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Jankovski L, Grosek Š, Žerjav MT, Šimic MV, Zaletel K. Neonatal Thyrotoxicosis in Infants of Mothers with Graves' Disease Treated for Radioiodine-Induced Hypothyroidism: A Literature Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:968. [PMID: 39201903 PMCID: PMC11352502 DOI: 10.3390/children11080968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/02/2024] [Accepted: 08/09/2024] [Indexed: 09/03/2024]
Abstract
Fetal and neonatal thyrotoxicosis occurs in up to 5% of pregnancies in mothers with Graves' disease (GD). This condition is caused by stimulating antibodies against the thyrotropin receptor (TRAbs) that cross the placenta and may stimulate the fetal thyroid, typically in the second half of pregnancy. GD is often treated with radioiodine, resulting in hypothyroidism in most patients, but TRAbs can persist for several years. Even if a pregnant mother is hypothyroid after radioiodine therapy or surgery, her TRAbs can still, although rarely, induce fetal hyperthyroidism. In this review, we first present two cases of neonatal hyperthyroidism in mothers with GD who became hypothyroid after prior radioiodine therapy, identified through a 10-year analysis of the National Perinatal System in Slovenia. Based on these cases, we provide an overview of existing data on this rare clinical condition in neonates. We also discuss the underlying mechanisms and clinical outcomes based on currently available data. In conclusion, our review highlights the importance of careful monitoring during pregnancy in all women with GD, even in those well managed after radioiodine therapy or surgery.
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Affiliation(s)
- Lucia Jankovski
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Štefan Grosek
- Neonatology Section, Department of Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Medical Ethics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mojca Tanšek Žerjav
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, Division of Pediatrics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Marijana Vidmar Šimic
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Katja Zaletel
- Division of Nuclear Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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2
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Song Y, Wei H, Cao L, Deng P, Du W, Liu S, Zhang Y. Clinical features of neonatal hyperthyroidism: a retrospective analysis in southwestern China. Front Pediatr 2024; 12:1282408. [PMID: 38966493 PMCID: PMC11222631 DOI: 10.3389/fped.2024.1282408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 05/21/2024] [Indexed: 07/06/2024] Open
Abstract
Purpose This study aimed to explore the clinical characteristics and evaluate the different types of thyroid dysfunction in babies with neonatal hyperthyroidism. Methods The clinical data of 19 neonates with hyperthyroidism admitted to the Children's Hospital of Chongqing Medical University between January 2012 and April 2021 were retrospectively analyzed. Results Fifteen (78.9%) infants were born to mothers with Graves' disease. Eleven (57.9%) infants were premature; two babies were born at small for gestational age. The age at diagnosis ranged from 3 to 34 days, with a mean of 18.53 ± 6.85 days. The majority of the babies presented with goiter (84.2%) and tachycardia (94.7%) after birth. Nine (47.4%) of them presented with abnormal weight gain, seven (36.8%) presented with stare or ocular protrusion, six (31.6%) presented with hyperexcitability, four (21.1%) presented with jaundice and liver dysfunction, two (10.5%) presented with sweating, one (5.3%) presented with fever, and one case presented without any symptoms. Transient hyperthyroidism was the main thyroid dysfunction in our study. Overt hyperthyroidism was diagnosed in 13 (68.4%) neonates. Another three babies (15.8%) presented with hyperthyroidism with slightly elevated free triiodothyronine levels, normal thyroxine (T4) levels, and low thyroid-stimulating hormone (TSH) levels. Normal thyroid hormone levels with low TSH levels were observed in three (15.8%) neonates. Ten children were treated with antithyroid drugs. Eighteen children recovered normal thyroid function at 1-3 months of age; one baby in the study group required further levothyroxine supplementation due to primary hypothyroidism (HT). One child was found to have developmental delay at 2 years of age during follow-up. Conclusions Our study highlights the need for prolonged monitoring of thyroid function in suspected patients. A single normal screening for hyperthyroidism or the absence of a maternal history of hyperthyroidism cannot exclude this disease.
