Neonatal Graves' Disease with Maternal Hypothyroidism

Abstract

Neonatal Graves' disease presenting as conjugated hyperbilirubinemia is a diagnostic challenge because the differential includes a gamut of liver and systemic diseases. We present a unique case of neonatal Graves' disease in a premature infant with conjugated hyperbilirubinemia born to a mother with hypothyroidism during pregnancy and remote history of Graves' disease. Infant was treated with a combination of methimazole, propranolol, and potassium iodide for 4 weeks. Thyroid function improved after 8 weeks of treatment with full recovery of thyroid function, disappearance of thyroid-stimulating antibodies, and resolution of failure to thrive and conjugated hyperbilirubinemia. This case provides several clinical vignettes as it is a rare, severe, presentation of an uncommon neonatal disease, signs, symptoms, and clinical history presented a diagnostic challenge for neonatologists and endocrinologists, normal newborn screen was misleading, and yet timely treatment led to a full recovery.

Keywords

cholestasis - failure to thrive - hyperthyroidism - Graves' disease

• References

• 1 van der Kaay DC, Wasserman JD, Palmert MR. Management of neonates born to mothers with Graves' disease. Pediatrics 2016; 137 (04) e20151878
• 2 Zimmerman D. Fetal and neonatal hyperthyroidism. Thyroid 1999; 9 (07) 727-733
• 3 Polak M, Van Vliet G. Therapeutic approach of fetal thyroid disorders. Horm Res Paediatr 2010; 74 (01) 1-5
• 4 Mitsuda N, Tamaki H, Amino N, Hosono T, Miyai K, Tanizawa O. Risk factors for developmental disorders in infants born to women with Graves disease. Obstet Gynecol 1992; 80 (3 Pt 1): 359-364
• 5 Peleg D, Cada S, Peleg A, Ben-Ami M. The relationship between maternal serum thyroid-stimulating immunoglobulin and fetal and neonatal thyrotoxicosis. Obstet Gynecol 2002; 99 (06) 1040-1043
• 6 Smit BJ, Kok JH, Vulsma T, Briët JM, Boer K, Wiersinga WM. Neurologic development of the newborn and young child in relation to maternal thyroid function. Acta Paediatr 2000; 89 (03) 291-295
• 7 Messer PM, Hauffa BP, Olbricht T, Benker G, Kotulla P, Reinwein D. Antithyroid drug treatment of Graves' disease in pregnancy: long-term effects on somatic growth, intellectual development and thyroid function of the offspring. Acta Endocrinol (Copenh) 1990; 123 (03) 311-316
• 8 Beroukhim RS, Moon TD, Felner EI. Neonatal thyrotoxicosis and conjugated hyperbilirubinemia. J Matern Fetal Neonatal Med 2003; 13 (06) 426-428
• 9 Loomba-Albrecht LA, Bremer AA, Wong A, Philipps AF. Neonatal cholestasis caused by hyperthyroidism. J Pediatr Gastroenterol Nutr 2012; 54 (03) 433-434
• 10 Khadora MM, Al Dubayee M. Neonatal Graves' disease with unusual metabolic association from presentation to resolution. BMJ Case Rep 2014; 2014: 1-5
• 11 Varier RU, Jensen MK, Adams CJ, Book LS. Neonatal cholestasis caused by undiagnosed maternal Graves' disease. ACG Case Rep J 2014; 2 (01) 58-60
• 12 Papendieck P, Chiesa A, Prieto L, Gruñeiro-Papendieck L. Thyroid disorders of neonates born to mothers with Graves' disease. J Pediatr Endocrinol Metab 2009; 22 (06) 547-553
• 13 Dryden C, Simpson JH, Hunter LE, Jackson L. An unusual cause of neonatal coagulopathy and liver disease. J Perinatol 2007; 27 (05) 320-322