Neonatal Graves' Disease (Hyperthyroidism)

Graves' disease is an autoimmune disease. The immune system normally protects the body from germs with chemicals called antibodies. But with an autoimmune disease, the immune system sees the body's normal tissue as strange and then attacks it. With Graves' disease, antibodies cause the thyroid gland to make too much thyroid hormone. This is known as hyperthyroidism. Extra thyroid hormone in the bloodstream leads to the body's metabolism being too active. It can cause problems such as low weight, fast heartbeat, high blood pressure and heart failure.

Graves' disease occurs more often in children than in newborns. But it can also occur in newborn babies. If not diagnosed shortly after birth, Graves' disease can be fatal to a newborn baby.

Graves' disease in a newborn most often occurs when the mother has or had Graves' disease. The mother’s antibodies can cross the placenta and affect the thyroid gland in the growing baby. Graves' disease in a pregnant woman can result in stillbirth, miscarriage or preterm birth.

The biggest risk factor for Graves' disease in a newborn is when the mother has or had Graves' disease. But not all newborns born to mothers with Graves' disease will have the disorder.

 Signs can occur a bit differently in each baby. They can include:

• Low birth weight
• Small or abnormally shaped head
• Poor weight gain (failure to thrive)
• Enlarged liver and spleen
• Swelling of the front of the neck due to large thyroid (goiter)
• Fast heartbeat, which can lead to heart failure
• Warm, moist skin
• High blood pressure
• Nervousness
• Irritability
• Trouble sleeping
• Bulging eyes
• Vomiting
• Diarrhea
• Trouble breathing if a goiter is pressing on the windpipe

The signs of Graves' disease can be like other health conditions. Make sure your baby sees their healthcare provider for a diagnosis.

If not diagnosed shortly after birth, Graves' disease can be fatal to a newborn baby. The healthcare provider will ask about your baby’s signs and health history. They may also ask about the birth mother’s health history and do a physical exam. Your baby will likely also have a blood test to check the level of thyroid hormones, the level of autoantibodies and the level of a pituitary hormone called thyroid stimulating hormone. This hormone normally stimulates the thyroid.

With treatment right away, babies usually recover fully within a few weeks. But Graves' disease may recur during the first 6 months to the first year of life. The goal of treatment is to restore the thyroid gland to normal function so that it makes normal levels of thyroid hormone.

Treatment may include:

• Medicine that blocks the production of thyroid hormones and treats rapid heart rate
• Treatment for heart failure

Untreated Graves' disease in a newborn can be fatal. It can also cause:

• Early closing of bones in the skull
• Intellectual disability
• Hyperactivity
• Fast growth that slows and then stops early, leading to short height

There is no known way to prevent the disorder. Even women who are cured of Graves' disease by ablation of the thyroid gland are still at risk for babies with neonatal Graves' disease.

A pregnant woman who had or has Graves' disease needs to tell her healthcare provider as soon as she knows she is pregnant. This is so her baby can be checked at birth and treated right away if needed. With treatment right away, babies usually recover fully within a few weeks. But Graves' disease may recur during the first 6 months to the first year of life. It’s important to continually watch your baby for signs of Graves' disease.

Call your baby’s healthcare provider if you think your baby has signs of Graves' disease.