Recommendations for the diagnosis and followup of the foetus and newborn child born to mothers with autoimmune thyroid disease

array:24 ["pii" => "S2341287918301546" "issn" => "23412879" "doi" => "10.1016/j.anpede.2018.08.004" "estado" => "S300" "fechaPublicacion" => "2018-10-01" "aid" => "2498" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2018;89:254.e1-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1632 "formatos" => array:3 [ "EPUB" => 123 "HTML" => 1078 "PDF" => 431 ] ] "itemSiguiente" => array:19 [ "pii" => "S2341287918301558" "issn" => "23412879" "doi" => "10.1016/j.anpede.2018.08.005" "estado" => "S300" "fechaPublicacion" => "2018-10-01" "aid" => "2510" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2018;89:255.e1-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1395 "formatos" => array:3 [ "EPUB" => 122 "HTML" => 558 "PDF" => 715 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Special Article" "titulo" => "Examining hypertension in children and adolescents: Clinical implications of the differences between the European and American Guidelines" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "255.e1" "paginaFinal" => "255.e5" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La hipertensión arterial en niños y adolescentes a examen: implicaciones clínicas de las diferencias entre la Guía Europea y la Americana" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Empar Lurbe i Ferrer" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Empar" "apellidos" => "Lurbe i Ferrer" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301558?idApp=UINPBA00005H" "url" => "/23412879/0000008900000004/v1_201810020628/S2341287918301558/v1_201810020628/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2341287918301467" "issn" => "23412879" "doi" => "10.1016/j.anpede.2017.11.008" "estado" => "S300" "fechaPublicacion" => "2018-10-01" "aid" => "2344" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2018;89:251-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1056 "formatos" => array:3 [ "EPUB" => 120 "HTML" => 648 "PDF" => 288 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Scientific Letter" "titulo" => "Optimisation of measures to protect premature neonates of less than 35 weeks from the cold in the first hour of life" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "251" "paginaFinal" => "253" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Optimización de medidas para evitar el enfriamiento en la primera hora de vida de los prematuros menores de 35 semanas de gestación" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Herranz Barbero, Erika Sánchez Ortiz, Mª Dolors Salvia-Roigés, Rocío Cortés Albuixech, José Manuel Rodríguez-Miguélez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Ana" "apellidos" => "Herranz Barbero" ] 1 => array:2 [ "nombre" => "Erika" "apellidos" => "Sánchez Ortiz" ] 2 => array:2 [ "nombre" => "Mª Dolors" "apellidos" => "Salvia-Roigés" ] 3 => array:2 [ "nombre" => "Rocío" "apellidos" => "Cortés Albuixech" ] 4 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Rodríguez-Miguélez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403317304630" "doi" => "10.1016/j.anpedi.2017.11.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403317304630?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301467?idApp=UINPBA00005H" "url" => "/23412879/0000008900000004/v1_201810020628/S2341287918301467/v1_201810020628/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Spanish Association of Paediatrics" "titulo" => "Recommendations for the diagnosis and followup of the foetus and newborn child born to mothers with autoimmune thyroid disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "254.e1" "paginaFinal" => "254.e7" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Susana Ares Segura, Carmen Temboury Molina, María Jesús Chueca Guindulain, Gema Grau Bolado, María Jesus Alija Merillas, María Caimari Jaume, Paula Casano Sancho, José Carlos Moreno Navarro, José Manuel Rial Rodríguez, Amparo Rodríguez Sánchez" "autores" => array:11 [ 0 => array:4 [ "nombre" => "Susana" "apellidos" => "Ares Segura" "email" => array:1 [ 0 => "susana.ares@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Carmen" "apellidos" => "Temboury Molina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "María Jesús" "apellidos" => "Chueca Guindulain" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Gema" "apellidos" => "Grau Bolado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "María Jesus" "apellidos" => "Alija Merillas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "María" "apellidos" => "Caimari Jaume" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "Paula" "apellidos" => "Casano Sancho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "José Carlos" "apellidos" => "Moreno Navarro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] ] ] 8 => array:3 [ "nombre" => "José Manuel" "apellidos" => "Rial Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "i" "identificador" => "aff0045" ] ] ] 9 => array:3 [ "nombre" => "Amparo" "apellidos" => "Rodríguez Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "j" "identificador" => "aff0050" ] ] ] 10 => array:1 [ "colaborador" => "en representación del Grupo de trabajo de tiroides de la Sociedad Española de Endocrinología Pediátrica" ] ] "afiliaciones" => array:10 [ 0 => array:3 [ "entidad" => "Servicio de Neonatología, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Universitario del Sureste, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Endocrinología Pediátrica, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Endocrinología Infantil, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Universitario de Guadalajara, Guadalajara, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Endocrinología Pediátrica, Hospital Universitario Son Espases, Palma de Mallorca, Baleares, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Sección de Endocrinología Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Institute for Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, La Paz, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Pediatría, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Unidad de Metabolismo y Desarrollo, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "j" "identificador" => "aff0050" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recomendaciones para el diagnóstico y seguimiento del feto y del recién nacido hijo de madre con patología tiroidea autoinmune" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1777 "Ancho" => 1760 "Tamanyo" => 339015 ] ] "descripcion" => array:1 [ "en" => "Approach to the management of an infant born to a mother with GD or hyperthyroidism (current or past). Pregnant mother: measure TRAb levels in the second to third trimester of pregnancy. Inform the neonatologist of results. If TRAb status positive or unknown: high-risk NB. If TRAb status negative: low-risk NB. Newborn (NB): measure TRAb in cord blood (hormone levels not useful) and monitor." ] ] ] "textoCompleto" => "IntroductionIn the last few years, there have been significant advances in our knowledge of thyroid disorders during pregnancy, which have resulted in the recent publication of clinical practice guidelines by the American Thyroid Association (ATA),<a class="elsevierStyleCrossRef" href="#bib0195">1</a> European Thyroid Association (ETA)<a class="elsevierStyleCrossRef" href="#bib0200">2</a> and the Sociedad Española de Endocrinología y Nutrición (Spanish Society of Endocrinology and Nutrition, SEEN).<a class="elsevierStyleCrossRef" href="#bib0205">3</a> Since 2012, the ATA, the ETA and the Working Group on Iodine Deficiency and Thyroid Dysfunction of the SEEN recommend screening for thyroid dysfunction in nearly all pregnant women.<a class="elsevierStyleCrossRefs" href="#bib0195">1–3</a> This recommendation has led to an increase in the detection of thyroid disorders during pregnancy, which in turn has resulted in an increase in the treatment and followup of pregnant women and their newborns.The development of healthy thyroid function in the foetus requires normal embryogenesis, differentiation and maturation of the thyroid gland, and also the integrity of the hypothalamic–pituitary–thyroid axis and the mechanisms that regulate the metabolism of thyroid hormones. The normal unfolding of all these processes depends on multiple foetal and maternal factors, with maternal thyroid function, thyroid autoantibodies and iodine intake playing key roles.During pregnancy, the passage of thyroxine (T4) from the mother to the foetus protects the developing brain. Even in the early stages of pregnancy, T4 can be found in embryonal fluids, and later in pregnancy, when hormone secretion by the foetal thyroid has already started, maternal hormones continue to contribute to neurologic development.<a class="elsevierStyleCrossRefs" href="#bib0210">4–6</a>In areas where severe iodine deficiency is endemic, women may not have sufficient iodine stores and already have hypothyroxinaemia in the critical early stage of foetal neurodevelopment. Women with adequate iodine intake before and during pregnancy have sufficient intrathyroidal iodine stores and can adapt to the increasing requirements of pregnancy without difficulty. Although there is evidence that iodine supplementation may trigger thyroid autoimmunity in a small percentage of women, ensuring adequate iodine intake in pregnant women is a health priority. At present, a daily iodine intake of 250μg is recommended in all pregnant women, excepting those with hyperthyroidism or currently in treatment with levothyroxine.<a class="elsevierStyleCrossRef" href="#bib0225">7</a>When we speak of maternal thyroid autoimmunity, we refer to the detection of thyroid autoantibodies in the pregnant women. In women of childbearing age, the prevalence of anti-thyroid peroxidase antibodies (TPOAb) and/or anti-thyroglobulin antibodies (TgAb) ranges between 8 and 14% depending on the study. Its presence in pregnant women is associated with an increased risk of maternal hypothyroidism during pregnancy.<a class="elsevierStyleCrossRefs" href="#bib0210">4,8–10</a> There are multiple studies in the literature on their presence and analysing the impact on the thyroid function of the foetus and newborn. Both TPOAb and TgAb of the IgG type can freely cross the placental barrier, which explains why more than 95% of newborns of mothers with Hashimoto thyroiditis (HT) have circulating autoantibodies.<a class="elsevierStyleCrossRef" href="#bib0240">10</a>The prevalence of maternal hyperthyroidism due to Graves disease during pregnancy is much lower, ranging between 0.1 and 2.7%. The long-acting thyroid-stimulating hormone (TSH) receptor antibodies (TRAb) that cause this disease freely cross the placenta in the second half of pregnancy and have been shown to cause transient neonatal Graves disease in up to 2–20% of the offspring in cohort studies.Infants born to mothers with HTThe most prevalent thyroid disorder in women of childbearing age is autoimmune thyroiditis due to Hashimoto disease, also known as Hashimoto thyroiditis (prevalence, 2.5%).Impact on the mother and foetusThe presence of TPOAb and/or TgAb during pregnancy is independently associated with fertility problems, recurrent miscarriages, preterm birth and gestational diabetes.