title: Management of neonates born to women with Graves' disease: a cohort study.
abstract: OBJECTIVE
  Hyperthyroidism in neonates born to mothers with Graves' disease (GD) can be associated with significant morbidity and mortality, but is still overlooked by clinicians. Management of neonatal hyperthyroidism would be improved by a better understanding of the predictive factors involved. The aim of this study was to evaluate the course of thyroid function and clinical outcomes during the first postnatal month in babies born to mothers with GD.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Sixty-eight neonates born to mothers with GD were managed from birth and divided into three groups based on thyrotropin receptor antibody (TRAb) and anti-thyroid drug (ATD) status in the mother: TRAb(-ve)/ATD(-ve), n=27; TRAb(-ve)/ATD(+) (ve), n=8; and TRAb(+ve)/ATD(+ve), n=33. The main outcome measures were clinical examination, thyroid function tests (TSH, free thyroxine (FT4), free triiodothyronine, and TRAb), echocardiography, thyroid ultrasonography, and bone maturation assessment.
  
  
  RESULTS
  None of the infants born to TRAb(-ve) mothers with GD developed neonatal hyperthyroidism. Of the 33 TRAb(+ve)/ATD(+ve) neonates, 24 (72.7%) had positive TRAb on cord blood assays, and seven of these developed neonatal hyperthyroidism. FT4 elevation between days 3 and 7 but not at birth was predictive of the development of hyperthyroidism.
  
  
  CONCLUSIONS
  TRAb status should be checked in the third trimester in mothers with GD and on cord blood in their neonates; if positive, it indicates a high risk of neonatal hyperthyroidism. FT4 measurement at birth should be repeated between days 3 and 5 (and by day 7 at the latest); rapid FT4 elevation during the first postnatal week is predictive of hyperthyroidism and warrants ATD therapy.
authors.affiliation: Endocrinologie Gynécologie Diabétologie PédiatriquesHôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, 149 Rue de Sèvres, 75015 Paris FranceINSERM U1016IMAGINE Institute, Université Paris Descartes, Sorbonne Paris Cité, Paris, FranceDépartement de Maternité Bichat-BeaujonAssistance Publique-Hôpitaux de Paris, DHU Risque et Grossesse, Université Paris VII, Paris, France.
authors.forename: Alix
authors.initials: A
authors.lastname: Besançon
authors.affiliation: Endocrinologie Gynécologie Diabétologie PédiatriquesHôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, 149 Rue de Sèvres, 75015 Paris FranceINSERM U1016IMAGINE Institute, Université Paris Descartes, Sorbonne Paris Cité, Paris, FranceDépartement de Maternité Bichat-BeaujonAssistance Publique-Hôpitaux de Paris, DHU Risque et Grossesse, Université Paris VII, Paris, FranceEndocrinologie Gynécologie Diabétologie PédiatriquesHôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, 149 Rue de Sèvres, 75015 Paris FranceINSERM U1016IMAGINE Institute, Université Paris Descartes, Sorbonne Paris Cité, Paris, FranceDépartement de Maternité Bichat-BeaujonAssistance Publique-Hôpitaux de Paris, DHU Risque et Grossesse, Université Paris VII, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Beltrand
authors.affiliation: Endocrinologie Gynécologie Diabétologie PédiatriquesHôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, 149 Rue de Sèvres, 75015 Paris FranceINSERM U1016IMAGINE Institute, Université Paris Descartes, Sorbonne Paris Cité, Paris, FranceDépartement de Maternité Bichat-BeaujonAssistance Publique-Hôpitaux de Paris, DHU Risque et Grossesse, Université Paris VII, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Le Gac
authors.affiliation: Endocrinologie Gynécologie Diabétologie PédiatriquesHôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, 149 Rue de Sèvres, 75015 Paris FranceINSERM U1016IMAGINE Institute, Université Paris Descartes, Sorbonne Paris Cité, Paris, FranceDépartement de Maternité Bichat-BeaujonAssistance Publique-Hôpitaux de Paris, DHU Risque et Grossesse, Université Paris VII, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Luton
authors.affiliation: Endocrinologie Gynécologie Diabétologie PédiatriquesHôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, 149 Rue de Sèvres, 75015 Paris FranceINSERM U1016IMAGINE Institute, Université Paris Descartes, Sorbonne Paris Cité, Paris, FranceDépartement de Maternité Bichat-BeaujonAssistance Publique-Hôpitaux de Paris, DHU Risque et Grossesse, Université Paris VII, Paris, FranceEndocrinologie Gynécologie Diabétologie PédiatriquesHôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, 149 Rue de Sèvres, 75015 Paris FranceINSERM U1016IMAGINE Institute, Université Paris Descartes, Sorbonne Paris Cité, Paris, FranceDépartement de Maternité Bichat-BeaujonAssistance Publique-Hôpitaux de Paris, DHU Risque et Grossesse, Université Paris VII, Paris, France Michel.polak@nck.aphp.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Polak
mesh_terms: D013956:Antithyroid Agents / Q000627:therapeutic use; D016241:Child of Impaired Parents; D015331:Cohort Studies; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006111:Graves Disease; D006801:Humans; D006980:Hyperthyroidism / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications; D011297:Prenatal Exposure Delayed Effects / Q000097:blood / Q000628:therapy*; D013960:Thyroid Function Tests
chemical_list: D013956:Antithyroid Agents; D018828:Immunoglobulins, Thyroid-Stimulating