Endocrine Abstracts

Introduction: Maternal thyroid disorders influence neonatal thyroid status. Neonatal thyrotoxicosis (NT) is a potentially fatal condition with high risk in those with clinical signs, high or unknown maternal thyroid receptor antibody (TRAb) status and where mother is clinically hyperthyroid or on treatment. The aim of post-natal management of these babies is to identify those at risk of NT and monitor them. There is, however, no available national or international consensus.

Aim: To evaluate local practice in order to develop local guideline to aid the management of these infants.

Method: This is a retrospective analysis of case notes and investigations of infants born to mothers with thyroid problems during a one-year period between 1/4/2017 to 30/3/2018. The following criteria were assessed – mother’s thyroid disorder, cause of maternal hypothyroidism, maternal treatment, biochemical and clinical status, neonatal clinical review, timing of neonatal bloods, results and if treatment was started.

Result: There were 49 neonates born to 48 mothers with thyroid disorders (one set of twins). 38 women had hypothyroidism out of which 5 were post treatment for Grave’s disease and 9 women were hyperthyroid. 14 neonates in total were at risk of NT with 11 being at high risk. Among these, maternal thyroid disorder details were recorded in 2 notes, none of the neonatal notes had maternal TRAb status documentation. Only one neonate had a clinical review. 3 infants had thyroid function tests, all performed after day of life 5 with no abnormal results and no infant required treatment. The audit showed that majority of babies at risk of NT were not recognized.

Conclusion: This audit served to highlight the importance of identifying neonates at risk of NT and to ensure appropriate monitoring and follow up of these infants. It highlighted the need to develop local guidelines which we have since completed.