<a class="elsevierStyleCrossRefs" href="#bib0245">11–13</a> Some authors have reported an adverse impact on neuropsychological outcomes<a class="elsevierStyleCrossRef" href="#bib0260">14</a> and an increased incidence of hearing loss and attention deficit hyperactivity disorder (ADHD)<a class="elsevierStyleCrossRefs" href="#bib0265">15–20</a> in children born to mothers that test positive for thyroid autoantibodies. These abnormalities could be directly mediated by autoantibodies even in the absence of concomitant maternal hypothyroidism, although the exact pathophysiological mechanism remains unclear.In recent years, there have been initiatives for the establishment of routine screening for thyroid dysfunction and autoimmunity aimed at verifying normal thyroid function from the early stages of gestation. Establishing normal ranges for thyroid function markers during pregnancy poses challenges on account of the numerous adaptive changes that take place in this stage of life. In the first 10 weeks of gestation, TSH levels decrease due to an increase in the levels of β-human chorionic gonadotropin (βhCG) (thyrotropic effect) and placental type 3 deiodinase; later on, as βhCG levels decrease, levels of TSH increase as levels of FT4 decrease.The most recent guidelines recommend early screening of thyroid dysfunction in pregnant women, starting with measurement of TSH levels. Treatment with levothyroxine is indicated when TSH levels are 10mU/L or greater or when TSH levels between 2.5 and 10mU/L are associated with low FT4 levels. The diagnosis of subclinical gestational hypothyroidism should be considered in women with TSH levels above the upper reference limit for the specific trimester of pregnancy. To this end, establishment of population- and trimester-specific reference ranges is recommended, which should be based exclusively on the values found in pregnant women with adequate iodine intake who have tested negative for TPOAb.<a class="elsevierStyleCrossRefs" href="#bib0195">1–4,21,22</a> If reference ranges are not available for the population of interest, it is recommended that a TSH upper reference limit of 4mU/L is used during pregnancy.<a class="elsevierStyleCrossRef" href="#bib0195">1</a> When it comes to establishing a cut-off point to define low levels of thyroxine in pregnant women, many authors consider that measurement of total TT4 is more appropriate, given the greater variability of FT4 levels. Thus, the ETA recommends estimating the reference range for pregnancy by multiplying the applicable range in the general population by 1.5 (it is estimated that normal ranges of TT4 during pregnancy are about 50% greater compared to the general population).<a class="elsevierStyleCrossRef" href="#bib0200">2</a>Impact on newbornsA small percentage of pregnant women with HT will have TSH-stimulation blocking antibodies (TSBAb), and an even smaller percentage will have thyroid-stimulating antibodies (TSAb). It used to be believed that these antibodies caused transient neonatal hypothyroidism. However, recent studies suggest that TPOAb and TgAb do not block the child's thyroid function.<a class="elsevierStyleCrossRefs" href="#bib0305">23–25</a>The current data show that approximately 25% of newborns of mothers with HT will have mild elevation of TSH or even subclinical hypothyroidism. Specifically, more than 75% have mild hyperthyrotropinaemia (TSH<15μIU/mL) on day 3 post birth, which resolves within a few days or weeks (levels normalise in >70% shortly before 1 month post birth), with spontaneous resolution in most patients.<a class="elsevierStyleCrossRefs" href="#bib0305">23,24,26,27</a> The development of hyperthyroidism in the newborn associated with the presence of TSBAb from a mother with HT is extremely rare (only one case reported in the literature). Therefore, it does not seem that the thyroid function of the foetus or the newborn could be permanently impaired by the presence of thyroid antibodies.Management of infants born to mothers with HTStudies published in recent years have recommended followup of these children with protocols that require collection of multiple blood samples and several visits to a hospital.<a class="elsevierStyleCrossRef" href="#bib0330">28</a> Currently, the benefits observed with such a followup hardly justify it, and based on our experience and the review of the recent literature we would not recommend it.<a class="elsevierStyleCrossRefs" href="#bib0305">23–27</a>In newborns of mothers with HT, screening for congenital hypothyroiditis at 48h post birth a non-invasive and sufficient intervention to assess thyroid function in the newborn.The presence of hypothyroidism in pregnant women does not warrant a different approach to neonatal screening for thyroid dysfunction.Infants born to mothers with Graves-Basedow diseaseChildren born to mothers with Graves disease (GD) are at significant risk of morbidity and mortality and thus require the use of appropriate protocols for their identification and management.<a class="elsevierStyleCrossRef" href="#bib0330">28</a> The most recent guidelines and systematic reviews have offered suggestions on how to approach these patients, acknowledging that the lack of evidence and consensus precludes making specific recommendations.<a class="elsevierStyleCrossRef" href="#bib0335">29</a>The antibodies that cause GD are long-acting TRAb, that belong to the immunoglobulin G class and can freely cross the placenta in the second trimester of gestation,<a class="elsevierStyleCrossRefs" href="#bib0200">2,29</a> of which there are two types:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-TSH-receptor stimulating antibodies that bind the TSH receptor in thyroid follicular cells and cause autonomous thyroid hormone production.</li><li class="elsevierStyleListItem" id="lsti0010">-TSBAb that bind the TSH receptor but do not trigger the intracellular signal cascade.</li></ul>At present, two methods are available for the measurement of TRAb. Second-generation methods measure immunoglobulin levels and do not discriminate between thyroid-stimulating or thyroid-blocking antibodies, but they are inexpensive and widely available. Third-generation methods are less available, more complicated and more expensive, but can discriminate between blocking and stimulating antibodies. The presence of stimulating antibodies is associated with a high risk of neonatal hyperthyroidism.<a class="elsevierStyleCrossRef" href="#bib0335">29</a>A mother with current GD or a history of treated GD may have a healthy child, a child with foetal and/or neonatal hyperthyroidism or a child with hypothyroidism.<a class="elsevierStyleCrossRef" href="#bib0340">30</a> The coexistence of blocking and stimulating antibodies may delay the onset of hyperthyroidism.<a class="elsevierStyleCrossRefs" href="#bib0340">30–33</a>The levels of TRAb in a woman with GD may remain elevated for many years after its cure, be it by means of thyroidectomy, antithyroid medication or radioactive iodine. They should be measured between weeks 20 and 24 of gestation<a class="elsevierStyleCrossRef" href="#bib0220">6</a>; if the results are negative, the newborn can be considered to be at low risk, but if they are positive, the newborn should be considered to be at high risk.<a class="elsevierStyleCrossRefs" href="#bib0200">2,29,35</a>Impact on the foetus<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015">•Foetal hyperthyroidism:It usually develops in the third trimester of gestation. It manifests with tachycardia, heart failure, non-immune hydrops fetalis, goitre, intrauterine growth restriction, preterm birth, accelerated bone maturation and craniosynostosis. These symptomatic cases may be treated with administration of antithyroid medication to the pregnant patient.<a class="elsevierStyleCrossRefs" href="#bib0200">2,32</a></li><li class="elsevierStyleListItem" id="lsti0020">•Risk of congenital malformations: secondary to treatment with antithyroid medication.<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0025">∘Methimazole (MMI)/carbimazole: may produce aplasia cutis, embryopathy with facial dysmorphism, choanal atresia, oesophageal atresia, abdominal wall defects, umbilicocele, urinary tract defects and ventricular septal defects, especially if exposure occurs in the first trimester of gestation.<a class="elsevierStyleCrossRefs" href="#bib0200">2,33</a></li><li class="elsevierStyleListItem" id="lsti0030">∘Propylthiouracil (PTU) can not only lead to maternal hepatotoxicity, but may also cause minor congenital malformations, such as cysts in the face and neck or urinary tract anomalies.<a class="elsevierStyleCrossRefs" href="#bib0200">2,33,36</a></li><li class="elsevierStyleListItem" id="lsti0035">∘The ATA recommends suspending treatment during the first trimester if the mother with GD is stable in early pregnancy. If this were not possible, it is preferable to use PTU during this trimester and, given the risk of liver failure, switch to MMI in the second and third trimesters.<a class="elsevierStyleCrossRefs" href="#bib0200">2,33</a> The foetus is more sensitive to antithyroid drugs than the mother, so the mother should be given the lowest possible dose to maintain her hormone levels slightly above the normal range.<a class="elsevierStyleCrossRefs" href="#bib0200">2,6</a> Women with hyperthyroidism require a meticulous endocrinological followup, including measurement of TRAb levels and sonographic assessment of the foetal thyroid in the third trimester.<a class="elsevierStyleCrossRefs" href="#bib0200">2,29</a></li><li class="elsevierStyleListItem" id="lsti0040">∘PTU and MMI are secreted in breast milk in very small concentrations, do not affect the thyroid of the newborn and are safe drugs during lactation.<a class="elsevierStyleCrossRef" href="#bib0200">2</a></li></ul></li></ul>Impact on newborns<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0045">•Neonatal hyperthyroidism or GD</li></ul>There is considerable variation in the signs and symptoms of neonatal GD, and they may last 3–4 months, or even longer. Possible findings include goitre, tracheal compression, low weight, periorbital oedema, retraction of the eyelid, hyperthermia, diarrhoea, irritability, skin redness and warmth, difficulty feeding, stagnant weight gain, tachycardia, heart failure, hypertension, splenomegaly, cholestasis, thrombocytopenia and hyperviscosity. These symptoms are non-specific and could be attributed to congenital infection or sepsis. If these newborns are not identified and managed correctly, the mortality can be as high as 20%.<a class="elsevierStyleCrossRefs" href="#bib0200">2,29,35</a>Complications in the child are more severe if the mother remains hyperthyroid in the second half of pregnancy, as sustained normal levels of thyroid hormones are essential for the healthy development of the foetal central nervous system. Children of mothers with GD that are euthyroid at birth usually have a normal cognitive development, but children that have neonatal hyperthyroidism may experience neurodevelopmental impairment.<a class="elsevierStyleCrossRef" href="#bib0355">33</a><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0050">•Neonatal hypothyroidismInfants born to mothers with GD may also present features of hypothyroidism.<a class="elsevierStyleCrossRefs" href="#bib0350">32,34</a><ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0055">-Transient central hypothyroidism. If maternal hyperthyroidism is poorly controlled during pregnancy, the high levels of thyroid hormones hinder the normal development and maturation of the thyroid gland and the hypothalamic–pituitary–thyroid axis in the foetus. This is a transient condition that usually improves in 3–19 months.<a class="elsevierStyleCrossRefs" href="#bib0345">31,33</a></li><li class="elsevierStyleListItem" id="lsti0060">-Primary hypothyroidism or transient hyperthyrotropinaemia<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0065">∘If there is a predominance of blocking antibodies.<a class="elsevierStyleCrossRef" href="#bib0375">37</a></li><li class="elsevierStyleListItem" id="lsti0070">∘In 15–20% of infants born to mothers treated with antithyroid medication. It usually manifests in the first 4–5 days after birth, and followup of hyperthyroidism may be indicated depending on TRAb levels.