propylthiouracil and Jaundice--Neonatal

A male preterm infant (born at 34 weeks, birth weight 2130 g) developed jaundice (total bilirubin 7.4 mg/dl), hepatosplenomegaly, thrombocytopenia (82,000/microliters) and a raised C-reactive protein (1.2 mg/dl). Although sepsis was suspected, no organism was demonstrated. When the mother visited the child for the first time after 2 weeks, she had florid hyperthyroidism. This explained many of the child's clinical features (poor weight gain, tachycardia, exophthalmos). Both mother and child had raised TSH receptor antibodies (mother: 684.6 U/l; 54.1 U/l, normal < 15 U/l), an increased free T4 and a suppressed TSH. Because of the tachycardia, the child was treated with propranolol (1 mg/kg.d for 5 weeks). He was also initially given Lugol's solution (25 mg iodide/kg.d for 1 week) and then propylthiouracil (7 mg/kg.d) because of the increasing total T3. L-Thyroxine replacement was subsequently required for a period of 2.5 weeks because of treatment-related hypothyroidism. Since stopping treatment (at 12 weeks of age), the child has developed normally.--Neonatal hyperthyroidism due to transplacental transfer of TSH receptor antibodies associated with maternal Graves' disease is a rare self-limiting condition. However, it may pose considerable danger to the child both in utero and postnatally (with a mortality if untreated of up to 20%). Interdisciplinary cooperation is essential.

Topics: Adult; Bilirubin; C-Reactive Protein; Drug Therapy, Combination; Female; Graves Disease; Hepatomegaly; Humans; Hyperthyroidism; Infant, Newborn; Iodides; Jaundice, Neonatal; Male; Pregnancy; Pregnancy Complications; Propranolol; Propylthiouracil; Receptors, Thyrotropin; Solutions; Splenomegaly; Thrombocytopenia; Thyroid Hormones; Thyrotropin; Thyroxine

We report here six pregnancies in 5 women with juvenile diabetes and Graves disease. The diabetes was managed in a standard fashion. The Graves disease was managed with propylthiouracil when required. The course of neither the diabetes nor Graves disease was different than expected. When established guidelines for therapy are followed the two have no interaction with one another. One infant was mildly hypothyroid. None developed neonatal Graves disease. Four of the infants had hyperbilirubinemia.

Topics: Adult; Diabetes Mellitus, Type 1; Female; Graves Disease; Humans; Infant, Newborn; Insulin; Jaundice, Neonatal; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Propylthiouracil