Evaluation and management of infants at risk for neonatal Graves disease

TSHR-Ab: thyroid-stimulating hormone receptor antibodies; fT4: free thyroxine; T3: triiodothyronine; TSH: thyroid-stimulating hormone; DOL: day of life; MMI: methimazole; TSH-R: thyroid-stimulating hormone receptor.
* For infants coming to medical attention after birth, thyroid function tests are performed as soon as the possibility of neonatal Graves disease is recognized and repeated during the first 2 weeks of life, as shown. Results of maternal TSHR-Ab tests, if available, may be helpful to estimate the infant's risk of developing neonatal Graves disease.
¶ Follow-up is recommended because some TSH-R antibody tests may have false-negative results.
Δ Thyroid function tests should be interpreted in the context of the infant's gestation and age because the normal values for these tests are higher during the first few weeks of life compared with values in older infants (refer to UpToDate topic text for details).
◊ In most of these infants, the hypothyroidism is transient and is due to maternal antithyroid drug treatments, although some cases are caused by maternal TSH-R blocking antibodies. The infant may become euthyroid or hyperthyroid anytime during the first few weeks of life. As neonatal Graves disease resolves, some infants may develop central hypothyroidism (low fT4 and low TSH). Central hypothyroidism also may be transient but should be treated with levothyroxine until the hypothyroidism resolves.