<a class="elsevierStyleCrossRefs" href="#bib0200">2,33,37</a></li></ul></li></ul></li></ul>Clinical management of infants born with neonatal hyperthyroidismAt birth, there may be overt manifestations of hyperthyroidism, but in most cases the onset is delayed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0075">-Laboratory tests: the presence of TRAb in cord blood is associated with a high risk of developing neonatal hyperthyroidism in the first 2 weeks of life.<a class="elsevierStyleCrossRef" href="#bib0360">34</a> However, the levels of TSH and FT4 in cord blood have no predictive value when it comes to neonatal hyperthyroidism, as they simply reflect the thyroid function in the foetus.<ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0080">•Low-risk newborns: they usually require no followup after 2 weeks post birth (once it is verified that they are healthy and have a normal thyroid function).<a class="elsevierStyleCrossRef" href="#bib0335">29</a></li><li class="elsevierStyleListItem" id="lsti0085">•High-risk newborns: in newborns whose mothers did not receive antithyroid medication, the diagnosis is usually made between days 1 and 3 post birth, compared to between days 5 and 15 post birth in newborns whose mothers received antithyroid drugs (the duration of action of MMI is 3 days compared to 24h for PTU).<a class="elsevierStyleCrossRefs" href="#bib0200">2,29,32</a> Of all newborns that develop neonatal hyperthyroidism, 95% have onset in the first month of life (most frequently in the first 2 weeks).</li></ul></li></ul><elsevierMultimedia ident="fig0005"></elsevierMultimedia>In newborns, FT4 and TSH levels should be measured between days 3 and 5 post birth (or before if patient is symptomatic), and again between days 10 and 14 post birth (use age-specific reference ranges). If there are no abnormalities in the first 2 weeks of life, performance of clinical assessments at 4 weeks, 2 months and 3 months post birth (with the option of additional biochemical assessment) suffice for the detection of potential late-onset cases.<a class="elsevierStyleCrossRef" href="#bib0335">29</a><ul class="elsevierStyleList" id="lis0050"><li class="elsevierStyleListItem" id="lsti0090">-Indications for initiating treatment in newborns:<ul class="elsevierStyleList" id="lis0055"><li class="elsevierStyleListItem" id="lsti0095">•Subclinical biochemical hyperthyroidism: a significant proportion of at-risk newborns are asymptomatic. There is no consensus as to whether they should or not be treated, but it is recommended that they be closely monitored. Some authors propose initiating treatment if FT4 levels exceed 35pmol/L between days 2 and 14 post birth to prevent neonatal hyperthyroidism. Others consider that asymptomatic patients with FT4 levels between 43 and 154pmol/L should not be treated (limiting treatment to patients with symptoms or goitre).<a class="elsevierStyleCrossRefs" href="#bib0200">2,29,34</a></li><li class="elsevierStyleListItem" id="lsti0100">•Biochemical hyperthyroidism with clinically significant symptoms: there is widespread agreement that treatment should be initiated as soon as the patient develops symptoms to prevent heart failure and long-term sequelae such as intellectual disability.<a class="elsevierStyleCrossRefs" href="#bib0200">2,29,35</a></li></ul></li></ul>Treatment of neonatal hyperthyroidism:<ul class="elsevierStyleList" id="lis0060"><li class="elsevierStyleListItem" id="lsti0105">-Both MMI and PTU inhibit thyroid peroxidase and therefore synthesis of thyroid hormones. In addition, PTU inhibits peripheral deiodination of T4 to T3, but due to the risk of liver failure, it should only be offered as a short course in the case of thyroid storm, intolerance to MMI treatment or severe complications such as agranulocytosis.<a class="elsevierStyleCrossRefs" href="#bib0200">2,33,38</a> The clinical and biochemical effects of antithyroid medication may not be noticeable for a few days, until thyroid hormone stores are depleted. Initiate MMI when symptoms develop in the context of biochemical hyperthyroidism, generally at 0.2–0.5mg/kg/day divided into two or three doses (a maximum dose of 1mg/kg/day).<a class="elsevierStyleCrossRef" href="#bib0335">29</a></li><li class="elsevierStyleListItem" id="lsti0110">-Perform biochemical assessments weekly until the patient stabilises, and every 1–2 weeks thereafter.</li><li class="elsevierStyleListItem" id="lsti0115">-If the patient exhibits sympathetic hyperactivity (tachycardia, hypertension, congestive heart failure or poor feeding), add propranolol at 2mg/kg/day administered in two doses for 1 or 2 weeks. These infants need to be admitted to hospital for monitoring.<a class="elsevierStyleCrossRef" href="#bib0335">29</a></li><li class="elsevierStyleListItem" id="lsti0120">-In severe or refractory cases, add potassium iodide or Lugol solution. The first dose must be administered at least 1h after the first dose of MMI to prevent iodide from being used in the synthesis of new thyroid hormones (Lugol solution [0.05mL], one drop every 8h, or potassium iodide solution, 1 drop/day).</li><li class="elsevierStyleListItem" id="lsti0125">-In the case of haemodynamic instability, respiratory distress or heart failure, add a short course of oral glucocorticoids, which inhibit thyroid hormone secretion and peripheral deiodination of T4 to T3 (prednisolone at 2mg/kg/day administered in 2 doses).<a class="elsevierStyleCrossRef" href="#bib0335">29</a></li></ul>Side effects of MMI occur in 28% of children, and most are mild, such as mild elevation of liver enzymes, transient leukopenia, gastrointestinal symptoms, skin rashes, arthralgia or myalgia. Severe problems may develop in 0.5% of patients, such as agranulocytosis, Stevens-Johnson syndrome, liver damage or vasculitis.<a class="elsevierStyleCrossRef" href="#bib0380">38</a><ul class="elsevierStyleList" id="lis0065"><li class="elsevierStyleListItem" id="lsti0130">-Duration of treatment in neonatal hyperthyroidism:</li></ul>Neonatal hyperthyroidism is self-limiting, as it only lasts for as long as it takes the body to clear the circulating antibodies, whose half-life is 12 days. Hormone levels have normalised by 6 months in most patients, although there are cases that persist up to the age of 12 months. The usual duration of the treatment is 1–2 months. The dose must be tapered off based on the FT4 levels. The decision to end treatment must take into account the clinical condition of the patient and the FT4 levels.<a class="elsevierStyleCrossRef" href="#bib0335">29</a>Clinical management of infants with neonatal hypothyroidismThese cases are usually diagnosed between 4 and 30 days post birth.<a class="elsevierStyleCrossRefs" href="#bib0345">31,33</a> Treatment with levothyroxine should be initiated at a dose of 10mcg/kg/day, with testing every 2–4 weeks to taper the dose.Most patients improve gradually between ages 3 and 19 months, although many authors prefer waiting until the age of 3 years to attempt discontinuation of treatment.<a class="elsevierStyleCrossRefs" href="#bib0200">2,29</a>Final recommendations are given in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1089600" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1033012" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1089601" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1033013" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Infants born to mothers with HT" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Impact on the mother and foetus" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Impact on newborns" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Management of infants born to mothers with HT" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Infants born to mothers with Graves-Basedow disease" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Impact on the foetus" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Impact on newborns" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Clinical management of infants born with neonatal hyperthyroidism" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Clinical management of infants with neonatal hypothyroidism" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-06-25" "fechaAceptado" => "2018-07-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1033012" "palabras" => array:5 [ 0 => "Newborn" 1 => "Gestational autoimmune thyroid disease" 2 => "Hashimoto thyroiditis" 3 => "Grave's disease" 4 => "Thyroid antibodies in pregnancy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1033013" "palabras" => array:5 [ 0 => "Recién nacido" 1 => "Patología tiroidea autoinmune gestacional" 2 => "Tiroiditis de Hashimoto" 3 => "Enfermedad de Graves" 4 => "Anticuerpos antitiroideos en el embarazo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The objective of this document is to review the current recommendations in the management of the foetus and the newborn child born to mothers with autoimmune thyroid disease. In 2017, the American Thyroid Association published guidelines for the diagnosis and management of thyroid disease during pregnancy and post-partum. In this guide, 97 recommendations were made, and an algorithm for the diagnosis and treatment of gestational hypothyroidism was proposed. Also, in the last year, a wide review was published on the foetal and neonatal approach of the child of a mother with Graves’ disease. The importance of the determination of maternal antibodies against thyrotropin receptor in the second half of pregnancy is stressed, in order to adequately stratify the risk in the neonate." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "El objetivo de este documento es revisar las recomendaciones actuales en el manejo del hijo de madre con patología autoinmune tiroidea. En este 2017 se ha publicado la guía de la Asociación Americana de Tiroides para el diagnóstico y manejo de la enfermedad tiroidea durante el embarazo y el posparto. En dicha guía se establecen 97 recomendaciones y se propone un algoritmo de diagnóstico y tratamiento del hipotiroidismo gestacional. También en este último año se ha publicado una amplia revisión sobre el abordaje foetal y neonatal del hijo de madre con enfermedad de Graves. Se insiste en la trascendencia de la determinación de anticuerpos maternos frente al receptor de TSH en la segunda mitad del embarazo para estratificar adecuadamente el riesgo en el neonato." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Ares Segura S, Temboury Molina C, Chueca Guindulain MJ, Grau Bolado G, Alija Merillas MJ, Caimari Jaume M, et al. Recomendaciones para el diagnóstico y seguimiento del feto y del recién nacido hijo de madre con patología tiroidea autoinmune. Ann Pediatr (Barc). 2018;89:255." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1777 "Ancho" => 1760 "Tamanyo" => 339015 ] ] "descripcion" => array:1 [ "en" => "Approach to the management of an infant born to a mother with GD or hyperthyroidism (current or past). Pregnant mother: measure TRAb levels in the second to third trimester of pregnancy. Inform the neonatologist of results. If TRAb status positive or unknown: high-risk NB. If TRAb status negative: low-risk NB. Newborn (NB): measure TRAb in cord blood (hormone levels not useful) and monitor." