日本新生児成育医学会雑誌　第33巻　第1号　97 ～ 102頁（2021年）

日本新生児成育医学会雑誌　33(1)：97-102；2021　

受付日：2020．07．10

受理日：2020．10．19

新生児遷延性肺高血圧症を呈した新生児甲状腺機能亢進症の1 例

Neonatal Hyperthyroidism Presenting as Persistent Pulmonary Hypertension of the Newborn

りんくう総合医療センター　小児科

Pediatrics, Rinku General Medical Center

山野由貴・和田芳郎・上山敦子・山本昌周・住田　裕

Yuki YAMANO，Yoshiro WADA，Atsuko UEYAMA，Masahiro YAMAMOTO，Yutaka SUMIDA

Key Words：neonatal hyperthyroidism，pulmonary hypertension

　在胎34 週3 日，出生体重2,100g の男児。母体は過去に甲状腺機能亢進症のため，同亜全摘術を受けていた。FT3， FT4 値は正常化したが，TSH 刺激性レセプター抗体は著明な高値で経過していた。児は，出生後，呻吟，多呼吸を呈し，低酸素血症を認めNICU に入院した。経皮酸素飽和度にてpre，post ductal で差を認め，心臓超音波検査で動脈管と卵円孔レベルで右左短絡血流を認めた。血液検査にて，TSH 0.01μIU/mL 未満，FT3 8.5pg/mL，FT4 6.4 ng/dL，TSAb 3,081％であり，甲状腺機能亢進症に伴う新生児遷延性肺高血圧症と診断し，人工呼吸管理，NO 吸入療法，抗甲状腺薬で治療し軽快した。
　甲状腺機能亢進症母体から出生した児は，新生児遷延性肺高血圧症を発症しうることを認識し診療にあたる必要がある。

A newborn male with a gestational age of 34 weeks was admitted to the neonatal intensive care unit for respiratory distress. The mother had a medical history of hyperthyroidism, which was treated by subtotal thyroidectomy because medical treatment was not indicated due to her susceptibility to allergic reactions. The thyroid function of the mother was preserved during her pregnancy, but her thyroid-stimulating antibody levels were high. Blood sample from the newborn was taken and thyroid function tests results indicated severe neonatal hyperthyroidism and hypoxemia. The diagnosis of persistent pulmonary hypertension of the newborn （PPHN） was confirmed by echocardiography. Inotropic supports to stabilize circulation, mechanical ventilation with nitric oxide, and administration of thiamazole with potassium iodide for the treatment of neonatal hyperthyroidism were initiated. The pulmonary hypertension gradually improved, and finally resolved at day 3 after birth. PPHN was attributed to neonatal hyperthyroidism because there were no other risk factors（ e.g., meconium aspiration syndrome, asphyxia） present. Although the control of thyroid function during the course of pregnancy was difficult to achieve for the newborn, all medications were stopped until 7 months postconception. Neurodevelopment and thyroid function were normal at 18 months. It is important to note that the newborns with maternal hyperthyroidism have a risk of developing PPHN.