs, symptoms, and clinical history presented a diagnostic challenge for neonatologists and endocrinologists, normal newborn screen was misleading, and yet timely treatment led to a full recovery.
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Affiliation(s)
- Gangaram Akangire
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Alain Cuna
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Charisse Lachica
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Ryan Fischer
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Sripriya Raman
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Venkatesh Sampath
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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