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Since a high percentage of pregnant women have autoimmune thyroid disease, we recommend getting information from the mother or requesting previous records on the disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TPOAb and TgAb do not seem to block the child's thyroid gland. Newborns of mothers with thyroid autoantibodies and hypothyroidism treated with levothyroxine do not require a thyroid evaluation other than neonatal screening \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">In newborns of mothers with HT, the neonatal screen for congenital hypothyroidism at 48h of life is a non-invasive test that suffices to ensure normal thyroid function in the newborn. Consequently, the presence of hypothyroidism in the pregnant mother does not require a different approach to assess thyroid function in the newborn \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Children of mothers with GD, past or present, are at risk of developing foetal or neonatal hyperthyroidism, which may have severe consequences on future health. They may also develop transient hypothyroidism or congenital defects secondary to exposure to maternal medication. These cases require careful followup during pregnancy and in the first months of life. Measurement of TRAb levels during pregnancy or in cord blood is very useful to discriminate between newborns at high risk and at low risk of hyperthyroidism \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Followup is indicated in all children born to mothers with GD, past or current, treated or untreated, especially if antibodies persist \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Initiation and maintenance of breastfeeding must be promoted in all newborns of mothers with autoimmune thyroid disorders, even if the mother is currently being treated with MMI, PTU or levothyroxine. The sole contraindication is maternal treatment with radioactive iodine during pregnancy \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1862809.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:38 [ 0 => array:3 [ "identificador" => "bib0195" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.K. Alexander" 1 => "E.N. Pearce" 2 => "G.A. Brent" 3 => "R.S. Brown" 4 => "H. Chen" 5 => "C. Dosiou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/thy.2016.0457" "Revista" => array:6 [ "tituloSerie" => "Thyroid" "fecha" => "2017" "volumen" => "27" "paginaInicial" => "315" "paginaFinal" => "389" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28056690" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0200" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2014 European Thyroid Association Guidelines for the management of subclinical hypothyroidism in pregnancy and in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Lazarus" 1 => "R.S. Brown" 2 => "C. Daumerie" 3 => "A. Hubalewska-Dydejczyk" 4 => "R. Negro" 5 => "B. Vaidya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000362597" "Revista" => array:7 [ "tituloSerie" => "Eur Thyroid J" "fecha" => "2014" "volumen" => "3" "paginaInicial" => "76" "paginaFinal" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25114871" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0165178114005277" "estado" => "S300" "issn" => "01651781" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0205" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Detección de la disfunción tiroidea en la población gestante: ¿está justificado el cribado universal?" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Grupo de Trabajo de Trastornos por Deficiencia de Yodo y Disfunción Tiroidea de la Sociedad Española de Endocrinología y Nutrición; Sociedad Española de Ginecología y Obstetricia" "etal" => true "autores" => array:6 [ 0 => "L. Vila" 1 => "I. Velasco" 2 => "S. González" 3 => "F. Morales" 4 => "E. Sánchez" 5 => "J.M. Lailla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2012" "volumen" => "139" "paginaInicial" => "509e1" "paginaFinal" => "509e11" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0210" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "CD011263" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Spencer" 1 => "T. Bubner" 2 => "E. Bain" 3 => "P. Middleton" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2015" "volumen" => "21" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0215" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal early pregnancy and newborn thyroid hormone parameters: the Generation R study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Medici" 1 => "Y.B. de Rijke" 2 => "R.P. Peeters" 3 => "W. Visser" 4 => "S.M. de Muinck Keizer-Schrama" 5 => "V.V. Jaddoe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2011-2398" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2012" "volumen" => "97" "paginaInicial" => "646" "paginaFinal" => "652" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22162477" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0220" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. DeGroot" 1 => "M. Abalovich" 2 => "E. Alexander" 3 => "N. Amino" 4 => "L. Barbour" 5 => "R. Cobin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2011-2803" "Revista" => array:7 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2012" "volumen" => "97" "paginaInicial" => "2543" "paginaFinal" => "2565" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22869843" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S016517811630796X" "estado" => "S300" "issn" => "01651781" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0225" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal thyroid hormones early in pregnancy and fetal brain development" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.M. De Escobar" 1 => "M.J. Obregón" 2 => "F.E. del Rey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.beem.2004.03.012" "Revista" => array:6 [ "tituloSerie" => "Best Pract Res Clin Endocrinol Metab" "fecha" => "2004" "volumen" => "18" "paginaInicial" => "225" "paginaFinal" => "248" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15157838" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0230" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Burren C. Guideline for the management of infant of mother with thyroid disease. NHS; 2016. Available from: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.swneonatalnetwork.co.uk/media/89839/swnn-guideline-management-of-infant-of-mother-with-thyroid-disease-final-january-2016-version-03.pdf">http://www.swneonatalnetwork.co.uk/media/89839/swnn-guideline-management-of-infant-of-mother-with-thyroid-disease-final-january-2016-version-03.pdf</a>" ] ] ] 8 => array:3 [ "identificador" => "bib0235" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dynamics and predictors of serum TSH and fT4 reference limits in early pregnancy: a study within the Danish National Birth Cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Laurberg" 1 => "S.L. Andersen" 2 => "P. Hindersson" 3 => "E.A. Nohr" 4 => "J. Olsen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2016-1387" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2016" "volumen" => "101" "paginaInicial" => "2484" "paginaFinal" => "2492" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27115059" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0240" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anti-TPO antibodies diffusion through the placental barrier during pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Seror" 1 => "G. Amand" 2 => "J. Guibourdenche" 3 => "P.F. Ceccaldi" 4 => "D. Luton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0084647" "Revista" => array:5 [ "tituloSerie" => "PLoS ONE" "fecha" => "2014" "volumen" => "9" "paginaInicial" => "e84647" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24497920" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0245" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Stagnaro-Green" 1 => "S.H. Roman" 2 => "R.H. Cobin" 3 => "E. el-Harazy" 4 => "M. Alvarez-Marfany" 5 => "T.F. Davies" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA" "fecha" => "1990" "volumen" => "264" "paginaInicial" => "14225" "paginaFinal" => "21425" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0250" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of thyroid peroxidase antibodies in the outcome of pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Ghafoor" 1 => "M. Mansoor" 2 => "T. Malik" 3 => "M.S. Malik" 4 => "A.U. Khan" 5 => "R. Edwards" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "7.2006/JCPSP.468471" "Revista" => array:6 [ "tituloSerie" => "J Coll Physicians Surg Pak" "fecha" => "2006" "volumen" => "16" "paginaInicial" => "468" "paginaFinal" => "471" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16827958" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0255" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Van den Boogaard" 1 => "R. Vissenberg" 2 => "J.A. Land" 3 => "M. van Wely" 4 => "J.A. van der Post" 5 => "M. Goddijn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/humupd/dmr024" "Revista" => array:6 [ "tituloSerie" => "Hum Reprod Update" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "605" "paginaFinal" => "619" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21622978" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0260" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.E. Haddow" 1 => "G.E. Palomaki" 2 => "W.C. Allan" 3 => "J.R. Williams" 4 => "G.J. Knight" 5 => "J. Gagnon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199908193410801" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1999" "volumen" => "341" "paginaInicial" => "549" "paginaFinal" => "555" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10451459" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0265" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal thyroid peroxidase antibodies during pregnancy: a marker of impaired child development?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V.J. Pop" 1 => "E. de Vries" 2 => "A.L. van Baar" 3 => "J.J. Waelkens" 4 => "H.A. de Rooy" 5 => "M. Horsten" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "1995" "volumen" => "80" "paginaInicial" => "6" "paginaFinal" => "3561" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0270" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood IQ, hearing loss, and maternal thyroid autoimmunity in the Baltimore Collaborative Perinatal Project" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.E. Wasserman" 1 => "J.P. Pillion" 2 => "A. Duggan" 3 => "K. Nelson" 4 => "C. Rohde" 5 => "E.C. Seaberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/pr.2012.117" "Revista" => array:7 [ "tituloSerie" => "Pediatr Res" "fecha" => "2012" "volumen" => "72" "paginaInicial" => "525" "paginaFinal" => "530" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22918523" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0165178115304157" "estado" => "S300" "issn" => "01651781" ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0275" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of mild thyroid hormone deficiency in pregnancy on cognitive function in children: lessons from the Generation R study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Ghassabian" 1 => "J. Henrichs" 2 => "H. Tiemeier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.beem.2013.04.008" "Revista" => array:6 [ "tituloSerie" => "Best Pract Res Clin Endocrinol Metab" "fecha" => "2014" "volumen" => "28" "paginaInicial" => "221" "paginaFinal" => "232" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24629863" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0280" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal hypothyroxinemia in early pregnancy predicts reduced performance in reaction time tests in 5- to 6-year-old offspring" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.J. Finken" 1 => "M. van Eijsden" 2 => "E.M. Loomans" 3 => "T.G. Vrijkotte" 4 => "J. Rotteveel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2012-3389" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2013" "volumen" => "98" "paginaInicial" => "1417" "paginaFinal" => "1426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23408575" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0285" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Downstream