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Neonatal thyrotoxicosis – maternal Graves — RACP Paediatrics MCQ

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ModerateEndocrineNeonatal thyrotoxicosis – maternal GravesRACP Paediatrics

A neonate born to a mother with Graves disease (treated with carbimazole during pregnancy) is jittery, tachycardic (HR 200), has a goitre, and is losing weight. TSH is suppressed. Free T4 is markedly elevated. What is the diagnosis?

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Correct answer: A — Neonatal thyrotoxicosis

Neonatal thyrotoxicosis occurs in ~1-5% of infants born to mothers with Graves disease due to transplacental passage of thyroid-stimulating immunoglobulins (TSI/TRAb). It is usually self-limiting (weeks to months) as maternal antibodies are cleared. Severe cases require treatment with propranolol (for symptoms) and carbimazole/methimazole (to block thyroid hormone synthesis). Lugol iodine may be used acutely.

Reference: RCH Melbourne – 2023 – Neonatal Thyroid CPG; RACP Paediatric Curriculum – Endocrine