Management of neonates born to women with Graves' disease: a cohort study
Management of neonates born to women with Graves' disease: a cohort study
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DOI：
10.1530/eje-13-0994
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发表时间：
2014-06-01
影响因子：
5.8
通讯作者：
Polak, Michel
中科院分区：
文献类型：
--
作者：
Besancon, Alix;Beltrand, Jacques;Polak, Michel
目的：与Graves病(GD)母亲配对的新生儿甲状腺功能亢进(甲亢)可导致显著的发病率和死亡率，但仍被临床医生所忽视。通过更好地了解所涉及的预测因素，新生儿甲状腺功能亢进症的治疗将得到改善。设计：前瞻性观察研究。方法：68例GD母亲所生新生儿，根据母亲的促甲状腺激素受体抗体(TRAb)和抗甲状腺药物(ATD)状况分为三组：TRAb(-ve)/ATD-(Ve)27例；TRAb(-ve)/ATD(+ve)，n=8；TRAb(+ve)/ATD(+ve)，n=33。主要观察指标为临床检查、甲状腺功能检查(TSH、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT4)和TRAb)、超声心动图、甲状腺超声和骨成熟评估。结果：TRAb阴性的GD母亲所生婴儿均未发生新生儿甲状腺功能亢进。在33例TRAb(+ve)/ATD(+ve)新生儿中，脐血TRAb阳性24例(72.7%)，其中7例发展为新生儿甲亢。FT4在出生后3~7天升高可预测甲亢的发生。结论：在妊娠晚期应对GD母亲及新生儿脐血进行TRAb检测，若阳性，则提示新生儿甲亢的高危。出生时FT4的测定应在出生后第3天至第5天之间重复(最迟在第7天)；出生后第一周FT4的快速升高预示着甲亢，并需要进行ATD治疗。
Objective: Hyperthyroidism in neonates bor'n to mothers with Graves' disease (GD) can be associated with significant morbidity and mortality, but is still overlooked by clinicians. Management of neonatal hyperthyroidism would be improved by a better understanding of the predictive factors involved. The aim of this study was to evaluate the course of thyroid function and clinical outcomes during the first postnatal month in babies born to mothers with GD.Design: Prospective observational study.Methods: Sixty-eight neonates born to mothers with GD were managed from birth and divided into three groups based on thyrotropin receptor antibody (TRAb) and anti-thyroid drug (ATD) status in the mother: TRAb(-ve) /ATD-(ve,) n=27; TRAb(-ve) /ATD(+ve), n=8; and TRAb(+ve)/ATD(+ve), n=33. The main outcome measures were clinical examination, thyroid function tests (TSH, free thyroxine (FT4), free triiodothyronine, and TRAb), echocardiography, thyroid ultrasonography, and bone maturation assessment.Results: None of the infants born to TRAb(-ve) mothers with GD developed neonatal hyperthyroidism. Of the 33 TRAb(+ve)/ATD(+ve) neonates, 24 (72.7%) had positive TRAb on cord blood assays, and seven of these developed neonatal hyperthyroidism. FT4 elevation between days 3 and 7 but not at birth was predictive of the development of hyperthyroidism.Conclusions: TRAb status should be checked in the third trimester in mothers with GD and on cord blood in their neonates; if positive, it indicates a high risk of neonatal hyperthyroidism. FT4 measurement at birth should be repeated between days 3 and 5 (and by day 7 at the latest); rapid FT4 elevation during the first postnatal week is predictive of hyperthyroidism and warrants ATD therapy.