effects of maternal hypothyroxinemia in early pregnancy: nonverbal IQ and brain morphology in school-age children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.E. Ghassabian" 1 => "H. Marroun" 2 => "R.P. Peeters" 3 => "V.W. Jaddoe" 4 => "A. Hofman" 5 => "F.C. Verhulst" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2013-4281" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2014" "volumen" => "99" "paginaInicial" => "2383" "paginaFinal" => "2390" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24684462" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0290" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antenatal thyroid screening and childhood cognitive function" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.H. Lazarus" 1 => "J.P. Bestwick" 2 => "S. Channon" 3 => "R. Paradice" 4 => "A. Maina" 5 => "R. Rees" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1106104" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2012" "volumen" => "366" "paginaInicial" => "493" "paginaFinal" => "501" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22316443" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0295" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.M. Casey" 1 => "E.A. Thom" 2 => "A.M. Peaceman" 3 => "M.W. Varner" 4 => "Y. Sorokin" 5 => "D.G. Hirtz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1606205" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2017" "volumen" => "376" "paginaInicial" => "815" "paginaFinal" => "825" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28249134" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0300" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A moderate and transient deficiency of maternal thyroid function at the beginning of fetal neocorticogenesis alters neuronal migration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Ausó" 1 => "R. Lavado-Autric" 2 => "E. Cuevas" 3 => "F.E. del Rey" 4 => "G. Morreale De Escobar" 5 => "P. Berbel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/en.2004-0274" "Revista" => array:6 [ "tituloSerie" => "Endocrinology" "fecha" => "2004" "volumen" => "145" "paginaInicial" => "4037" "paginaFinal" => "4047" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15087434" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0305" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Newborn of mothers affected by autoimmune thyroiditis: the importance of thyroid function monitoring in the first months of life" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Rovelli" 1 => "M.C. Vigone" 2 => "C. Giovanettoni" 3 => "A. Passoni" 4 => "L. Maina" 5 => "A. Corrias" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1824-7288-36-24" "Revista" => array:5 [ "tituloSerie" => "Ital J Pediatr" "fecha" => "2010" "volumen" => "36" "paginaInicial" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20219125" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0310" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal autoimmune thyroid disease: relevance for the newborn" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.C. Temboury Molina" 1 => "M.J. Rivero Martín" 2 => "J. de Juan Ruiz" 3 => "S. Ares Segura" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2015" "volumen" => "144" "paginaInicial" => "297" "paginaFinal" => "303" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0315" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "317.e2" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transient neonatal hypothyroidism is associated with elevated serum anti-thyroglobulin antibody levels in newborns and their mothers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Ordookhani" 1 => "P. Mirmiran" 2 => "P.G. Walfish" 3 => "F. Azizi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpeds.2006.11.034" "Revista" => array:6 [ "tituloSerie" => "J Pediatr" "fecha" => "2007" "volumen" => "150" "paginaInicial" => "315" "paginaFinal" => "317" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17307555" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0320" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of a follow up protocol of infants born to mothers with antithyroid antibodies during pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B. Fernandez Rodriguez" 1 => "A.J. Perez Diaz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/14767058.2017.1285886" "Revista" => array:6 [ "tituloSerie" => "J Matern Fetal Neonatal Med" "fecha" => "2017" "volumen" => "14" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14563084" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0325" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedades frecuentes del tiroides en la infancia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Ares Segura" 1 => "J. Quero Jiménez" 2 => "G. Morreale de Escobar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Pediatr Aten Primaria" "fecha" => "2009" "volumen" => "11" "numero" => "Supl. 16" "paginaInicial" => "s173" "paginaFinal" => "s204" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0330" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Do we need to assess the thyroid function in the infants of mothers with Hashimoto's thyroiditis?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Habeb" 1 => "M. Zubier" 2 => "P. Pairaudeau" 3 => "V. Mathew" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Arch Dis Child Fetal Neonatal" "fecha" => "2003" "volumen" => "88" "paginaInicial" => "F258" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0335" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of neonates born to mothers with Graves’ disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.C. Van der Kaay" 1 => "J.D. Wasserman" 2 => "M.R. Palmert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2015-1878" "Revista" => array:5 [ "tituloSerie" => "Pediatrics" "fecha" => "2016" "volumen" => "137" "paginaInicial" => "e20151878" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26980880" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0340" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neonatal hyperthyroidism: neonatal clinical course of two brothers born to a mother with Graves-Basedow disease, before and after total thyroidectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.A. Zuppa" 1 => "P. Sindico" 2 => "I. Savarese" 3 => "V. d’Andrea" 4 => "A. Fracciolla" 5 => "F. Cota" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Endocrinol Metab" "fecha" => "2007" "volumen" => "20" "paginaInicial" => "535" "paginaFinal" => "539" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17550218" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0345" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Loss of integrity of thyroid morphology and function in children born to mothers with inadequately treated Graves’ disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J.E. Kempers" 1 => "A.S.P. van Trosenburg" 2 => "R.R. van Rijn" 3 => "A.M.J.B. Smets" 4 => "B.J. Smit" 5 => "J.J.M. de Vijlder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2006-2042" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2007" "volumen" => "92" "paginaInicial" => "2984" "paginaFinal" => "2991" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17504907" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0350" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thyroid disorders of neonates born to mothers with Graves’ disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Papendieck" 1 => "A. Chiesa" 2 => "L. Prieto" 3 => "L. Gruñeiro-Papendieck" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Endocrinol Metab" "fecha" => "2009" "volumen" => "22" "paginaInicial" => "547" "paginaFinal" => "553" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19694202" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0355" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of hyperthyroidism during pregnancy and lactation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Azizi" 1 => "A. Amouzegar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1530/EJE-10-1030" "Revista" => array:6 [ "tituloSerie" => "Eur J Endocrinol" "fecha" => "2011" "volumen" => "164" "paginaInicial" => "871" "paginaFinal" => "876" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21389085" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0360" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Follow-up of newborns of mothers with Graves’ disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Y. Levy-Shraga" 1 => "L. Tamir-Hostovsky" 2 => "V. Boyko" 3 => "L. Lerner-Geva" 4 => "O. Pinhas-Hamiel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/thy.2013.0489" "Revista" => array:6 [ "tituloSerie" => "Thyroid" "fecha" => "2014" "volumen" => "24" "paginaInicial" => "1032" "paginaFinal" => "1039" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24472020" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0365" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severity of birth defects after propylthiouracil exposure in early pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.L. Andersen" 1 => "J. Olsen" 2 => "C.S. Wu" 3 => "P. Laurberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/thy.2014.0150" "Revista" => array:6 [ "tituloSerie" => "Thyroid" "fecha" => "2014" "volumen" => "24" "paginaInicial" => "1533" "paginaFinal" => "1540" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24963758" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0370" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of neonates born to women with Graves’ disease: a cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Besançon" 1 => "J. Beltrand" 2 => "I. Le Gac" 3 => "D. Luton" 4 => "M. Polak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1530/EJE-13-0994" "Revista" => array:6 [ "tituloSerie" => "Eur J Endocrinol" "fecha" => "2014" "volumen" => "170" "paginaInicial" => "855" "paginaFinal" => "862" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24670885" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0375" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transient congenital hypothyroidism due to thyroid-stimulating hormone receptor blocking antibodies: a case series" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Evans" 1 => "J.W. Gregory" 2 => "J. Barton" 3 => "C. Bidder" 4 => "J. Gibbs" 5 => "R. Pryce" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1258/acb.2011.011007" "Revista" => array:6 [ "tituloSerie" => "Ann Clin Biochem" "fecha" => "2011" "volumen" => "48" "paginaInicial" => "386" "paginaFinal" => "390" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21606073" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0380" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Methimazole associated neutropenia in a preterm neonate treated for hyperthyroidism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Angelis" 1 => "R.A. Kubicky" 2 => "A.B. Zubrow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2015/680191" "Revista" => array:5 [ "tituloSerie" => "Case Rep Endocrinol" "fecha" => "2015" "volumen" => "2015" "paginaInicial" => "680191" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25810932" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008900000004/v1_201810020628/S2341287918301546/v1_201810020628/en/main.assets" "Apartado" => array:4 [ "identificador" => "33443" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Spanish Association of Paediatrics" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008900000004/v1_201810020628/S2341287918301546/v1_201810020628/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301546?idApp=UINPBA00005H"]