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Affiliation(s)
- Yan Song
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Hong Wei
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Luying Cao
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Pinglan Deng
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Weixia Du
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Shan Liu
- Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
- Department of Nuclear Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
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Soto J, Weissglas B, von Plessing-Pierry G, del Solar MP, Peña-Villa C, Flores X, Arancibia M, Campos L. Fetal Hyperthyroidism Secondary to Maternal Basedow-Graves' Disease. AJP Rep 2024; 14:e176-e183. [PMID: 38827649 PMCID: PMC11142847 DOI: 10.1055/a-2317-9431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/10/2024] [Indexed: 06/04/2024] Open
Abstract
Fetal hyperthyroidism is a rare prenatal disease and can be life-threatening. The diagnosis is based on ultrasound in mothers with a history of Basedow-Graves' disease and elevation of thyrotropin receptor antibodies (TRAbs) levels. The treatment consists of antithyroid drugs. We present a mother with Basedow-Graves' disease, treated with radioactive iodine 16 years ago. She had an unplanned pregnancy at the age of 29 years, and an elevation of TRAbs (21 U/L) was found at the sixth week of pregnancy. At 22 weeks of gestation, fetal ultrasound displayed tachycardia, goiter, exophthalmos, and suspicion of craniosynostosis, hence methimazole was started. Concomitantly, suppressed maternal thyroid-stimulating hormone (TSH) was found. Her daughter was born at 33 + 6 weeks showing clinical and laboratory findings of hyperthyroidism. Consequently, treatment with methimazole was prescribed. Normal thyroid function was documented in the mother after giving birth. Clear explanation has not been found for the alteration of maternal TSH during pregnancy.
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Affiliation(s)
- Julio Soto
- Department of Pediatrics, School of Medicine, Universidad de Concepcion, Concepcion, Chile
- Division of Pediatric Endocrinology, Pediatrics Service, Hospital Las Higueras, Talcahuano, Chile
| | - Bunio Weissglas
- Department of Internal Medicine, School of Medicine, Universidad de Concepcion, Concepcion, Chile
| | | | - Maria Paz del Solar
- Department of Clinical and Preclinical Sciences, School of Medicine, Universidad Catolica de la Santisima Concepcion, Concepcion, Chile
| | - Carolina Peña-Villa
- Department of Internal Medicine, School of Medicine, Universidad de Concepcion, Concepcion, Chile
- Division of Endocrinology, Internal Medicine Service, Hospital Las Higueras, Talcahuano, Chile
| | - Ximena Flores
- Division of Obstetric and Gynecologic Ultrasound, Obstetrics and Gynecology Service, Hospital Las Higueras, Talcahuano, Chile
- Department of Obstetrics and Ginecology, School of Medicine, Universidad de Concepcion, Concepcion, Chile
| | - Monica Arancibia
- Division of Pediatric Endocrinology, Pediatrics Service, Hospital Las Higueras, Talcahuano, Chile
| | - Laura Campos
- Division of Pediatric Endocrinology, Pediatrics Service, Hospital Las Higueras, Talcahuano, Chile
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Aygün E, Semerci SY, Çakıl Sağlık A, Yurdakul Ertürk E. Neurodevelopmental Outcome of Infants with Transient Hypothyroxinemia of Prematurity in a Newborn Intensive Care Unit. J Clin Res Pediatr Endocrinol 2024; 16:60-68. [PMID: 37750208 PMCID: PMC10938524 DOI: 10.4274/jcrpe.galenos.2023.2023-6-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/25/2023] [Indexed: 09/27/2023] Open
Abstract
Objective The aim of this study was to evaluate neurological development of infants with transient premature hypothyroxinemia (THOP). Methods This prospective study included newborns who were born between 28-36 weeks of gestation (GW) and were admitted to the neonatal intensive care unit. Newborns exposed to maternal thyroid disease, or with severe intracranial problems, and congenital anomalies were excluded. Infants with THOP were the study group and those without THOP formed the control group. The study group was subdivided into those receiving levothyroxine replacement (5 μg/kg/day) and those who were untreated. Neonatal demographics, and morbidities, including respiratory distress syndrome, bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) were evaluated. The Ages and Stages Questionnaire (ASQ) and ASQ:Social-Emotional (ASQ:SE) developmental screening tests were administered to the entire study population at the corrected age of two years. Results Seventy infants were included in this study, 40 of whom had THOP. The mean GW was 34.4±3.8 weeks in the study group and 37.2±2.3 weeks in controls (p=0.69). Mean overall birth weight was 1640±428 g. Levothyroxine replacement was started in 12/40 infants (30%). The groups were similar in terms of demographic characteristics. Rates of BPD and ROP were higher in the treated group (p=0.01). ASQ and ASQ:SE results did not differ between groups (p=0.75), nor did these scores differ between infants with THOP who did or did not receive levothyroxine (p=0.14). Conclusion Although levothyroxine replacement therapy was associated with increased rates of BPD and ROP, this treatment did not appear to improve long-term neurological outcomes in this small group of infants with THOP. Prospective controlled studies with much larger sample sizes are needed to clarify the role of levothyroxine replacement in THOP.
