ESPR EUROPEAN SOCIETY FOR PEDIATRIC RESEARCH Siena, Italy August 31, 2005 – September 3, 2005

290 Neonatal Thyrotoxicosis: Pathogenesis, Clinical Features and Diagnosis

Abstract

Introduction: Neonatal Thyrotoxicosis (1:4000) is caused by the transplacental passage of thyroid stimulating immunoglobulins (TSIs) from mothers with Basedow disease/Hashimoto thyroiditis. Hyperthyroidism is characterized: By growth retardation, goitre, tachycardia, hydrops, craniosinostosis, increased foetal motility, accelerated bone maturation in the foetus; tachycardia, arrhythmia, periorbital oedema, irritability, poor weight gain in the newborn. Symptoms may be observed at birth or after several days.

Objectives and methods the objectives of our study were to evaluate the incidence of thyroid disease during pregnancy and suggest a guide-line for the management of baby at risk. The study was performed between January 1999 and December 2004 in mothers with Basedow disease. The period of maternal diagnosis, the medical treatment, the TSIs level at the delivery were considered. For every neonate we observed: The clinical signs, the level of thyroid hormone and antibodies; ecography of thyroid and of encephalon, X-ray of carp.

Results: We detected 9 newborns (1/2459) all preterm. Babies of mothers without treatment were hospitalized for the cardiac risk. In babies of treated mothers, clinical signs appeared between 10 -15 days of life. TSIs level of mothers at delivery was well above the upper limit. However babies had a resolution from an endocrinological and clinical point of view and a good prognosis for neurological and psychological development.

Conclusions: It is important to recognize and treat Basedow disease in mothers as soon as possible. It is necessary: To consider euthyroid or hypothyroid mothers with a high level of TSIs; to measure TSIs levels in the third quarter of pregnancy and at the delivery; to screen the foetus with a sonografic approach during the pregnancy. For babies at high risk of thyrotoxicosis, the neonatal observation and the measurement of TSH, fT4 TSIs at birth, at age 2–7 days and at 10–14 days are important.

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