Endocrine Abstracts

Introduction: Infants born to mothers with a history of thyroid disease may be at risk of developing neonatal thyrotoxicosis. Although rare, affecting approximately 1% of infants, maternal thyroid disease can have serious consequences including intrauterine death or neonatal death. Maternal Grave’s disease poses significant risk due to trans-placental passage of TRAB.

Methods: Mothers with thyroid disease and their subsequent infants were audited retrospectively against local guidance between 1 March 2014 – 1 March 2015. In addition, maternal thyroid antibody status was also collated in order to determine the extent current testing.

Results: The exact aetiology of maternal thyroid disease was only documented on 16% of neonatal alert forms and 79% of infants notes. There was no evidence that any infants were affected with symptomatic thyroid disease during this audit period. Three asymptomatic infants, however, had abnormal TFTs on day 6. TRAB were only tested in 61% of hyperthyroid mothers and only 70% of those with Graves disease were tested. 0% of these had their TRAB documented on the neonatal alert form or infants notes.

Discussion/conclusion: This audit highlights the importance of accurate identification of maternal thyroid aetiology on the neonatal alert form and newborn review in order to identify and manage risk, especially to infants of mothers with secondary hypothyroidism. Therefore pre-alert of all mothers with thyroid disease is currently deemed necessary. The introduction of TRAB testing for all hyperthyroid mothers (present or current) would greater identify infants at risk and remove the need to identify mothers with primary hypothyroidism to the neonatal team.