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Affiliation(s)
- Erhan Aygün
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Neonatology, İstanbul, Turkey
| | - Seda Yılmaz Semerci
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Neonatology, İstanbul, Turkey
| | - Adviye Çakıl Sağlık
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Neonatology, İstanbul, Turkey
| | - Emine Yurdakul Ertürk
- Ordu University Training and Research Hospital, Department of Pediatrics, Ordu, Turkey
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5
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Zhu L, Wang J, Liu W. The tortuous diagnosis of one case of neonatal hyperthyroidism. BMC Pediatr 2024; 24:43. [PMID: 38218773 PMCID: PMC10787401 DOI: 10.1186/s12887-024-04531-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE To outline the clinical signs, diagnosis, and course of care for a single case of neonatal hyperthyroidism while also summarizing common diagnostic errors related to this condition. METHODS Medical records of the neonate of hyperthyroidism were collected and analyzed in combination with literature. RESULTS The neonate's mother had thyroid disease, but her thyrotropin receptor antibody (TRAb) levels were not monitored during pregnancy. The neonate exhibited typical symptoms of hyperthyroidism on the day of birth but was not diagnosed until 15 days later. Impaired liver (cholestasis, elevated liver enzymes) and cardiac function (pulmonary hypertension, right heart enlargement) are the main manifestations. Treatment with methimazole (1.0 mg /kg·d) and propranolol (2.0 mg /kg·d) led to recovery, and the neonate stayed in the hospital for 27 days before being discharged with medication. The diagnosis was temporary hyperthyroidism, and the medication was discontinued at 72 days of age. CONCLUSION It is important to strengthen the management of high-risk pregnant women with thyroid disease. Monitoring TRAb levels in both mothers and neonates should be done dynamically to enable early prediction and diagnosis of neonatal hyperthyroidism. Most neonates with hyperthyroidism have a good prognosis when timely and appropriate medical treatment is provided.
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Affiliation(s)
- Lin Zhu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1098 Jiefang Avenue, Wuhan, Hubei, 430077, P.R. China
| | - Jing Wang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1098 Jiefang Avenue, Wuhan, Hubei, 430077, P.R. China.
| | - Wei Liu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1098 Jiefang Avenue, Wuhan, Hubei, 430077, P.R. China.