Statistics

Spanish Association of Paediatrics

Recommendations for the diagnosis and followup of the foetus and newborn child born to mothers with autoimmune thyroid disease

Recomendaciones para el diagnóstico y seguimiento del feto y del recién nacido hijo de madre con patología tiroidea autoinmune

Susana Ares Seguraa,

Corresponding author

susana.ares@salud.madrid.org

Corresponding author.

, Carmen Temboury Molinab, María Jesús Chueca Guindulainc, Gema Grau Boladod, María Jesus Alija Merillase, María Caimari Jaumef, Paula Casano Sanchog, José Carlos Moreno Navarroh, José Manuel Rial Rodríguezi, Amparo Rodríguez Sánchezj, en representación del Grupo de trabajo de tiroides de la Sociedad Española de Endocrinología Pediátrica

a Servicio de Neonatología, Hospital Universitario La Paz, Madrid, Spain

b Servicio de Pediatría, Hospital Universitario del Sureste, Madrid, Spain

c Endocrinología Pediátrica, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain

d Endocrinología Infantil, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain

e Servicio de Pediatría, Hospital Universitario de Guadalajara, Guadalajara, Spain

f Endocrinología Pediátrica, Hospital Universitario Son Espases, Palma de Mallorca, Baleares, Spain

g Sección de Endocrinología Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain

h Institute for Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, La Paz, Spain

i Pediatría, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain

j Unidad de Metabolismo y Desarrollo, Hospital General Universitario Gregorio Marañón, Madrid, Spain

