Neonatal Thyroid diseases (Hyperthyroidism and Hypothyroidism)
Newborns may have thyroid disorders such as hypothyroidism; when thyroid gland does not produce adequate amounts of the thyroid hormones, or hyperthyroidism; when there is an overproduction of the same hormones.
Neonatal Hypothyroidism
Underdeveloped thyroid gland, or its absence, is the usual reason for neonatal hypothyroidism. Occasionally, the thyroid gland which is present may not be producing adequate amounts of the hormones, resulting in hyperthyroidism.
Symptoms and Treatment
Hypothyroidism may not produce any symptoms in the beginning. But later on, many symptoms such as lethargy, and lack of muscle tone, may develop. The affected infant may have constipation and decreased appetite. Hoarseness of voice while crying, and bulging of the belly button due to the development of umbilical hernia are the other symptoms. Developmental delays, poor intellectual growth, and stunted physical growth, are the usual outcomes if hypothyroidism is not treated properly. Enlargement of the tongue, and rough facial features, are also characteristics of untreated congenital hypothyroidism.
The prognosis of neonatal hypothyroidism is good if it is detected early, and a simple treatment regimen is followed. In most of the developed countries, a routine blood test is done to assess the thyroid function of all infants. Hypothyroidism is indicated by low levels of the thyroid hormones and higher than normal levels of another hormone called thyroid stimulating hormone. An endocrinologist specializing in the thyroid disorders of infants may prescribe the correct dosage of the thyroid hormone thyroxin, which is given orally. Intellectual disabilities and physical deformities can be prevented by administering the thyroid hormone on a daily basis. Hypothyroidism in infants may require treatment throughout life.
Neonatal Hyperthyroidism
Hyperthyroidism, which is very rare in newborn babies, is known as neonatal Graves’ disease. Graves’ disease in the mother, either during pregnancy, or prior to it, raises the risk of the infant developing this condition. The thyroid stimulating antibodies produced in the mother induce her glands to produce more thyroid hormones. These antibodies, when they cross over to the infant through the placenta, stimulate the infant’s thyroid glands in the same way, resulting in excess production of the hormones.
Symptoms and Treatment
The usual symptoms displayed by the newborn with hyperthyroidism are rapid breathing, abnormally fast heart rate, and elevated metabolic rate. The infant may have excessive appetite, but it may not gain weight properly. A condition called exophthalmos, characterized by the bulging of eyes, may be present in both the infant and its mother. Goiter, or enlargement of the thyroid gland, if present, may cause difficulty in breathing in the newborn due to the pressure it exerts on the windpipe. Abnormally high heart rate may result in heart failure. Neonatal Graves’ disease is a life threatening situation which can result in death, if not detected early and treated appropriately.
The typical symptoms of hyperthyroidism alert the doctors to the possibility of the disorder in the newborn. High thyroid hormone levels in the infant’s blood help in diagnosis. High levels of thyroid stimulating antibodies from the mother’s blood also may be detected in the infant. Since hyperthyroidism is dangerous in infants, a routine thyroid function test in newborns may be a life-saving measure.
Hyperthyroidism in newborns is treated using drugs which retard the thyroid hormone production. Propylthiouracil is such a drug used to slow down the thyroid gland. After the first few months, the treatment can be discontinued, as the antibodies which crossed over from the mother’s bloodstream into the infant through the placenta gradually wear off.
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Yasser Elnahas
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