Chulalongkorn Medical Journal


Background : Both the status of maternal Graves’ disease and the methods of treatmentcan cause a variety of impacts on their fetuses and newborn infants.Objective : To determine the clinical outcome and thyroid function test (TFT) of theinfants born to the women who have been diagnosed with Graves’ disease.Methods : The study was performed on the infants born to mothers with Graves’disease at King Chulalongkorn Memorial Hospital between April 1999 andMarch 2006. They were examined and tested for serum FT4 or T4 and TSHlevels at age > 48 hours (screening tests). Infants suspected of thyroiddisease would have repeated serum FT4 and TSH test within 1 - 2 weeks.Tc99 thyroid scan was performed if congenital hypothyroidism wassuspected. The infants were divided into 3 groups according to the methodsof treatment their mothers had previously received. Group 1, 2, 3 weredefined for maternal treatment with anti-thyroid drug, I 131 and surgery,respectively. Comparison of clinical outcomes and TFT among these3 groups of infants were performed.Results : One hundred and ninety pregnant women delivered 191 infants wereenrolled. There were 131, 49 and 11 infants in group 1, 2 and 3, respectively.During pregnancy, 91 women were on propyl thiouracil (PTU), 47 onL-thyroxine and 52 were not on medication. There were more percentageof women in Group 1 who received PTU (64.6%, 12.2% and 9.1%respectively) and fewer of them (5.4%, 69.4% and 54.5% respectively)needed L-thyroxine. Among these infants, there was no statistical differencein terms of mean maternal age, gestational age, birth weight and proportionof small-for-gestational-age infants. Congenital anomalies were found in5 infants (2.6%). Thyroid dysfunction was found in 15 infants (7.8%). Fivewere found with congenital hypothyroidism, 1 transient hypothyroidism,2 fetal hyperthyroidism, 1 symptomatic hyperthyroidism and 6 asymptomatichyperthyroidism. Screening levels of TSH and FT4 of infants, whose motherswere taking PTU during pregnancy, were significantly higher and lowerthan the others (p < 0.001, ANOVA test). The maximum dosage of maternalPTU were also correlated significantly with the level of screening TSH(r = 0.44, p< 0.001) and screening FT4 (r = -0.47, p < 0.001) of the infants(Pearson Correlation).Conclusion : Infants born to Graves’ disease mothers are at risk of congenital anomaliesand thyroid dysfunction. Careful physical examination and thyroid functiontest should be closely monitored in these infants.


Faculty of Medicine, Chulalongkorn University

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