Published online January 3, 2005
PEDIATRICS Vol. 115 No. 1 January 2005, pp. e105-e108 (doi:10.1542/peds.2004-0554)
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ELECTRONIC ARTICLE

Neonatal Thyrotoxicosis and Persistent Pulmonary Hypertension Necessitating Extracorporeal Life Support

Jon Oden, MD* and Ira M. Cheifetz, MD, FCCM{ddagger}

* Pediatric Endocrinology and Diabetes
{ddagger} Pediatric Critical Care Medicine, Duke Children's Hospital, Durham, North Carolina

We report a case of neonatal Graves' disease involving an infant with severe persistent pulmonary hypertension (PPHN) associated with neonatal thyrotoxicosis that necessitated extracorporeal membrane oxygenation. Hyperthyroidism, although uncommon in the newborn period, has been associated with pulmonary hypertension among adults. The exact mechanisms responsible for this effect on pulmonary vascular pressure are not well understood. Recent studies have provided evidence that thyrotoxicosis has direct and indirect effects on pulmonary vascular maturation, metabolism of endogenous pulmonary vasodilators, oxygen economy, vascular smooth muscle reactivity, and surfactant production, all of which may contribute to the pathophysiologic development of PPHN. Therefore, because PPHN is a significant clinical entity among term newborns and the symptoms of hyperthyroidism may be confused initially with those of other underlying disorders associated with PPHN (eg, sepsis), it would be prudent to perform screening for hyperthyroidism among affected newborns.

Key Words: Graves' disease • persistent pulmonary hypertension of the newborn • extracorporeal life support • extracorporeal membrane oxygenation • shock • respiratory failure • neonate • hypoxia • hypotension • tachycardia • oxygen delivery • thyrotoxicosis • thyroid • hyperthyroidism

Abbreviations: PPHN, persistent pulmonary hypertension • PVR, pulmonary vascular resistance • ECMO, extracorporeal membrane oxygenation • NO, nitric oxide • NOS, nitric oxide synthase • TTF-1, thyroid transcription factor-1 • ADMA, asymmetric NG,NG-dimethyl-L-arginine

Accepted Aug 16, 2004.