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Hong L, Tang MHY, Cheung KW, Luo L, Cheung CKY, Dai X, Li Y, Xiong C, Liang W, Xiang W, Wang L, Chan KYK, Lin S. Fetal Hyperthyroidism with Maternal Hypothyroidism: Two Cases of Intrauterine Therapy. Diagnostics (Basel) 2024; 14:102. [PMID: 38201411 PMCID: PMC10795960 DOI: 10.3390/diagnostics14010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Fetal hyperthyroidism can occur secondary to maternal autoimmune hyperthyroidism. The thyroid-stimulating hormone receptor antibody (TRAb) transferred from the mother to the fetus stimulates the fetal thyroid and causes fetal thyrotoxicosis. Fetuses with this condition are difficult to detect, especially after maternal Graves disease therapy. Here, we present two cases of fetal hyperthyroidism with maternal hypothyroidism and review the assessment and intrauterine therapy for fetal hyperthyroidism. Both women were referred at 22+ and 23+ weeks of gestation with abnormal ultrasound findings, including fetal heart enlargement, pericardial effusion, and fetal tachycardia. Both women had a history of Graves disease while in a state of hypothyroidism with a high titer of TRAb. A sonographic examination showed a diffusely enlarged fetal thyroid with abundant blood flow. Invasive prenatal testing revealed no significant chromosomal aberration. Low fetal serum TSH and high TRAb levels were detected in the cord blood. Fetal hyperthyroidism was considered, and maternal oral methimazole (MMI) was administered as intrauterine therapy, with the slowing of fetal tachycardia, a reduction in fetal heart enlargement, and thyroid hyperemia. During therapy, maternal thyroid function was monitored, and the dosage of maternal levothyroxine was adjusted accordingly. Both women delivered spontaneously at 36+ weeks of gestation, and neonatal hyperthyroidism was confirmed in both newborns. After methimazole and propranolol drug treatment with levothyroxine for 8 and 12 months, both babies became euthyroid with normal growth and development.
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Affiliation(s)
- Lu Hong
- Prenatal Diagnosis Centre, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China
| | - Mary Hoi Yin Tang
- Prenatal Diagnosis Centre, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China
| | - Ka Wang Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong 999077, China
| | - Libing Luo
- Prenatal Diagnosis Centre, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China
| | - Cindy Ka Yee Cheung
- Prenatal Diagnosis Centre, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China
| | - Xiaoying Dai
- Prenatal Diagnosis Centre, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China
| | - Yanyan Li
- Prenatal Diagnosis Centre, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China
| | - Chuqin Xiong
- Department of Ultrasound, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China
| | - Wei Liang
- Department of Endocrinology, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China
| | - Wei Xiang
- Department of Endocrinology, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China
| | - Liangbing Wang
- Neonatal Intensive Care Unit, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China
| | - Kelvin Yuen Kwong Chan
- Department of Applied Science, School of Science and Technology, Hong Kong Metropolitan University, Hong Kong 999077, China
| | - Shengmou Lin
- Prenatal Diagnosis Centre, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China
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Ryu J, Igawa T, Mohole J, Coward M. Congenital Neck Masses. Neoreviews 2023; 24:e642-e649. [PMID: 37777610 DOI: 10.1542/neo.24-10-e642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
There are many possible causes of congenital neck masses, with the most common ones being thyroglossal duct cysts, branchial cleft anomalies, and vascular malformations. Most congenital neck masses are asymptomatic in the neonatal period, but depending on the location and the size, they can cause airway obstruction and serious complications at birth. Proper diagnosis is important for optimal treatment planning, and if the airway is compromised, multidisciplinary teamwork is critical for proper airway management. This review summarizes the clinical features, etiology, diagnosis, management, and prognosis of different types of congenital neck masses.
