A newborn child born with an 18-year-old mother who had suffered a vaginal delivery and amniotic fluid with meconium for 36 weeks, with irregular prenatal care.
A total of 1240 g (< p 3) weighed 41 cm (< p 3) at birth, with Apgar scores of 7 and 9.
She presented early respiratory distress requiring ventilatory support and pulmonary surfactant, with adequate response.
Extubation was achieved with CPAP, but she presented tachycardia and persistent tachypnea, so an echocardiogram was performed suggestive of aortic coarctation and was referred to a more complex center at 13 days of life.
Upon admission to the institution, blood pressure was taken in four limbs: right and left upper limbs 88/49 mean arterial pressure (MAP) 62 and 90/52 MAP 63, right and left lower limbs 86/44 distal heart rate increased systolic MAP 61
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Echocardiogram ruled out aortic coarctation, but showed myocardial dysfunction requiring inotropic support.
Transfontanellar and abdominal ultrasound were normal.
Initial laboratory tests showed liver function abnormalities, bilirubin 6.8 mg% (direct 5.3 mg%).
Upon evaluating the mother, a phenotype suggestive of hyperthyroidism was observed, with marked thinness and exophthalmos, so untreated thyroid disease was diagnosed.
Due to suspicion of neonatal hyperthyroidism, a thyroid profile was performed, which showed TSH 0.01 uUI/ml and TT4 7.7 (reference values 0.71-1.85 ng/dl).
Antimicrosomal antibodies were also performed, which were negative, but no thyrotropin receptor stimulating antibodies (TRAab) could be performed.
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When the patient was reassessed, diffuse goiter was observed and confirmed with ultrasound.
Methimazole 1 mg/kg/day was started divided into 3 doses, prophylactic treatment at a dose of 1 mg/kg/day in 2 doses, achieving improvement in tachycardia.
However, little weight gain was observed in the first days of management, a situation reversed after one week of treatment.
Oxygen withdrawal, resolution of hepatomegaly was achieved and after 1 week of treatment the T4 return decreased to 3.1 mg/dl, persisting with suppression of TSH to the moment of its pharmacological
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At week 13, thyroid function tests were normalized and antithyroid medication was withdrawn.
During follow-up, the infant was euthyroid, without cardiovascular or neurodevelopmental alterations.
The mother was referred to endocrinology for management and counseling for future pregnancies.
