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Neonatal TRAb at birth was associated with the duration of thiamazole treatment, while unmeasurably low TSH at birth increased secondary central hypothyroidism 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\nClinical features of neonatal Graves’ disease revealed by twelve cases that require-antithyroid therapy  \nEriko Adachi1 , Ryosei Iemura2 , Yumi Tanaka3 , Hisae Nakatani1, 4 , Ryuichi Nakagawa4 , Yuichi Miyakawa2 , Akito Sutani2 , Kei Takasawa1 , Makoto Ono5 , Takeru Yamauchi3 , Manabu Sugie1, 3 , Yoshihiro Minosaki2 , Tomohiro Morio1 , Kenichi Kashimada1, 6  \n1Department of Pediatrics and Developmental Biology, Institute of Science Tokyo, Tokyo, Japan  \n2Department of Neonatal Medicine, Kawaguchi Municipal Medical Center, Kawaguchi, Japan  \n3Department of Neonatology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan  \n4Department of Pediatrics, Musashino Red Cross Hospital, Tokyo, Japan  \n5Department of Pediatrics, Tokyobay UrayasuIchikawa Medical Center, Urayasu, Japan  \n6Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan  \nHighlight  \n● Maternal TRAb levels were significantly associated with neonatal TRAb levels.  \n● Neonatal TRAb levels at birth serve as a predictor of treatment duration.  \n● Undetectable TSH at birth have a higher risk of secondary central hypothyroidism.  \nAbstract. Neonatal Graves’ disease (GD) is rare and serious condition with a complicated clinical course, its details of the clinical features have not been clarified. This study aimed to clarify the clinical course of neonatal GD cases requiring anti-thyroid treatment. We retrospectively analyzed records from 12 neonates (7 males) diagnosed with GD from 2012 to 2021. All neonates had maternal histories of GD, with significantly elevated TRAb levels (≥ 19 IU/L) observed during the second or third trimester of pregnancy. At birth, TRAb levels were elevated in all neonates (≥ 17.4 IU/L) . Thiamazole (MMI) was given to 11 neonates, with additional potassium iodide (KI) and/or β-blockers in 10 cases; one received only KI and a β-blocker. Notably, maternal TRAb levels during late pregnancy were significantly correlated with neonatal TRAb levels at birth (R2 = 0 .8454, p = 0 .027), and neonatal TRAb levels at birth were significantly associated with the duration of MMI treatment (R2 = 0 . 750, p = 0 .002) . Secondary central hypothyroidism was observed in 33% of cases (4/12), with unmeasurably low TSH levels at birth (\u003C 0.01 μIU/mL) as a significant risk factor for its development (p \u003C 0 .03) . These findings suggest that maternal TRAb levels significantly influence neonatal TRAb levels at birth, and neonatal TRAb levels may predict the duration of anti-thyroidal treatment.  \nKey words: neonatal Graves’ disease, TRAb, hyperthyroidism, secondary central hypothyroidism  \nReceived: November 12, 2024 Accepted: September 16, 2025 Advanced Epub: October 10, 2025  \nCorresponding author: Kenichi Kashimada, M.D., Ph.D., Division of Endocrinology and Metabolism, National Center for  \nChild Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan [E-mail: kashimada-k@ncchd.go.jp](E-mail: kashimada-k@ncchd.go.jp)  \nThis is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial No Derivatives (by-nc-nd) License \u003C[http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)> .  \nCopyright© 2026 by The Japanese Society for Pediatric Endocrinology  \nClin Pediatr Endocrinol 58  \nIntroduction  \nGraves’ disease (GD) is an autoimmune disease characterized by hyperthyroidism caused by thyroidstimulating hormone (TSH) receptor antibodies (TRAb) that belong to the immunoglobulin class G (IgG). As IgG crosses the placenta (1, 2), maternal TRAb can cause overstimulation of the fetal and neonatal thyroid gland, leading to neonatal hyperthyroidism, namely neonatal GD (2–6) . Neonatal GD occurs in approximately 1 to 5 percent of infants born tomothers with GD, and based on the prevalence of GDin pregnant women (7, 8), neonatal GD is expected ","cbCaia3A2ukZn7L8","https://ap.wps.com/l/cbCaia3A2ukZn7L8","pdf",1418381,"English","# Introduction\n## Maternal TRAb transmission and neonatal hyperthyroidism\n## Anti-thyroid drug pharmacokinetics and timing\n## Secondary central hypothyroidism after TRAb disappearance","[{\"question\":\"What was the aim of this study on neonatal Graves’ disease?\",\"answer\":\"To clarify the clinical course and key clinical features of neonatal Graves’ disease cases that required anti-thyroid treatment.\"},{\"question\":\"How were cases selected and what was the study period?\",\"answer\":\"Twelve neonates diagnosed with Graves’ disease were retrospectively analyzed, covering diagnoses from 2012 to 2021.\"},{\"question\":\"Which factors were linked to secondary central hypothyroidism in the cases?\",\"answer\":\"Secondary central hypothyroidism occurred in 33% of cases, and unmeasurably low TSH at birth (\\u003c0.01 μIU/mL) was identified as a significant risk factor.\"}]","Clinical features of neonatal Graves’ disease revealed by twelve cases that require-antithyroid therapy | PDF",1790746794,25]