1 Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Ramat Gan, Israel .
Thyroid. 2014 Jun;24(6):1032-9. doi: 10.1089/thy.2013.0489. Epub 2014 Mar 17.
Overt neonatal Graves' disease is rare, but may be severe, even life threatening, with deleterious effects on neural development. The main objective of this study was to describe the course of thyrotropin (TSH) and free thyroxin (fT4) levels, as well as postnatal weight gain in relation to fT4 levels, in neonates born to women with Graves' disease without overt neonatal thyrotoxicosis. Such information is important to deduce the optimal schedule for evaluation.
We conducted a retrospective chart review of neonates born to mothers with Graves' disease between January 2007 and December 2012. The records were reviewed for sex, gestational age, birth weight, maternal treatment during pregnancy, and maternal thyroid stimulating immunoglobulin (TSI) level. For each visit in the clinic, the data included growth parameters, presence of symptoms suspected for hyperthyroidism, blood test results (levels of TSH, fT4, and TSI), and treatment.
Ninety-six neonates were included in the study (49 males), with a total of 320 measurements of thyroid function tests (TSH and fT4). Four neonates (4%) had overt neonatal Graves' disease; one of them along with nine others were born preterm. In 77 (92.9%) of the remaining 83 neonates (the subclinical group), fT4 levels were above the 95th percentile on day 5. All had normal fT4 on day 15. A negative association was found between fT4 and weight gain during the first two weeks.
In this cohort, most neonates born to mothers with Graves' disease had a subclinical course with abnormal fT4 levels that peaked at day 5. After day 14, all measurements of fT4 returned to the normal range, although measurements of TSH remained suppressed for up to three months. Elevated fT4 was associated with poor weight gain.
显性新生儿 Graves 病较为罕见，但可能较为严重，甚至危及生命，并对神经发育造成不良影响。本研究的主要目的是描述母体 Graves 病新生儿的促甲状腺激素（TSH）和游离甲状腺素（fT4）水平变化，以及游离甲状腺素水平与出生后体重增加的关系，这些信息对于推断最佳评估时间具有重要意义。
我们对 2007 年 1 月至 2012 年 12 月间患有 Graves 病的母亲所生的新生儿进行了回顾性病历审查。对性别、胎龄、出生体重、孕期母亲治疗及甲状腺刺激免疫球蛋白（TSI）水平进行了回顾。在每次就诊时，记录了生长参数、疑似甲状腺功能亢进症状、血液检查结果（TSH、fT4 和 TSI 水平）和治疗情况。
本研究共纳入 96 例新生儿（49 例男性），共进行了 320 次甲状腺功能检测（TSH 和 fT4）。4 例（4%）新生儿患有显性新生儿 Graves 病，其中 1 例与其他 9 例早产儿出生。在其余 83 例（亚临床组）新生儿中，77 例（92.9%）新生儿第 5 天 fT4 水平超过第 95 百分位。所有新生儿第 15 天 fT4 水平均恢复正常。在出生后的前两周，fT4 水平与体重增加呈负相关。
在本队列中，大多数母体 Graves 病新生儿的临床表现为亚临床型，fT4 水平异常，于第 5 天达到峰值。第 14 天后，所有 fT4 水平测量值均恢复正常范围，尽管 TSH 测量值在 3 个月内仍受到抑制。fT4 升高与体重增加不良有关。
