[Neonatal hyperthyroidism in non-diagnosed Basedow's disease of the mother. Problems of diagnosis and therapy illustrated by a case history].
A male preterm infant (born at 34 weeks, birth weight 2130 g) developed jaundice (total bilirubin 7.4 mg/dl), hepatosplenomegaly, thrombocytopenia (82,000/microliters) and a raised C-reactive protein (1.2 mg/dl). Although sepsis was suspected, no organism was demonstrated. When the mother visited the child for the first time after 2 weeks, she had florid hyperthyroidism. This explained many of the child's clinical features (poor weight gain, tachycardia, exophthalmos). Both mother and child had raised TSH receptor antibodies (mother: 684.6 U/l; 54.1 U/l, normal < 15 U/l), an increased free T4 and a suppressed TSH. Because of the tachycardia, the child was treated with propranolol (1 mg/kg.d for 5 weeks). He was also initially given Lugol's solution (25 mg iodide/kg.d for 1 week) and then propylthiouracil (7 mg/kg.d) because of the increasing total T3. L-Thyroxine replacement was subsequently required for a period of 2.5 weeks because of treatment-related hypothyroidism. Since stopping treatment (at 12 weeks of age), the child has developed normally.--Neonatal hyperthyroidism due to transplacental transfer of TSH receptor antibodies associated with maternal Graves' disease is a rare self-limiting condition. However, it may pose considerable danger to the child both in utero and postnatally (with a mortality if untreated of up to 20%). Interdisciplinary cooperation is essential.
Krüger
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Klinik mit Poliklinik für Kinder und Jugendliche, Universität Erlangen-Nürnberg.
Dörr
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Becker
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W
Wolf
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F
Harms
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D
D000328:Adult; D001663:Bilirubin / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D004359:Drug Therapy, Combination; D005260:Female; D006111:Graves Disease / Q000175:diagnosis*; D006529:Hepatomegaly; D006801:Humans; D006980:Hyperthyroidism / Q000151:congenital* / Q000175:diagnosis / Q000188:drug therapy; D007231:Infant, Newborn; D007454:Iodides / Q000627:therapeutic use; D007567:Jaundice, Neonatal; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D011433:Propranolol / Q000627:therapeutic use; D011441:Propylthiouracil / Q000627:therapeutic use; D011989:Receptors, Thyrotropin / Q000276:immunology; D012996:Solutions; D013163:Splenomegaly; D013921:Thrombocytopenia; D013963:Thyroid Hormones / Q000097:blood; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000627:therapeutic use
D007454:Iodides; D011989:Receptors, Thyrotropin; D012996:Solutions; D013963:Thyroid Hormones; D011441:Propylthiouracil; D013972:Thyrotropin; D002097:C-Reactive Protein; D011433:Propranolol; D013974:Thyroxine; D001663:Bilirubin; C010389:Lugol's solution
Neonatale Hyperthyreose bei nicht diagnostiziertem Morbus Basedow der Mutter. Probleme der Diagnostik und Therapie anhand einer Kasuistik.