Hepatic Dysfunction and Growth Failure Resulting from Undiagnosed Neonatal Graves Disease - A Case Report - Abstract
Hyperthyroidism is a common condition and presents most commonly as Graves disease in adults, but in neonates, congenital hyperthyroidism is a much rarer finding. Congenital hyperthyroidism is shown to be present in about 1:4000 patients and can cause significant disease with serious life-long ramifications if not recognized early. Neonates usually present with tachycardia, arrhythmias, growth retardation and prematurity in the fetal period and subsequently irritability, hypertension, and poor weight gain after birth. The etiology of congenital hyperthyroidism is most commonly due to transplacental transfer of maternal antibodies in mothers with Graves disease. Hyperthyroidism can also have effects on liver enzymes and lead to liver dysfunction as thyroid hormones are processed in the liver and excreted in bile. We present the case of a 14-day old preterm patient who presented with significant hepatic dysfunction and growth failure secondary to congenital hyperthyroidism due to maternal Graves disease. The Infant had been investigated for obstructive, genetic, infectious,
and metabolic causes of liver dysfunction prior to transfer which were negative. Further investigation revealed elevated thyroxine levels with significant suppression of thyroid stimulating hormone (TSH) and elevation of TSH receptor antibody (TRAb) levels. We present this case to highlight the importance of recognizing hepatic dysfunction as a clinical feature of congenital hyperthyroidism, as failure to accurately diagnose neonatal hyperthyroidism can result in long term complications such as craniosynostosis, severe developmental delay and mental retardation.