Abstract 13044: Hemodynamic Changes In Neonates Born To Mothers With Graves’ Disease

Abstract

Purpose: Cardiac insufficiency is a major morbidity in neonatal hyperthyroidism. It is therefore important to assess the hemodynamics in neonates born to mothers with Graves’ disease (GD). This study prospectively evaluated the hemodynamic changes in neonates born to mothers with GD. Methods: The subjects of this study were neonates born to mothers with GD who became pregnant between April 2006 and May 2018 and visited Hamamatsu University Hospital. This study included two groups: neonates born to mothers consistently negative for thyroid-stimulating hormone (TSH) receptor antibody (TRAb) in the third trimester of pregnancy, and neonates born to mothers with at least one positive TRAb assay in the third trimester of pregnancy. The serum levels of TSH, free triiodothyronine (FT3), free thyroxine (FT4), and N-terminal-pro-B-type natriuretic peptide (NT-proBNP), the cardiac output, and cardiac index (CI) evaluated by echocardiography were compared between the two groups at several postnatal points (day of delivery and 5, 10, and 30 days of life). Results: Overall, 80 newborns were enrolled. Thirty-six neonates were born to mothers with GD who were positive for TRAb, and 44 were born to mother negative for TRAb. During the study period, four newborns (11.1%) in the TRAb-positive group required treatment with ATD for overt neonatal hyperthyroidism. Eight newborns (22.2%) in the TRAb-positive group were diagnosed with subclinical hyperthyroidism based on findings of laboratory tests in the absence of any clinical symptoms. One neonate in the TRAb-positive group had subclinical hypothyroidism at birth, but there were no symptoms, so no treatment was required. The TRAb-positive newborns had higher FT4 levels and CI on Day 5 (both p < 0.05) and higher FT3 (p < 0.05) and FT4 levels (p < 0.01) and CI (p < 0.01) but lower TSH levels (p < 0.05) on Day 10 than the TRAb-negative newborns. The TRAb-positive newborns had significantly higher NT-proBNP levels on Days 5 (median 752 vs. 563 pg/mL, p = 0.034) and 10 (median 789 vs. 552 pg/mL, p = 0.002) than the TRAb-negative newborns. Conclusions: Hemodynamic changes in neonates born to TRAb-positive mothers with GD resulted in a higher CI and NT-proBNP levels than in those with TRAb-negative mothers from postnatal days 5 to 10.