Pediatric Graves Disease Guidelines

Updated: Nov 07, 2016
  • Author: Lynne Lipton Levitsky, MD; Chief Editor: Sasigarn A Bowden, MD  more...
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Guidelines

Guidelines Summary

A study by van der Kaay et al established a literature-based management algorithm for neonates born to mothers with Graves’ disease. The following eight suggestions were included [19, 20] :

1. Evaluate initial risk assessment on maternal thyroid stimulating hormone (TSH) receptor antibodies. If levels are negative, no need for follow-up; if positive, or not available, newborns should be considered "at risk" for hypothyroidism.

2. Newborns with negative TSH-receptor antibodies can be discharged from follow-up so test cord blood for TSH-receptor antibodies as soon as possible.

3. Measurement of cord fT4 and TSH levels is not indicated.

4. Evaluate fT4 and TSH levels at day 3 to 5, repeat at day 10 to 14, and follow clinically until 2 to 3 months.

5. The testing schedule is the same for neonates born to mother with treated or untreated Graves’ disease.

6. Methimazole (MMI) is the treatment of choice when warranted. Beta blockers can be added for sympathetic hyperactivity. Patients with refractory symptoms can also be given potassium iodide along with MMI. It is not clear whether asymptomatic infants with biochemical hyperthyroidism should be treated. It is not known whether asymptomatic infants with biochemical hyperthyroidism need to be treated.

7. Until they are stable, assess the MMI-treated newborn weekly and then every one to two weeks, with a decrease of medications as tolerated. The length of MMI treatment is generally one to two months.

8. Be mindful that central or primary hypothyroidism can develop in these newborns.