A 12-day-old infant born at term is irritable, feeds excessively, sweats, and has tachycardia of 190/min with wide pulse pressure. The mother has a history of treated Graves disease. TSH is undetectable and free T4 is markedly elevated. What is the most appropriate immediate treatment?
- A Carbimazole alone
- B Propranolol along with an antithyroid drug ✓
- C Radioiodine ablation
- D Levothyroxine replacement
Correct answer: B. Propranolol along with an antithyroid drug
Explanation
Neonatal Graves disease results from transplacental transfer of maternal TSH receptor stimulating immunoglobulins. Beta blockade with propranolol controls the life-threatening sympathetic features such as tachycardia and heart failure, while an antithyroid drug like carbimazole or methimazole reduces hormone synthesis. Radioiodine is contraindicated in infancy, and levothyroxine would worsen thyrotoxicosis. The condition is self-limiting as maternal antibodies decay over 3 to 12 weeks.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.