Súlyos keringési elégtelenséggel járó neonatalis hyperthyreosis = Severe circulatory insufficiency in a patient with neonatal hyperthyroidism

A szerzők egy Basedow–Graves-kor miatt korabban thyreoidectomian atesett, kezeletlen anya koraszulottjenek esetet ismertetik. Gondozatlan terhessegből magzati tachycardia, fenyegető intrauterin asphyxia miatt surgős csaszarmetszessel szuletett a 33. hetnek megfelelő erettsegű, 1350 gramm sulyu, dysmaturus (testsulypercentil 180/perc), cardialis decompensatio miatt beta-blokkolo, digoxin- es dobutaminterapiat igenyelt. Kivizsgalasa soran cardiomegalia, pericardialis folyadekgyulem, sulyos tudőhypoplasia, mitralis es tricuspidalis insufficientia, hepatosplenomegalia igazolodott. A pajzsmirigy-szabadhormonok szintje tobbszorosen meghaladta a referenciaerteket (fT4: > 6 ng/dl, fT3: > 30 pg/ml), a TSH-szint ugyanakkor 0 volt. Legzestamogatast 7, keringestamogatast 10 napig igenyelt, propranolol- mellett K-jodid-kezelesben reszesult. Tachycardiaja merseklődott, a beta-blokkolo kezelest csokkentett adagban kapta tovabb, pajzsmirigyhormonszintjei fokozatosan a normalis tartomanyba kerultek. A szerzők felhivjak a figyelmet arra, hogy a Basedow–Graves-korban szenvedő anya ujszulottjenel jelentős sulybeli, novekedesbeli elmaradas, sulyos keringesi elegtelenseg, thyreotoxicosis tunetei alakulhatnak ki, es hangsulyozzak az anyai hormon-, valamint antitestszintek nyomon kovetesenek jelentőseget. | Authors describe a case of a premature infant whose mother had a history of thyroidectomy due to Graves’ disease and her hormonal status was not controlled during pregnancy. She did not receive prenatal care and on 33rd week the premature infant was delivered by emergency cesarean section because of fetal tachycardia and imminent intrauterine asphyxia. The infant with a weight of 1350 gram (percentile 180/min) and cardiac decompensation. Further examinations proved cardiomegaly, pericardial fluid, severe pulmonary hypoplasia, mitral- and tricuspid insufficiency and hepatosplenomegaly. The level of free thyroid hormones was several times higher than normal (fT4: > 6 ng/dl, fT3 > 30 pg/ml), while TSH level was 0. Respiratory support was required for 7 days, inotropic support for 10 days; at the same time propranolol and K-iodide were administered. Eventually, the tachycardia settled and beta-blocker therapy was continued with reduced doses. Finally, the thyroid hormone levels became normal. Authors emphasize that newborns of women suffering from Graves’ disease can significantly lag behind in weight increase, may have severe circulatory insufficiency and symptoms of thyrotoxicosis. We also emphasize the importance of the monitoring maternal hormone levels and antibody titers.