Vol. 10, No 1, 2003 pp. 52 - 56
UC 616.441-008.64   616.441-008.61 
LATE ONSET TRANSIENT THYROID DYSFUNCTION
IN CHILDREN BORN TO MOTHERS
WITH AUTOIMMUNE THYROID DISEASE
Ljiljana Šaranac, Mirjana Miljković, Hristina Stamenković,
Radmila Mileusnić-Milenović, Goran Petrović, Borislav Kamenov
Pediatric Clinic, University Clinical Centre, Niš, Serbia
Summary. We report two rare cases of autoimmune dysthyroidism in children born to mothers with autoimmune thyroid disease. The first female baby was admitted with the clinical signs of overt hyperthyroidism that occur on 25th day of life: irritability, incessant crying, hyperreflection, dysphonia, tachycardia, tachypnoe, poor weight gain and ocular signs, including stare, eyelid retraction and even proptosis. The mother suffered from Chronic Autoimmune Thyroiditis (CAT) and received Na-l-thyroxine during pregnancy. Her hormonal status was normal, as well as that of her newborn. Determination of hormones using fluoroimmunometric assay (Delfia kits) revealed a high level of free T4 on 40th day of life. A small and soft goiter was found and the ultrasound examination showed a slightly enlarged thyroid with hypoechogeneity of the structure. A short course of propylthiouracil, corticotherapy and propranolol administration proved effective.
The second baby, also euthyroid at birth, was born to a hyperthyroid mother and examined at 2.5 months of age because of feeding difficulties. The baby presented "mixed dysthyroidism": retardation of growth, the length <P5 and weight +400 g over ideal, dysphonia, low position of umbilicus, as well as hyper-reflection, irritability and stare. Hormonal determination showed subclinical hypothyroidism. A five-month Na-l-thyroxin substitution therapy eliminated the clinical signs of dysfunction and improved growth to P50.
Transient thyroid dysfunction of the type opposite to maternal thyroid disease was in both cases caused by transplacental passage of TSH receptor antibodies with polyclonal activity and different half-life. These transient forms should be early diagnosed, treated and distinguished from persistent thyroid disease.
Key words:  Transient hyperthyroidism, transient hypothyroidism
KASNA FORMA TRANZITORNE TIROIDNE DISFUNKCIJE
U DECE MAJKI SA AUTOIMUNSKOM TIROIDNOM BOLEŠĆU
Kratak sadržaj: Prikazana su dva retka slučaja autoimunskog distiroidizma u dece majki sa autoimunskom tiroidnom bolešću (AITB). U prvom slučaju radilo se o ženskom novorodjenčetu koje je primljeno sa znacima jasnog hipertiroidizma koji se javljaju 25. dana života: razdražljivost, neprekidan plač, hiperrefleksija, dysphonia, tahikardija, tahipneja, loše napredovanje u težini i očni znaci - razrogačen pogled, retrakcija kapaka i čak proptoza. Majka je bolovala od hroničnog atoimunskog tiroiditisa (HAT) i dobijala Na-l-tiroksin u toku trudnoće. Njen hormonski status bio je normalan kao i status njenog novorodjenčeta. Odredjivanje hormona fluoroimunometrijskom metodom, upotrebom Delfia kitova pokazalo je visoke vrednosti slobodnog T4 u 40. danu života. Pronadjena je mala, mekana struma a ultrazvučno ispitivanje je pokazalo blago uvećanu štitnjacu hipoehogene strukture. Kratkotrajno lečenje propiltiouracilom, kortikoidima i propranololom bilo je efikasno.
Drugo odojče bilo je dete hipertiroidne majke i takodje eutiroidno na rodjenju. Ispitivano je u 2,5 mes uzrasta zbog teškoća u ishrani i imalo je "mešoviti distiroidizam"; retardaciju rasta, dužinu <P5, i + od 400 g u odnosu na idealnu telesnu masu, dysphoniu, nisko postavljen umbilicus, ali takodje i hiperrefleksiju, razdražljivost i razrogačen pogled. Odredjivanje hormona pokazalo je subklinički hipotiroidizam. Supstitucija Na-l-tiroksinom eliminisala je kliničke znake disfunkcije, pospešila rast do P50, a bila je neophodna 5 meseci.
Tranzitorna tiroidna disfunkcija suprotnog tipa od maternalne u oba slučaja izazvana je transplacentarnom pasažom TSH receptornih antitela poliklonalne aktivnosti i različitog poluživota. Ove tranzitorne forme treba da budu rano dijagnostikovane, lečene i razlikovane od perzistentne tiroidne bolesti.
Ključne reči: Prolazni hipertiroidizam, prolazni hipotiroidizam