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Affiliation(s)
- Jane Ryu
- Department of Pediatrics/Neonatology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, CA
| | - Teryn Igawa
- Department of Pediatrics/Neonatology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, CA
| | - Jyodi Mohole
- Department of Pediatrics/Neonatology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, CA
| | - Melissa Coward
- Department of Pediatrics/Neonatology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, CA
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Parra Meza C, Africano León ML, Quintero Reyes N, Suarez Mantilla SN, Alvarez Orduz CP. Fetal Goiter Diagnosed in a Euthyroid Patient: An Unusual Presentation of the Fetal Thyroid Disease. Cureus 2023; 15:e41483. [PMID: 37551241 PMCID: PMC10404307 DOI: 10.7759/cureus.41483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/09/2023] Open
Abstract
Fetal thyroid disease is rare, and the disease is mostly contextualized in the setting of a treated maternal thyroid disease. The presentation of thyroid disease in the fetus of a euthyroid mother is unusual. This paper presents the case of a 21-week pregnant woman with an incidental finding from a detailed anatomy ultrasound and evaluates available diagnostic and therapeutic management options. There is no consensus with sufficient evidence given the unusual presentation of this type of pathology. In most cases, the evidence is in the etiology of a mother with previous thyroid pathology that modifies the fetal outcome. Hence, it is important to describe cases to accumulate and, at some point, sufficient evidence of different treatments, with the intention of improving the quality of the recommendations. The management of fetal euthyroid goiter is a complex challenge. Most specialists manage the information on a case-by-case basis, with the same general goals as in patients with other thyroid pathologies.
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Affiliation(s)
- Carolina Parra Meza
- Gynecology and Obstetrics, Hospital Universitario de Santander, Bucaramanga, COL
- Maternal and Fetal Medicine, Universidad Industrial de Santander, Bucaramanga, COL
| | - Martha L Africano León
- Pediatrics, Clinica San Luis, Bucaramanga, COL
- Neonatology, Universidad Industrial de Santander, Bucaramanga, COL
| | - Natalia Quintero Reyes
- Gynecology and Obstetrics, Hospital Universitario de Santander, Bucaramanga, COL
- Gynecology and Obstetrics, Universidad Autónoma de Bucaramanga, Bucaramanga, COL
| | - Silvia N Suarez Mantilla
- Pediatrics, Hospital Universitario de Santander, Bucaramanga, COL
- Pediatrics, Universidad Industrial de Santander, Bucaramanga, COL
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Kayaş L, Çamtosun E, Akıncı A, Bircan R. TSHRV656F Activating Variant of the Thyroid Stimulating Hormone Receptor Gene in Neonatal Onset Hyperthyroidism: A Case Review. J Clin Res Pediatr Endocrinol 2022; 14:114-118. [PMID: 33443352 PMCID: PMC8900074 DOI: 10.4274/jcrpe.galenos.2020.2020.0229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
An activating variant of the thyroid stimulating hormone receptor (TSHR) gene is one of the rare causes of neonatal hyperthyroidism. This disorder may occur as a result of an autosomal dominant inheritance or sporadically through de novo variation. Here we present a case of neonatal onset congenital non-autoimmune hyperthyroidism (NAH) with a sporadic germline activating TSHRV656F variant. A female infant with tachycardia, who was transferred due to hyperthyroidism in the first week of life, displayed no other symptoms or signs. The patient’s mother did not have Graves’ disease, and TSHR stimulating antibodies were not present in the mother or baby. Imaging showed thyroid gland hyperplasia and left ventricular hypertrophy, the patient was subsequently put on methimazole treatment. After six months undergoing treatment, a heterozygous p.Val656Phe (V656F) (c.1966G>T) variant was detected on exon 10 of the TSHR gene. The variant was not identified in the mother and father, so the case was assumed to be sporadic. In conclusion, although the literature describes V656F variant as a somatic variant in children and adults with toxic thyroid nodule(s) that results in the structural activation of the TSH receptor, no previous cases of neonatal hyperthyroidism due to TSHRV656F variant have been reported. This study is the first case review that highlights the relationship between TSHRV656F variant and neonatal onset NAH.
