[Neonatal Basedow's disease in twins from a mother with severe T3 hyperthyroidism].
METHODS
Dizygotic twin sisters were born to a woman who, shortly before becoming pregnant, had developed Graves' disease with markedly elevated triiodothyronine (T3) levels and highly positive TSH receptor antibody titres (TRAb: 169 mU/ml). From the second week of life onwards they had a goitre and hyperexcitability, tachycardia and failure to thrive were noted. In addition, twin I had mild exophthalmos. As thyrostatic treatment of the mother was very difficult, intrauterine hypothyroidism or transitory hyperthyroidism had presumably occurred in the twins.


METHODS
Twin I had maximal thyroxine (T4) concentration of 26.2 micrograms/dl, while it was 24.7 micrograms/dl in twin II with suppressed TSH. Both twins had high concentrations of TRAb and antibodies against thyroid peroxidase.


METHODS
With the diagnosis of neonatal Graves' disease established, both twins were treated with propranolol (2 mg/kg.d) and phenobarbitone (2-4 mg/kg.d). Twin I, whose symptoms were more severe, also received propylthiouracil (5 mg/kg.d) until euthyroidism had been achieved. Although twin II became euthyroid spontaneously, she gained weight only slowly and microcephaly developed together with definite motor and mental retardation. It remains unclear whether these were consequences of intrauterine hypothyroidism or post-partum hyperthyroidism.


CONCLUSIONS
Graves' disease during pregnancy demands interdisciplinary collaboration between gynaecologist, physician and paediatrician to prevent severe sequelae in the children. Early risk assessment is possible by measuring the TSH receptor antibody titre in umbilical blood.
Roth
C
C
Universitäts-Kinderklinik, Humboldt-Universität, Virchow-Klinikum, Berlin.
Siggelkow
H
H
Grüters
A
A
Hüfner
M
M
Lakomek
M
M
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood; D002658:Developmental Disabilities / Q000209:etiology; D004200:Diseases in Twins / Q000209:etiology*; D005260:Female; D005312:Fetal Blood / Q000276:immunology; D006111:Graves Disease / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007453:Iodide Peroxidase / Q000276:immunology; D008831:Microcephaly / Q000209:etiology; D010634:Phenobarbital / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D011433:Propranolol / Q000627:therapeutic use; D011441:Propylthiouracil / Q000627:therapeutic use; D011989:Receptors, Thyrotropin / Q000276:immunology; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood*; D014429:Twins, Dizygotic
D000319:Adrenergic beta-Antagonists; D013956:Antithyroid Agents; D001323:Autoantibodies; D006993:Hypnotics and Sedatives; D011989:Receptors, Thyrotropin; D014284:Triiodothyronine; D011441:Propylthiouracil; D011433:Propranolol; D007453:Iodide Peroxidase; D013974:Thyroxine; D010634:Phenobarbital