A neonate born to a mother with Graves disease may develop transient hyperthyroidism. Skuza et al evaluated these infants and identified endpoints when antithyroid antibodies could be discontinued. The authors are from the University of Medicine and Dentistry-New Jersey, Children's Hospital of New Jersey in Newark and Endocrine Sciences in California.


Parameters to monitor in the neonate:

(1) serum antibodies to thyrotropin-receptor

(2) serum T3 and T4 (free and total)

(3) serum thryotropin (TSH)

(4) clinical symptoms


The assay for antibodies to thyrotropin receptor (Endocrine Sciences) had the following references ranges:


Serum Level (reported in binding inhibition)


< 0.10


0.10 - 0.15


> 0.15



A neonate with hyperthyroidism has:

(1) elevated levels of antibodies to thyrotropin receptor (usually > 0.25 binding inhibition)

(2) elevated free and total T3 and/or T4

(3) depressed levels of thyrotropin

(4) variable signs and symptoms of hyperthyroidism (jitteriness, poor feeding, tachycardia)


An infant with a low or indeterminate level of antibodies to thyrotropin receptor did not develop hyperthyroidism.


Treatment with propylthiouracil was continued for up to 4 months.


Antithyroid therapy was discontinued when:

(1) thyrotropin receptor antibodies were no longer elevated

(2) serum T3 and T4 were in the normal range

(3) there was no clinical evidence of hyperthyroidism


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