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Affiliation(s)
- Leman Kayaş
- İnönü University Faculty of Medicine, Department of Pediatric Endocrinology, Malatya, Turkey
| | - Emine Çamtosun
- İnönü University Faculty of Medicine, Department of Pediatric Endocrinology, Malatya, Turkey,* Address for Correspondence: İnönü University Faculty of Medicine, Department of Pediatric Endocrinology, Malatya, Turkey Phone: +90 505 254 17 95 E-mail:
| | - Ayşehan Akıncı
- İnönü University Faculty of Medicine, Department of Pediatric Endocrinology, Malatya, Turkey
| | - Rıfat Bircan
- Tekirdağ Namık Kemal University, Faculty of Science and Literature, Department of Molecular Biology and Genetics, Tekirdağ, Turkey
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10
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Sakrani NF, Kul Hasan H, Ibrahim A, Al Jubeh J, Al Teneiji A. Novel mutation causing propionic acidemia associated with unexplained autoimmune thyrotoxicosis. Mol Genet Metab Rep 2021; 29:100806. [PMID: 34646737 PMCID: PMC8498454 DOI: 10.1016/j.ymgmr.2021.100806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022] Open
Abstract
Propionic acidemia (PA) is a rare autosomal recessive inborn error of metabolism (IEM) with relatively higher prevalence in the United Arab Emirates (UAE). Absence of propionyl-CoA carboxylase (PCC) enzyme classically leads to acute decompensation in the early neonatal period. We report a novel homozygous frameshift variant c.2158_2159insT; p.Glu720Valfs*14 (NM_000282.3) in the last exon of the PCCA gene which led to a severe presentation of PA in a newborn Emirati female. Uniquely the diagnosis remained unclear since newborn screening revealed an isolated elevation in plasma proprionylcarnitine (C3) while urinary organic acids remained persistently negative for the classic biochemical abnormalities even during the period of critical illness. Additionally, the patient had an unexplained diagnosis of neonatal thyrotoxicosis. This case explores possible underlying causes through an extensive literature search. To date, there have been no similar reported cases in existing literature. Propionic acidemia Novel mutation Autoimmune thyrotoxicosis (maternal serology negative)
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Key Words
- AA, Amino Acids
- C3, proprionylcarnitine
- FT3/FT4, Free T3/Free T4
- G-CSF, growth colony stimulating factor
- HD, hemodialysis
- Hyperammonemia
- Hyperthyroidism
- IEM, Inborn Errors of Metabolism
- MMA, methlymalonic acid
- MRI, Magnetic Resonance Imaging
- Metabolic acidosis
- Neonate
- OA, Organic Acids
- PA, Propionic Acidema
- PCC, Propionyl-CoA Carboxylase
- PICU, pediatric intensive care unit
- Propionic acidemia
- TPN, Total parenteral nutrition
- TPO, Thyroid Peroxidase
- TRAB, Thyroid Receptor Antibodies
- TSH, Thyroid Stimulating Hormone
- TSI, Thyroid Stimulating Immunoglobulins
- Thyrotoxicosis
- UAE, United Arab Emirates
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Affiliation(s)
- Nida Fatima Sakrani
- General Pediatrics, Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Hala Kul Hasan
- General Pediatrics, Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Ahmed Ibrahim
- Division of Pediatric Endocrinology, Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Jamal Al Jubeh
- Division of Pediatric Endocrinology, Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Amal Al Teneiji
- Division of Metabolic and Genetics, Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Corresponding author at: Division of Metabolic and Genetics, Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Spoke C, Martin C. MATERNAL GRAVES DISEASE AND ABNORMAL CYP2D6 GENOTYPE WITH FETAL HYPERTHYROIDISM. AACE Clin Case Rep 2020; 6:e161-e164. [PMID: 32671217 DOI: 10.4158/accr-2019-0517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/02/2020] [Indexed: 11/15/2022] Open
Abstract
Objective Fetal hyperthyroidism is a rare yet potentially fatal complication of past or present maternal Graves disease (GD). Our objective was to present a unique case of fetal hyperthyroidism in a mother with a prior history of GD and a cytochrome P450 2D6 (CYP2D6) polymorphism. Methods The clinical course in addition to serial laboratory and imaging results are presented. These include thyroid-stimulating hormone, free thyroxine, and thyrotropin receptor antibody levels, as well as fetal ultrasound, doppler fetal heart rate, and cordocentesis testing. Results A 27-year-old with a history of GD previously treated with radioiodine and a known cytochrome P450 polymorphism was referred to an endocrinology clinic at 17 weeks gestation for evaluation and management of fetal thyrotoxicosis. Despite close follow-up with a multidisciplinary care team and an aggressive "block and replace" treatment approach, progressive disease resulted in intrauterine fetal demise at 28 weeks gestation. Conclusion To our knowledge, this is the first published case report of fetal hyperthyroidism accompanied by a maternal CYP2D6 polymorphism. We hypothesize that the maternal CYP2D6 poor metabolizer phenotype prevents formation of antithyroid drug (ATD) metabolites and thus decreases the efficacy of ATD treatment. We suggest this as an area of future research.
