Neonatal Med.  2021 Nov;28(4):161-166. 10.5385/nm.2021.28.4.161.

A Case of Neonatal Thyrotoxicosis with Cardiac Insufficiency

• Jeong JE
• Lee SH
• Kim YH
• Jang YY
• Kim JK

• KMID: 2522854
• DOI: http://doi.org/10.5385/nm.2021.28.4.161

Abstract

Neonatal thyrotoxicosis is rare and most of the cases are secondary to maternal Graves’ disease. It is usually transient, but can be associated with significant morbidity and mortality if not recognized promptly and treated adequately. Neonates born to mothers treated with antithyroid drugs or those who receive maternal thyroid blocking antibodies may exhibit normal thyroid function or even hypothyroidism at birth. Since there may not be any obvious symptoms of hyperthyroidism at birth, it may be overlooked. Therefore, such neonates should be evaluated properly and monitored regularly to prevent serious complications of hyperthyroidism. We report a case of a 21-day-old male infant who developed thyrotoxicosis with dyspnea, irritability, tachycardia, and cardiac insufficiency. He was born to a mother who was treated for Graves’ disease with antithyroid drugs during pregnancy. We have also discussed the importance of careful examination and monitoring to prevent the development of clinical hyperthyroidism.

Keyword

Thyrotoxicosis; Graves' disease; Hyperthyroidism; Infant, newborn; Heart failure

Figure

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  Figure 1. Infantogram shows cardiomegaly. It can rule out lung problems from the possible causes of tachypnea and tachycardia.

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  Figure 2. Both the thyroid lobes were enlarged and coarse on ultrasound. (A) The breadth and depth of the right lobe were 17.11 and 11.58 mm, respectively. (B) The breadth and depth of the left lobe were 15.86 and 11.20 mm, respectively. (C) The length estimated by Tc-99m pertechnetate scan was 29.3 mm and uptake was increased. This corresponds to 1.86 times the mean thyroid gland volume of a normal newborn (thyroid volume=length×breadth×depth×π/6) [7].

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  Figure 3. Trend of (A) thyroid function test and (B) treatment. The thyroid hormone was normalized on day 14 of hospitalization. However, the level of thyroid-stimulating hormone (TSH) receptor antibodies (TRAb) was decreased to 0.8 IU/L at 8 months of age. Day 1 of treatment was day 21 after birth. Abbreviations: T3, triiodothyronine; FT4, free thyroxine; HC, hydrocortisone; MMZ, methimazole.

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