Neonatology: neonatal Graves disease: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Neonatology: neonatal Graves disease

Sample item

On day 3 a newborn is irritable and tachycardic with a small goitre and a poor weight gain despite good feeding. His mother had thyroidectomy for Graves disease 5 years ago and takes thyroxine. What is the mechanism of his illness?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Transplacental thyroid-stimulating antibodies from the mother

Maternal TSH receptor stimulating antibodies persist after thyroidectomy and cross the placenta, producing transient neonatal thyrotoxicosis that lasts weeks to a few months until the antibodies clear. The mother can be euthyroid on thyroxine yet still carry the antibody. Treatment is propranolol with an antithyroid drug in significant disease.

Option by option

  • A. Transplacental thyroid-stimulating antibodies from the mother (correct)

    Correct. Stimulating TSH receptor IgG crosses the placenta and persists after surgery.

  • B. Fetal thyroid adenoma

    A fetal thyroid adenoma is extremely rare and would not clear with time.

  • C. Excess maternal iodide blocking fetal thyroid hormone release

    Iodide excess suppresses thyroid hormone release and would cause hypothyroidism.

  • D. Autonomous hyperfunction of the fetal pituitary

    Pituitary hyperfunction is not the mechanism of neonatal thyrotoxicosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, Transplacental thyroid-stimulating antibodies from the mother. Maternal TSH receptor stimulating antibodies persist after thyroidectomy and cross the placenta, producing transient neonatal thyrotoxicosis that lasts weeks to a few months until the antibodies clear.

Why is "Fetal thyroid adenoma" not the answer?

A fetal thyroid adenoma is extremely rare and would not clear with time.

Why is "Excess maternal iodide blocking fetal thyroid hormone release" not the answer?

Iodide excess suppresses thyroid hormone release and would cause hypothyroidism.

Why is "Autonomous hyperfunction of the fetal pituitary" not the answer?

Pituitary hyperfunction is not the mechanism of neonatal thyrotoxicosis.

What concept does this question test?

It tests Neonatology: neonatal Graves disease in Pediatrics. The mother can be euthyroid on thyroxine yet still carry the antibody. Treatment is propranolol with an antithyroid drug in significant disease.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neonatology: neonatal Graves disease?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.