Read

8656

Times
was read the article

2572

Total PDF

6084

Total HTML

Share statistics

 array:24 [
  "pii" => "S2341287918301546"
  "issn" => "23412879"
  "doi" => "10.1016/j.anpede.2018.08.004"
  "estado" => "S300"
  "fechaPublicacion" => "2018-10-01"
  "aid" => "2498"
  "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "An Pediatr &#40;Barc&#41;. 2018;89:254&#46;e1-7"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1632
    "formatos" => array:3 [
      "EPUB" => 123
      "HTML" => 1078
      "PDF" => 431
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2341287918301558"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2018.08.005"
    "estado" => "S300"
    "fechaPublicacion" => "2018-10-01"
    "aid" => "2510"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2018;89:255&#46;e1-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1395
      "formatos" => array:3 [
        "EPUB" => 122
        "HTML" => 558
        "PDF" => 715
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Special Article</span>"
      "titulo" => "Examining hypertension in children and adolescents&#58; Clinical implications of the differences between the European and American Guidelines"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "255&#46;e1"
          "paginaFinal" => "255&#46;e5"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "La hipertensi&#243;n arterial en ni&#241;os y adolescentes a examen&#58; implicaciones cl&#237;nicas de las diferencias entre la Gu&#237;a Europea y la Americana"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Empar Lurbe i Ferrer"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Empar"
              "apellidos" => "Lurbe i Ferrer"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301558?idApp=UINPBA00005H"
    "url" => "/23412879/0000008900000004/v1_201810020628/S2341287918301558/v1_201810020628/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2341287918301467"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2017.11.008"
    "estado" => "S300"
    "fechaPublicacion" => "2018-10-01"
    "aid" => "2344"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "An Pediatr &#40;Barc&#41;. 2018;89:251-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1056
      "formatos" => array:3 [
        "EPUB" => 120
        "HTML" => 648
        "PDF" => 288
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
      "titulo" => "Optimisation of measures to protect premature neonates of less than 35 weeks from the cold in the first hour of life"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "251"
          "paginaFinal" => "253"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Optimizaci&#243;n de medidas para evitar el enfriamiento en la primera hora de vida de los prematuros menores de 35 semanas de gestaci&#243;n"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ana Herranz Barbero, Erika S&#225;nchez Ortiz, M&#170; Dolors Salvia-Roig&#233;s, Roc&#237;o Cort&#233;s Albuixech, Jos&#233; Manuel Rodr&#237;guez-Migu&#233;lez"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Herranz Barbero"
            ]
            1 => array:2 [
              "nombre" => "Erika"
              "apellidos" => "S&#225;nchez Ortiz"
            ]
            2 => array:2 [
              "nombre" => "M&#170; Dolors"
              "apellidos" => "Salvia-Roig&#233;s"
            ]
            3 => array:2 [
              "nombre" => "Roc&#237;o"
              "apellidos" => "Cort&#233;s Albuixech"
            ]
            4 => array:2 [
              "nombre" => "Jos&#233; Manuel"
              "apellidos" => "Rodr&#237;guez-Migu&#233;lez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403317304630"
        "doi" => "10.1016/j.anpedi.2017.11.013"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403317304630?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301467?idApp=UINPBA00005H"
    "url" => "/23412879/0000008900000004/v1_201810020628/S2341287918301467/v1_201810020628/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Spanish Association of Paediatrics</span>"
    "titulo" => "Recommendations for the diagnosis and followup of the foetus and newborn child born to mothers with autoimmune thyroid disease"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "254&#46;e1"
        "paginaFinal" => "254&#46;e7"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Susana Ares Segura, Carmen Temboury Molina, Mar&#237;a Jes&#250;s Chueca Guindulain, Gema Grau Bolado, Mar&#237;a Jesus Alija Merillas, Mar&#237;a Caimari Jaume, Paula Casano Sancho, Jos&#233; Carlos Moreno Navarro, Jos&#233; Manuel Rial Rodr&#237;guez, Amparo Rodr&#237;guez S&#225;nchez"
        "autores" => array:11 [
          0 => array:4 [
            "nombre" => "Susana"
            "apellidos" => "Ares Segura"
            "email" => array:1 [
              0 => "susana&#46;ares&#64;salud&#46;madrid&#46;org"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Carmen"
            "apellidos" => "Temboury Molina"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Mar&#237;a Jes&#250;s"
            "apellidos" => "Chueca Guindulain"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Gema"
            "apellidos" => "Grau Bolado"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Mar&#237;a Jesus"
            "apellidos" => "Alija Merillas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Mar&#237;a"
            "apellidos" => "Caimari Jaume"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Paula"
            "apellidos" => "Casano Sancho"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Jos&#233; Carlos"
            "apellidos" => "Moreno Navarro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Jos&#233; Manuel"
            "apellidos" => "Rial Rodr&#237;guez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Amparo"
            "apellidos" => "Rodr&#237;guez S&#225;nchez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">j</span>"
                "identificador" => "aff0050"
              ]
            ]
          ]
          10 => array:1 [
            "colaborador" => "en representaci&#243;n del Grupo de trabajo de tiroides de la Sociedad Espa&#241;ola de Endocrinolog&#237;a Pedi&#225;trica"
          ]
        ]
        "afiliaciones" => array:10 [
          0 => array:3 [
            "entidad" => "Servicio de Neonatolog&#237;a&#44; Hospital Universitario La Paz&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Pediatr&#237;a&#44; Hospital Universitario del Sureste&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Endocrinolog&#237;a Pedi&#225;trica&#44; Complejo Hospitalario de Navarra&#44; Pamplona&#44; Navarra&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Endocrinolog&#237;a Infantil&#44; Hospital Universitario Cruces&#44; Barakaldo&#44; Vizcaya&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Pediatr&#237;a&#44; Hospital Universitario de Guadalajara&#44; Guadalajara&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Endocrinolog&#237;a Pedi&#225;trica&#44; Hospital Universitario Son Espases&#44; Palma de Mallorca&#44; Baleares&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Secci&#243;n de Endocrinolog&#237;a Pedi&#225;trica&#44; Hospital Sant Joan de D&#233;u&#44; Barcelona&#44; Spain"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Institute for Medical and Molecular Genetics &#40;INGEMM&#41;&#44; Hospital Universitario La Paz&#44; La Paz&#44; Spain"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
          8 => array:3 [
            "entidad" => "Pediatr&#237;a&#44; Hospital Universitario Nuestra Se&#241;ora de Candelaria&#44; Santa Cruz de Tenerife&#44; Spain"
            "etiqueta" => "i"
            "identificador" => "aff0045"
          ]
          9 => array:3 [
            "entidad" => "Unidad de Metabolismo y Desarrollo&#44; Hospital General Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Spain"
            "etiqueta" => "j"
            "identificador" => "aff0050"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Recomendaciones para el diagn&#243;stico y seguimiento del feto y del reci&#233;n nacido hijo de madre con patolog&#237;a tiroidea autoinmune"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1777
            "Ancho" => 1760
            "Tamanyo" => 339015
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Approach to the management of an infant born to a mother with GD or hyperthyroidism &#40;current or past&#41;&#46; Pregnant mother&#58; measure TRAb levels in the second to third trimester of pregnancy&#46; Inform the neonatologist of results&#46; If TRAb status positive or unknown&#58; high-risk NB&#46; If TRAb status negative&#58; low-risk NB&#46; Newborn &#40;NB&#41;&#58; measure TRAb in cord blood &#40;hormone levels not useful&#41; and monitor&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In the last few years&#44; there have been significant advances in our knowledge of thyroid disorders during pregnancy&#44; which have resulted in the recent publication of clinical practice guidelines by the American Thyroid Association &#40;ATA&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">1</span></a> European Thyroid Association &#40;ETA&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a> and the Sociedad Espa&#241;ola de Endocrinolog&#237;a y Nutrici&#243;n &#40;Spanish Society of Endocrinology and Nutrition&#44; SEEN&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a> Since 2012&#44; the ATA&#44; the ETA and the Working Group on Iodine Deficiency and Thyroid Dysfunction of the SEEN recommend screening for thyroid dysfunction in nearly all pregnant women&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#8211;3</span></a> This recommendation has led to an increase in the detection of thyroid disorders during pregnancy&#44; which in turn has resulted in an increase in the treatment and followup of pregnant women and their newborns&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The development of healthy thyroid function in the foetus requires normal embryogenesis&#44; differentiation and maturation of the thyroid gland&#44; and also the integrity of the hypothalamic&#8211;pituitary&#8211;thyroid axis and the mechanisms that regulate the metabolism of thyroid hormones&#46; The normal unfolding of all these processes depends on multiple foetal and maternal factors&#44; with maternal thyroid function&#44; thyroid autoantibodies and iodine intake playing key roles&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">During pregnancy&#44; the passage of thyroxine &#40;T4&#41; from the mother to the foetus protects the developing brain&#46; Even in the early stages of pregnancy&#44; T4 can be found in embryonal fluids&#44; and later in pregnancy&#44; when hormone secretion by the foetal thyroid has already started&#44; maternal hormones continue to contribute to neurologic development&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In areas where severe iodine deficiency is endemic&#44; women may not have sufficient iodine stores and already have hypothyroxinaemia in the critical early stage of foetal neurodevelopment&#46; Women with adequate iodine intake before and during pregnancy have sufficient intrathyroidal iodine stores and can adapt to the increasing requirements of pregnancy without difficulty&#46; Although there is evidence that iodine supplementation may trigger thyroid autoimmunity in a small percentage of women&#44; ensuring adequate iodine intake in pregnant women is a health priority&#46; At present&#44; a daily iodine intake of 250<span class="elsevierStyleHsp" style=""></span>&#956;g is recommended in all pregnant women&#44; excepting those with hyperthyroidism or currently in treatment with levothyroxine&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">When we speak of maternal thyroid autoimmunity&#44; we refer to the detection of thyroid autoantibodies in the pregnant women&#46; In women of childbearing age&#44; the prevalence of anti-thyroid peroxidase antibodies &#40;TPOAb&#41; and&#47;or anti-thyroglobulin antibodies &#40;TgAb&#41; ranges between 8 and 14&#37; depending on the study&#46; Its presence in pregnant women is associated with an increased risk of maternal hypothyroidism during pregnancy&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">4&#44;8&#8211;10</span></a> There are multiple studies in the literature on their presence and analysing the impact on the thyroid function of the foetus and newborn&#46; Both TPOAb and TgAb of the IgG type can freely cross the placental barrier&#44; which explains why more than 95&#37; of newborns of mothers with Hashimoto thyroiditis &#40;HT&#41; have circulating autoantibodies&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The prevalence of maternal hyperthyroidism due to Graves disease during pregnancy is much lower&#44; ranging between 0&#46;1 and 2&#46;7&#37;&#46; The long-acting thyroid-stimulating hormone &#40;TSH&#41; receptor antibodies &#40;TRAb&#41; that cause this disease freely cross the placenta in the second half of pregnancy and have been shown to cause transient neonatal Graves disease in up to 2&#8211;20&#37; of the offspring in cohort studies&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Infants born to mothers with HT</span><p id="par0035" class="elsevierStylePara elsevierViewall">The most prevalent thyroid disorder in women of childbearing age is autoimmune thyroiditis due to Hashimoto disease&#44; also known as Hashimoto thyroiditis &#40;prevalence&#44; 2&#46;5&#37;&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Impact on the mother and foetus</span><p id="par0040" class="elsevierStylePara elsevierViewall">The presence of TPOAb and&#47;or TgAb during pregnancy is independently associated with fertility problems&#44; recurrent miscarriages&#44; preterm birth and gestational diabetes&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">11&#8211;13</span></a> Some authors have reported an adverse impact on neuropsychological outcomes<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">14</span></a> and an increased incidence of hearing loss and attention deficit hyperactivity disorder &#40;ADHD&#41;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">15&#8211;20</span></a> in children born to mothers that test positive for thyroid autoantibodies&#46; These abnormalities could be directly mediated by