title: Management of Neonates Born to Mothers With Graves' Disease.
abstract: Neonates born to mothers with Graves' disease are at risk for significant morbidity and mortality and need to be appropriately identified and managed. Because no consensus guidelines regarding the treatment of these newborns exist, we sought to generate a literature-based management algorithm. The suggestions include the following: (1) Base initial risk assessment on maternal thyroid stimulating hormone (TSH) receptor antibodies. If levels are negative, no specific neonatal follow-up is necessary; if unavailable or positive, regard the newborn as "at risk" for the development of hyperthyroidism. (2) Determine levels of TSH-receptor antibodies in cord blood, or as soon as possible thereafter, so that newborns with negative antibodies can be discharged from follow-up. (3) Measurement of cord TSH and fT4 levels is not indicated. (4) Perform fT4 and TSH levels at day 3 to 5 of life, repeat at day 10 to 14 of life and follow clinically until 2 to 3 months of life. (5) Use the same testing schedule in neonates born to mothers with treated or untreated Graves' disease. (6) When warranted, use methimazole (MMI) as the treatment of choice; β-blockers can be added for sympathetic hyperactivity. In refractory cases, potassium iodide may be used in conjunction with MMI. The need for treatment of asymptomatic infants with biochemical hyperthyroidism is uncertain. (7) Assess the MMI-treated newborn on a weekly basis until stable, then every 1 to 2 weeks, with a decrease of MMI (and other medications) as tolerated. MMI treatment duration is most commonly 1 to 2 months. (8) Be cognizant that central or primary hypothyroidism can occur in these newborns.
authors.affiliation: Division of Endocrinology, The Hospital for Sick Children; and d.vanderkaay@hagaziekenhuis.nl.
authors.forename: Daniëlle C M
authors.initials: DC
authors.lastname: van der Kaay
authors.affiliation: Division of Endocrinology, The Hospital for Sick Children; and Departments of Paediatrics and.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Wasserman
authors.affiliation: Division of Endocrinology, The Hospital for Sick Children; and Departments of Paediatrics and Physiology, The University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Palmert
mesh_terms: D013956:Antithyroid Agents / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D006111:Graves Disease / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood; D007231:Infant, Newborn; D008713:Methimazole / Q000627:therapeutic use; D009035:Mothers; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D011297:Prenatal Exposure Delayed Effects / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D013960:Thyroid Function Tests / Q000379:methods
chemical_list: D013956:Antithyroid Agents; D018828:Immunoglobulins, Thyroid-Stimulating; C094372:thyrotropin-binding inhibitory immunoglobulin; D008713:Methimazole