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12
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Munoz JL. Fetal thyroid disorders: Pathophysiology, diagnosis and therapeutic approaches. J Gynecol Obstet Hum Reprod 2019; 48:231-233. [PMID: 30634005 DOI: 10.1016/j.jogoh.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/17/2018] [Accepted: 01/08/2019] [Indexed: 11/28/2022]
Abstract
Fetal thyroid disorders while uncommon in general, have significant morbidity and profound effects in the neonate. Pregnancy provides the opportunity not only for the diagnosis of these conditions but also for therapeutic interventions. In careful balance, these disorders range from hypothyroidism to hyperthyroidism, both may manifest with fetal thyroid goiters as well. The intrauterine therapeutic approach of these must also weight the balance in this range as well as the maternal well being which may also express thyroid dysfunction. In this review we explore the different fetal manifestations of thyroid disease, describe the pathophysiology and therapeutic approaches both in practice and in development.
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Affiliation(s)
- Jessian L Munoz
- OB/GYN and Women's Health Institute A81, Cleveland Clinic, Cleveland, OH, 44105, USA.
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Yoshihara A, Iwaku K, Noh JY, Watanabe N, Kunii Y, Ohye H, Suzuki M, Matsumoto M, Suzuki N, Tadokoro R, Sekiyama C, Hiruma M, Sugino K, Ito K. Incidence of Neonatal Hyperthyroidism Among Newborns of Graves' Disease Patients Treated with Radioiodine Therapy. Thyroid 2019; 29:128-134. [PMID: 30426886 DOI: 10.1089/thy.2018.0165] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The serum thyrotropin receptor antibody (TRAb) titers of Graves' disease (GD) patients are known to increase after radioiodine (RAI) therapy, and they can remain high for years. The incidence of neonatal hyperthyroidism (NH) among newborns of mothers with GD who conceived after RAI therapy has not been previously reported. The aims of this study were to investigate the incidence of NH among newborns of mothers who conceived within two years after RAI therapy, and to identify predictors of NH. METHODS GD patients (n = 145) who conceived within two years after RAI therapy were retrospectively reviewed, and information regarding their newborns was collected. RESULTS Of the 145 pregnant women, 54 (37%) were treated with antithyroid drugs or potassium iodide for maternal hyperthyroidism during the first trimester. There were eight newborns with NH, resulting in an incidence of 5.5%. Seven of the eight mothers whose newborns had NH were treated with antithyroid drugs or potassium iodide during their pregnancy. The incidence of NH among the newborns of mothers who conceived within 6-12 months after RAI therapy was 8.8%, within 12-18 months was 5.5%, and within 18-24 months was 3.6%. Multivariate analysis revealed that the TRAb values in the third trimester were the only risk factor for NH. The cutoff TRAb value in the third trimester for predicting NH was 9.7 IU/L (reference value <2.0 IU/L). CONCLUSIONS The incidence of NH among newborns of mothers who conceived within two years after RAI therapy was 5.5%. The fetuses of pregnant GD patients whose TRAb value is high in the third trimester should be carefully followed by an obstetrician during pregnancy, and the newborns should be carefully followed by a pediatrician after birth.
