Endocrine Abstracts

Neonatal thyrotoxicosis (NT) is a rare condition caused by the transplacental passage of maternal thyroid-stimulating antibodies from mothers with active Graves’ disease or a past history of the condition. We suspected that there were wide differences in the way that babies at risk of NT were managed in our locality and undertook a survey to establish the local approach to this clinical problem.

Method: The lead clinician who was considered most likely to be involved in managing infants at risk of NT at each of nine local units was identified and sent an electronic survey that posed questions about how at risk babies should be managed.

Results: A total of eight responses to the survey were received. Most respondents to the survey were general paediatricians with a specialist interest in endocrinology (4/8), with 3/8 being neonatologists and the other respondent being a paediatric endocrinologist from the regional tertiary centre. The majority (87.5%) of respondents used a written policy based on published expert opinion for the management of infants at risk of NT. The variation in notification strategies for at risk infants, follow up pathways and treatment plans was extensive with some units opting for close surveillance of all at-risk infants with at least two clinical assessments and thyroid function tests and others discharging the clinically well baby with no formal follow up. There was no clear management plan in terms of intervention criteria and choice of treatment.

Discussion: This survey identified a wide variation in follow up and treatment approaches to babies thought to be at risk of NT within one region of England. There is a need for further studies and then the development of an evidence based guideline that can provide a framework for clinicians faced with this potentially challenging clinical problem.