Clinical features of neonatal Graves’ disease revealed by twelve cases that require- antithyroid therapy

Neonatal Graves' disease (GD) is rare and serious condition with a complicated clinical course, its details of the clinical features have not been clarified. This study aimed to clarify the clinical course of neonatal GD cases requiring anti-thyroid treatment. We retrospectively analyzed records from 12 neonates (7 males) diagnosed with GD from 2012 to 2021. All neonates had maternal histories of GD, with significantly elevated TRAb levels (≥ 19 IU/L) observed during the second or third trimester of pregnancy. At birth, TRAb levels were elevated in all neonates (≥ 17.4 IU/L). Thiamazole (MMI) was given to 11 neonates, with additional potassium iodide (KI) and/or β-blockers in 10 cases; one received only KI and a β-blocker. Notably, maternal TRAb levels during late pregnancy were significantly correlated with neonatal TRAb levels at birth (R² = 0.8454, p = 0.027), and neonatal TRAb levels at birth were significantly associated with the duration of MMI treatment (R² = 0.750, p = 0.002). Secondary central hypothyroidism was observed in 33% of cases (4/12), with unmeasurably low TSH levels at birth (< 0.01 μIU/mL) as a significant risk factor for its development (p < 0.03). These findings suggest that maternal TRAb levels significantly influence neonatal TRAb levels at birth, and neonatal TRAb levels may predict the duration of anti-thyroidal treatment.