新生儿甲亢患儿甲状腺功能随访。
Follow-Up of Thyroid Function in Children With Neonatal Hyperthyroidism.
机构信息
Department of Paediatrics and Endocrinology, Medical University of Warsaw, Warsaw, Poland.
出版信息
Front Endocrinol (Lausanne). 2022 May 4;13:877119. doi: 10.3389/fendo.2022.877119. eCollection 2022.
INTRODUCTION
Neonatal hyperthyroidism mainly occurring in the children born to mothers with Graves' disease (GD). The influence of maternal GD on the newborn's thyroid function includes not only hyperthyroidism, but also various forms of hypothyroidism. Maternally transferred thyrotropin receptor antibodies (TRAb), the antithyroid drug (ATD) administration during pregnancy and previous definitive treatment of GD (radioactive iodine therapy or thyroidectomy) in the mother impact the function of the fetal/neonatal thyroid. Some newborns born to mothers with GD may present central hypothyroidism (CeH) due to impaired regulation of the fetal hypothalamic-pituitary-thyroid axis. The aim of this study was to evaluate different types of thyroid dysfunction in babies with neonatal hyperthyroidism.
MATERIALS AND METHODS
Medical records of 14 infants with neonatal hyperthyroidism (13 born to mothers with GD, and one born to mother with Hashimoto thyroiditis) were analyzed.
RESULTS
Transient hyperthyroidism was the main thyroid dysfunction in our study group. Overt hyperthyroidism with highly increased TRAb levels (mean 13.0 ± 7.0 IU/L) was diagnosed in 6 (43%) neonates. Another 6 (43%) babies presented hyperthyroidism with slightly increased fT4 and/or fT3 levels and TSH levels in the lower limit of the normal range coinciding with positive TRAb levels (mean 3.8 ± 1.6 IU/L). Normal thyroid hormone levels with TSH levels below the lower limit of the range were observed in 2 (14%) neonates. Four babies in the study group (28.5%) required further levothyroxine (L-T4) supplementation due to CeH or, in one case, due to primary hypothyroidism.
CONCLUSION
Our study highlights the need for prolonged monitoring of thyroid function in children born to mothers with GD. Diagnosis of CeH could be delayed due to its masking by transient hyperthyroidism. Prolonged thyroid-stimulating hormone suppression after TRAb elimination should be considered as a signal announcing CeH.
介绍
新生儿甲亢主要发生在患有格雷夫斯病（GD）的母亲所生的孩子中。母体 GD 对新生儿甲状腺功能的影响不仅包括甲亢，还包括各种形式的甲减。母体转移的促甲状腺素受体抗体（TRAb）、妊娠期间使用抗甲状腺药物（ATD）以及母亲之前对 GD 的明确治疗（放射性碘治疗或甲状腺切除术）都会影响胎儿/新生儿甲状腺的功能。由于胎儿下丘脑-垂体-甲状腺轴的调节受损，一些患有 GD 的母亲所生的新生儿可能会出现中枢性甲状腺功能减退症（CeH）。本研究旨在评估新生儿甲亢婴儿不同类型的甲状腺功能障碍。
材料和方法
分析了 14 例新生儿甲亢（13 例来自 GD 母亲，1 例来自桥本甲状腺炎母亲）婴儿的病历。
结果
在我们的研究组中，暂时性甲亢是主要的甲状腺功能障碍。6 名（43%）新生儿诊断为明显甲亢，伴有 TRAb 水平高度升高（均值 13.0 ± 7.0 IU/L）。另有 6 名（43%）婴儿表现为甲亢，FT4 和/或 FT3 水平略有升高，TSH 水平在正常范围下限，同时 TRAb 水平阳性（均值 3.8 ± 1.6 IU/L）。2 名（14%）新生儿甲状腺激素水平正常，TSH 水平在下限以下。研究组中 4 名婴儿（28.5%）因 CeH 或 1 例原发性甲状腺功能减退需要进一步补充左甲状腺素（L-T4）。
结论
本研究强调了需要对患有 GD 的母亲所生的儿童进行甲状腺功能的长期监测。由于其被短暂性甲亢所掩盖，CeH 的诊断可能会延迟。在 TRAb 消除后甲状腺刺激素持续抑制应被视为预示 CeH 的信号。
Zotero 插件