Seguimiento del hijo de madre con patología tiroidea autoinmune. ¿Qué no debemos cribar? / Follow-up of infants born to mothers with autoinmune thyroid disease. What should not be screened?

Introducción: La patología tiroidea es un problema frecuente en las mujeres embarazadas. Su etiología suele ser autoinmune siendo la tiroiditis de Hashimoto y la enfermedad de Graves las entidades principales. A pesar de las posibles alteraciones hormonales y del paso transplacentario de anticuerpos estimulantes, la realización de un cribado neonatal específico no ha demostrado su utilidad en el neonato. Pacientes y métodos: Estudio prospectivo (noviembre de 2013-diciembre de 2016) de los hijos de madre con patología tiroidea autoinmune nacidos en un hospital universitario nivel III. Los recién nacidos se seleccionaron en maternidad. Se excluyeron los casos de asfixia perinatal. Los datos se recogieron de las historias clínicas de madres y recién nacidos. Resultados: Se incluyeron 191 recién nacidos. El 90% de las madres estaban diagnosticadas de hipotiroidismo autoinmune, de cuyos hijos solo un 5,8% tuvo alguna alteración analítica tratándose de leves ascensos de tirotropina, con normalización al mes de vida, no correlacionándose con los niveles de anti-TPO. Se diagnosticó una hipertirotropinemia transitoria que precisó tratamiento durante el primer año de vida. El 36,8% de los hijos de madre con Graves tuvo algún control analítico alterado en los primeros 7 días de vida, no diagnosticándose ningún caso de hipertiroidismo y solo una hipertirotropinemia transitoria. Conclusiones: La experiencia de nuestro centro en el manejo del cribado neonatal tiroideo muestra un elevado número de controles analíticos con un escaso rendimiento diagnóstico. No encontramos relación entre niveles de anticuerpos anti-TPO y disfunción tiroidea. Apoyamos las recomendaciones de mantener el cribado neonatal universal como única exploración en los hijos de madre hipotiroidea

Introduction: Thyroid dysfunction is a common problem in pregnant women. It is usually of an autoimmune origin, with Hashimotós thyroiditis and Graveś disease being the most common conditions. Although hormonal changes and transplacental antibody transfer may occur, specific neonatal screening has not been shown to be useful. Patients and method: A prospective study of newborns of women with autoimmune thyroid disease born at a level III university hospital (November 2013-December 2016). Neonates were selected during their stay at the maternity. Babies with perinatal asphyxia were excluded. Data were collected from the clinical histories of mothers and newborns. Results: A total of 191 neonates were included. Ninety percent of mothers had been diagnosed with autoimmune hypothyroidism. Only 5.8% of newborns had some laboratory disorder, consisting of slightly increased thyroid-stimulating hormone levels, which returned to normal at the age of one month and did not correlate to thyroid peroxidase antibody levels. Transient hyperthyrotropinemia was diagnosed in one newborn and required thyroxin treatment during the first year of life. Among newborns from mothers with Graveś disease, 36.8% had some abnormal laboratory value during the first 7 days of life, but there were no cases of hyperthyroidism and only one of transient hyperthyrotropinemia. Conclusions: Experience at our hospital in screening of newborns from hypothyroid mothers reveals a high number of laboratory controls with a poor diagnostic yield. No relationship was found between thyroid peroxidase antibody levels and thyroid dysfunction. We support the recommendations to continue testing serum thyroid-stimulating hormone and FT4 levels at 48h of life in newborns of mothers with autoimmune hypothyroidism

Follow-up of infants born to mothers with autoinmune thyroid disease. What should not be screened? / Seguimiento del hijo de madre con patología tiroidea autoinmune. ¿Qué no debemos cribar?

INTRODUCTION: Thyroid dysfunction is a common problem in pregnant women. It is usually of an autoimmune origin, with Hashimotós thyroiditis and Graves disease being the most common conditions. Although hormonal changes and transplacental antibody transfer may occur, specific neonatal screening has not been shown to be useful. PATIENTS AND METHOD: A prospective study of newborns of women with autoimmune thyroid disease born at a level III university hospital (November 2013-December 2016). Neonates were selected during their stay at the maternity. Babies with perinatal asphyxia were excluded. Data were collected from the clinical histories of mothers and newborns. RESULTS: A total of 191 neonates were included. Ninety percent of mothers had been diagnosed with autoimmune hypothyroidism. Only 5.8% of newborns had some laboratory disorder, consisting of slightly increased thyroid-stimulating hormone levels, which returned to normal at the age of one month and did not correlate to thyroid peroxidase antibody levels. Transient hyperthyrotropinemia was diagnosed in one newborn and required thyroxin treatment during the first year of life. Among newborns from mothers with Graves disease, 36.8% had some abnormal laboratory value during the first 7 days of life, but there were no cases of hyperthyroidism and only one of transient hyperthyrotropinemia. CONCLUSIONS: Experience at our hospital in screening of newborns from hypothyroid mothers reveals a high number of laboratory controls with a poor diagnostic yield. No relationship was found between thyroid peroxidase antibody levels and thyroid dysfunction. We support the recommendations to continue testing serum thyroid-stimulating hormone and FT4 levels at 48h of life in newborns of mothers with autoimmune hypothyroidism.

Afectación multiorgánica en paciente con tiroiditis crónica autoinmune / Multiorgan involvement in patients with chronic autoimmune thyroiditis

El hipotiroidismo afecta a alrededor del 4,6% de la población (manifiesto un 0,3% y subclínico un 4,3%). La tiroiditis crónica autoinmune (TCAI) es la forma de tiroiditis y de enfermedad autoinmune órgano-específica más frecuente siendo la causa más común de bocio e hipotiroidismo en los países con suficientes aportes de yodo en la alimentación. Es conocido el papel de las hormonas tiroideas en múltiples órganos y sistemas si bien muchos casos de hipotiroidismo cursan de forma asintomática. Generalmente los síntomas por los que los pacientes consultan son bocio, hipocrecimiento y obesidad. Presentamos el caso de una adolescente de trece años con hipotiroidismo franco de origen autoinmune con grave afectación multiorgánica a destacar insuficiencia renal, anemia con acantocitosis y miocardiopatía con hipertrofia septal asimétrica; forma poco frecuente de presentación al diagnóstico de las TCAI en el momento actual. Dichas alteraciones son reversibles, normalizándose los parámetros de las distintas pruebas complementarias con el tratamiento sustitutivo

Hypothyroidism occurs in about 4.6% of people (0,3% of them suffer symptoms and 4,3% suffer subclinical hypothyroidism). Chronic autoimmune thyroiditis is the most common type of thyroiditis and organ-specific autoimmune disease, and it´s the most common cause of goiter and hypothyroidism in countries with enough iodine contribution on feed. The role of thyroid hormones is known in multiple organ systems, although many cases of hypothyroidism are asymptomatic. Usually patients consult for goiter, short stature and obesity. We report a 13-years-old teenager case who is a chronic autoinmune hypothiroidism affected, with a several multiorganic disease, including renal failure, anemia, acanthocytosis, and asymmetric septal hypertrophy cardiomyopathy; an unusual presentation to diagnose the chronic autoinmune thyroiditis nowadays. Every alteration is reversible and returns to the normal state with hormone replacement therapy

Pubarquia prematura y masa suprarrenal / Premature pubarche associated with adrenal mass

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