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Affiliation(s)
- Ai Yoshihara
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | - Kenji Iwaku
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | | | | | - Yo Kunii
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | - Hidemi Ohye
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | - Miho Suzuki
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | | | - Nami Suzuki
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | - Rie Tadokoro
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | | | - Marino Hiruma
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | | | - Koichi Ito
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
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14
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Özon A, Tekin N, Şıklar Z, Gülcan H, Kara C, Taştekin A, Demir K, Koç E, Evliyaoğlu O, Kurtoğlu S. Neonatal effects of thyroid diseases in pregnancy and approach to the infant with increased TSH: Turkish Neonatal and Pediatric Endocrinology and Diabetes Societies consensus report. TURK PEDIATRI ARSIVI 2018; 53:S209-S223. [PMID: 31236034 PMCID: PMC6568290 DOI: 10.5152/turkpediatriars.2018.01819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Thyroid functions in the fetus and newborn carry importance in terms of the baby's health and development of the central nervous system. Maternaliodine deficiency, exposure to iodine, thyroid diseases (Hashimoto thyroiditis, Graves') and drugs used by the mother affect thyroid functions in the fetus. Reflections of these effects are observed immediately after delivery. Investigation of the mother in terms of thyroid diseases during pregnancy, recognition and appropriate assessment of the required conditions, screening of all newborns in the first days of life in terms of congenital hypothyroidism, timely and appropriate evaluation of the screening results, early diagnosis and appropriate treatment of cases of congenital hypothyroidism, assessment and management of cases of transient thyroid hormone disorders and close monitoring of the thyroid functions and development of patients in whom treatment has been initiated with a diagnosis of hypothyroidism are crucial in terms of developmental outcomes of the babies who have thyroid function disorders or hypothyroidism. This guideline was written with the objective of guiding pediatricians, neonatologists and pediatric endocrinologists in the issue of assessment, diagnosis and management of thyroid function disorders and thyroid diseases concerning the fetus and baby during gestation and neonatal period.
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Affiliation(s)
- Alev Özon
- Division of Endocrinology, Department of Pediatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Neslihan Tekin
- Division of Neonatology, Department of Pediatrics, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Zeynep Şıklar
- Division of Endocrinology, Department of Pediatrics, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Hande Gülcan
- Division of Neonatology, Başkent University Adana Application Hospital, Adana, Turkey
| | - Cengiz Kara
- Division of Endocrinology, Department of Pediatrics, Ondokuz Mayıs University, Faculty of Medicine, Samsun, Turkey
| | - Ayhan Taştekin
- Division of Neonatology, Medipol University, Faculty of Medicine, İstanbul, Turkey
| | - Korcan Demir
- Division of Endocrinology, Department of Pediatrics, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Esin Koç
- Division of Neonatology, Department of Pediatrics, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Olcay Evliyaoğlu
- Division of Endocrinology, Department of Pediatrics, Istanbul University Cerrahpaşa Medical Faculty, İstanbul, Turkey
| | - Selim Kurtoğlu
- Pediatric Endocrinolgy Unit, Memorial Kayseri Hospital, Kayseri, Turkey
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15
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Dayal D, Aggarwal A. Neonatal Grave's disease: a caution while treating. Turk Arch Pediatr 2018; 52:244. [PMID: 29483807 DOI: 10.5152/turkpediatriars.2017.5766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/30/2017] [Indexed: 11/22/2022]
Affiliation(s)
- Devi Dayal
- Pediatric Endocrinology & Diabetes Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anshita Aggarwal
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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Singh V, Pandita A, Gupta G, Shukla A. Neck mass: an obstructive cause of respiratory distress with medical management. BMJ Case Rep 2017; 2017:bcr-2017-222457. [PMID: 29197845 DOI: 10.1136/bcr-2017-222457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Congenital goitre is a known cause of hypothyroidism in newborn. Congenital goitre can be due to defective synthesis of thyroxine or administration of antithyroid drugs to the mother during pregnancy. In this case report, we report an instance of a preterm male infant with antenatally detected goitre presenting as a neck mass with congenital hypothyroidism. Hormonal replacement therapy was started immediately after birth which lead to resolution of the mass and normalisation of thyroid function.
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Affiliation(s)
- Vijay Singh
- Department of Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Aakash Pandita
- Department of Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Girish Gupta
- Department of Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amit Shukla
- Department of Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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