Concurrence of Persistent Pulmonary Hypertension of the Newborn Myocardial Ischemia Supraventricular Tachycardia and Congestive Heart Failure as a Harbinger of Neonatal Graves’ Disease

摘要

Neonatal Graves’ disease (NGD) is a rare disease affecting approximately 1 of 50,000 neonates, and most commonly caused by transplacental passage of thyroid stimulating immunoglobulin (TSI) from the mother to the fetus. A diagnosis of Graves’ disease (GD) can usually be made by characteristic clinical manifestations of hyperthyroidism. However, a constellation of persistent pulmonary hypertension of the newborn (PPHN), myocardial ischemia (MI) without coronary artery disease, supraventricular tachycardia (SVT), and congestive heart failure (CHF) has never been reported simultaneously in NGD in the English literature. We reported here a 12-day-old baby boy, born of a 34-year-old mother with unquenched or refractory hyperthyroidism incriminating GD, presenting postnatally with tachycardia, tachypnea, and systemic hypertension due to a flagrant constellation of PPHN, MI, SVT, and CHF. To our knowledge, such a scenario has never been reported as a harbinger of NGD in the English literature. We highlight that early diagnosis of NGD can be achieved by clinical manifestations of tachycardia, tachypnea, and systemic hypertension, laboratory data of hyperthyroidism, a maternal history of unquenched or refractory hyperthyroidism of GD, and elevations of TSI in the mother and the baby. The pathogenesis of PPHN, MI, SVT, and CHF in NGD will be briefly discussed.