Thyrotoxicosis detected in a mass-screening program for neonatal hypothyroidism: demonstration of placental transfer of an immunoglobulin with marked lipolytic activity.

A female infant born to a mother with active Graves disease and a strongly positive LATS developed neonatal thyrotoxicosis. The diagnosis was confirmed rapidly by the markedly elevated filter paper spot T4 (5.45 ng/40 microliter) taken on the fifth day of life as part of the Quebec Screening Program for Neonatal Hypothyroidism. Although the infant's serum was negative for LATS, it reacted strongly (as did the maternal serum) in the lipolytic assay for LATS. This case illustrates the ability of screening programs for neonatal hypothyroidism to detect cases of neonatal thyrotoxicosis and supports the hypothesis that this condition is secondary to the placental transfer of a thyroid-stimulating immunoglobulin.