Neonatal thyrotoxicosis is a rare but potentially life-threatening condition, most commonly caused by transplacental passage of thyroid-stimulating hormone receptor antibodies (TRAb) from mothers affected by Graves’ disease. Early diagnosis is essential to prevent serious cardiovascular, neurological, and developmental complications. Ultrasound imaging, particularly when combined with advanced Doppler techniques, may play a crucial role in both diagnosis and follow-up. We report the case of a full-term male neonate born to a mother with hyperthyroidism treated with propylthiouracil. At 20 days of life, the infant presented with significant weight loss and biochemical evidence of thyrotoxicosis, including suppressed thyroid-stimulating hormone (TSH), elevated TRAb levels, and increased free thyroid hormones. Thyroid ultrasound revealed gland enlargement, heterogeneous echotexture, and marked hypervascularization with a characteristic “thyroid inferno” pattern on color Doppler and Superb Microvascular Imaging (SMI). Treatment with methimazole and propranolol led to rapid clinical and biochemical improvement. Follow-up ultrasound demonstrated normalization of thyroid volume and vascularization. This case highlights the importance of ultrasound, including microvascular imaging techniques, as a first-line diagnostic tool in neonatal thyroid disorders. Early imaging evaluation in at-risk neonates may allow prompt diagnosis and timely management, reducing the risk of severe complications.
Paviglianiti et al. (Mon,) studied this question.