autoantibodies even in the absence of concomitant maternal hypothyroidism&#44; although the exact pathophysiological mechanism remains unclear&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In recent years&#44; there have been initiatives for the establishment of routine screening for thyroid dysfunction and autoimmunity aimed at verifying normal thyroid function from the early stages of gestation&#46; Establishing normal ranges for thyroid function markers during pregnancy poses challenges on account of the numerous adaptive changes that take place in this stage of life&#46; In the first 10 weeks of gestation&#44; TSH levels decrease due to an increase in the levels of &#946;-human chorionic gonadotropin &#40;&#946;hCG&#41; &#40;thyrotropic effect&#41; and placental type 3 deiodinase&#59; later on&#44; as &#946;hCG levels decrease&#44; levels of TSH increase as levels of FT<span class="elsevierStyleInf">4</span> decrease&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The most recent guidelines recommend early screening of thyroid dysfunction in pregnant women&#44; starting with measurement of TSH levels&#46; Treatment with levothyroxine is indicated when TSH levels are 10<span class="elsevierStyleHsp" style=""></span>mU&#47;L or greater or when TSH levels between 2&#46;5 and 10<span class="elsevierStyleHsp" style=""></span>mU&#47;L are associated with low FT<span class="elsevierStyleInf">4</span> levels&#46; The diagnosis of subclinical gestational hypothyroidism should be considered in women with TSH levels above the upper reference limit for the specific trimester of pregnancy&#46; To this end&#44; establishment of population- and trimester-specific reference ranges is recommended&#44; which should be based exclusively on the values found in pregnant women with adequate iodine intake who have tested negative for TPOAb&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#8211;4&#44;21&#44;22</span></a> If reference ranges are not available for the population of interest&#44; it is recommended that a TSH upper reference limit of 4<span class="elsevierStyleHsp" style=""></span>mU&#47;L is used during pregnancy&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">1</span></a> When it comes to establishing a cut-off point to define low levels of thyroxine in pregnant women&#44; many authors consider that measurement of total TT<span class="elsevierStyleInf">4</span> is more appropriate&#44; given the greater variability of FT<span class="elsevierStyleInf">4</span> levels&#46; Thus&#44; the ETA recommends estimating the reference range for pregnancy by multiplying the applicable range in the general population by 1&#46;5 &#40;it is estimated that normal ranges of TT<span class="elsevierStyleInf">4</span> during pregnancy are about 50&#37; greater compared to the general population&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Impact on newborns</span><p id="par0055" class="elsevierStylePara elsevierViewall">A small percentage of pregnant women with HT will have TSH-stimulation blocking antibodies &#40;TSBAb&#41;&#44; and an even smaller percentage will have thyroid-stimulating antibodies &#40;TSAb&#41;&#46; It used to be believed that these antibodies caused transient neonatal hypothyroidism&#46; However&#44; recent studies suggest that TPOAb and TgAb do not block the child&#39;s thyroid function&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">23&#8211;25</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The current data show that approximately 25&#37; of newborns of mothers with HT will have mild elevation of TSH or even subclinical hypothyroidism&#46; Specifically&#44; more than 75&#37; have mild hyperthyrotropinaemia &#40;TSH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>&#956;IU&#47;mL&#41; on day 3 post birth&#44; which resolves within a few days or weeks &#40;levels normalise in &#62;70&#37; shortly before 1 month post birth&#41;&#44; with spontaneous resolution in most patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">23&#44;24&#44;26&#44;27</span></a> The development of hyperthyroidism in the newborn associated with the presence of TSBAb from a mother with HT is extremely rare &#40;only one case reported in the literature&#41;&#46; Therefore&#44; it does not seem that the thyroid function of the foetus or the newborn could be permanently impaired by the presence of thyroid antibodies&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Management of infants born to mothers with HT</span><p id="par0065" class="elsevierStylePara elsevierViewall">Studies published in recent years have recommended followup of these children with protocols that require collection of multiple blood samples and several visits to a hospital&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a> Currently&#44; the benefits observed with such a followup hardly justify it&#44; and based on our experience and the review of the recent literature we would not recommend it&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">23&#8211;27</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In newborns of mothers with HT&#44; screening for congenital hypothyroiditis at 48<span class="elsevierStyleHsp" style=""></span>h post birth a non-invasive and sufficient intervention to assess thyroid function in the newborn&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The presence of hypothyroidism in pregnant women does not warrant a different approach to neonatal screening for thyroid dysfunction&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Infants born to mothers with Graves-Basedow disease</span><p id="par0080" class="elsevierStylePara elsevierViewall">Children born to mothers with Graves disease &#40;GD&#41; are at significant risk of morbidity and mortality and thus require the use of appropriate protocols for their identification and management&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a> The most recent guidelines and systematic reviews have offered suggestions on how to approach these patients&#44; acknowledging that the lack of evidence and consensus precludes making specific recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The antibodies that cause GD are long-acting TRAb&#44; that belong to the immunoglobulin G class and can freely cross the placenta in the second trimester of gestation&#44;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;29</span></a> of which there are two types&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">TSH-receptor stimulating antibodies that bind the TSH receptor in thyroid follicular cells and cause autonomous thyroid hormone production&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">TSBAb that bind the TSH receptor but do not trigger the intracellular signal cascade&#46;</p></li></ul></p><p id="par0100" class="elsevierStylePara elsevierViewall">At present&#44; two methods are available for the measurement of TRAb&#46; Second-generation methods measure immunoglobulin levels and do not discriminate between thyroid-stimulating or thyroid-blocking antibodies&#44; but they are inexpensive and widely available&#46; Third-generation methods are less available&#44; more complicated and more expensive&#44; but can discriminate between blocking and stimulating antibodies&#46; The presence of stimulating antibodies is associated with a high risk of neonatal hyperthyroidism&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">A mother with current GD or a history of treated GD may have a healthy child&#44; a child with foetal and&#47;or neonatal hyperthyroidism or a child with hypothyroidism&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a> The coexistence of blocking and stimulating antibodies may delay the onset of hyperthyroidism&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">30&#8211;33</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The levels of TRAb in a woman with GD may remain elevated for many years after its cure&#44; be it by means of thyroidectomy&#44; antithyroid medication or radioactive iodine&#46; They should be measured between weeks 20 and 24 of gestation<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a>&#59; if the results are negative&#44; the newborn can be considered to be at low risk&#44; but if they are positive&#44; the newborn should be considered to be at high risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;29&#44;35</span></a></p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Impact on the foetus</span><p id="par0115" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Foetal hyperthyroidism&#58;</span></p><p id="par0125" class="elsevierStylePara elsevierViewall">It usually develops in the third trimester of gestation&#46; It manifests with tachycardia&#44; heart failure&#44; non-immune hydrops fetalis&#44; goitre&#44; intrauterine growth restriction&#44; preterm birth&#44; accelerated bone maturation and craniosynostosis&#46; These symptomatic cases may be treated with administration of antithyroid medication to the pregnant patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;32</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Risk of congenital malformations&#58;</span> secondary to treatment with antithyroid medication&#46;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8728;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Methimazole &#40;MMI&#41;&#47;carbimazole&#58; may produce aplasia cutis&#44; embryopathy with facial dysmorphism&#44; choanal atresia&#44; oesophageal atresia&#44; abdominal wall defects&#44; umbilicocele&#44; urinary tract defects and ventricular septal defects&#44; especially if exposure occurs in the first trimester of gestation&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;33</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8728;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Propylthiouracil &#40;PTU&#41; can not only lead to maternal hepatotoxicity&#44; but may also cause minor congenital malformations&#44; such as cysts in the face and neck or urinary tract anomalies&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;33&#44;36</span></a></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8728;</span><p id="par0145" class="elsevierStylePara elsevierViewall">The ATA recommends suspending treatment during the first trimester if the mother with GD is stable in early pregnancy&#46; If this were not possible&#44; it is preferable to use PTU during this trimester and&#44; given the risk of liver failure&#44; switch to MMI in the second and third trimesters&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;33</span></a> The foetus is more sensitive to antithyroid drugs than the mother&#44; so the mother should be given the lowest possible dose to maintain her hormone levels slightly above the normal range&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;6</span></a> Women with hyperthyroidism require a meticulous endocrinological followup&#44; including measurement of TRAb levels and sonographic assessment of the foetal thyroid in the third trimester&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;29</span></a></p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8728;</span><p id="par0150" class="elsevierStylePara elsevierViewall">PTU and MMI are secreted in breast milk in very small concentrations&#44; do not affect the thyroid of the newborn and are safe drugs during lactation&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a></p></li></ul></p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Impact on newborns</span><p id="par0155" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Neonatal hyperthyroidism or GD</p></li></ul></p><p id="par0165" class="elsevierStylePara elsevierViewall">There is considerable variation in the signs and symptoms of neonatal GD&#44; and they may last 3&#8211;4 months&#44; or even longer&#46; Possible findings include goitre&#44; tracheal compression&#44; low weight&#44; periorbital oedema&#44; retraction of the eyelid&#44; hyperthermia&#44; diarrhoea&#44; irritability&#44; skin redness and warmth&#44; difficulty feeding&#44; stagnant weight gain&#44; tachycardia&#44; heart failure&#44; hypertension&#44; splenomegaly&#44; cholestasis&#44; thrombocytopenia and hyperviscosity&#46; These symptoms are non-specific and could be attributed to congenital infection or sepsis&#46; If these newborns are not identified and managed correctly&#44; the mortality can be as high as 20&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;29&#44;35</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Complications in the child are more severe if the mother remains hyperthyroid in the second half of pregnancy&#44; as sustained normal levels of thyroid hormones are essential for the healthy development of the foetal central nervous system&#46; Children of mothers with GD that are euthyroid at birth usually have a normal cognitive development&#44; but children that have neonatal hyperthyroidism may experience neurodevelopmental impairment&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">33</span></a><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Neonatal hypothyroidism</p><p id="par0180" class="elsevierStylePara elsevierViewall">Infants born to mothers with GD may also present features of hypothyroidism&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">32&#44;34</span></a><ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0185" class="elsevierStylePara elsevierViewall">Transient central hypothyroidism&#46; If maternal hyperthyroidism is poorly controlled during pregnancy&#44; the high levels of thyroid hormones hinder the normal development and maturation of the thyroid gland and the hypothalamic&#8211;pituitary&#8211;thyroid axis in the foetus&#46; This is a transient condition that usually improves in 3&#8211;19 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">31&#44;33</span></a></p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">-</span><p id="par0190" class="elsevierStylePara elsevierViewall">Primary hypothyroidism or transient hyperthyrotropinaemia<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8728;</span><p id="par0195" class="elsevierStylePara elsevierViewall">If there is a predominance of blocking antibodies&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">37</span></a></p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8728;</span><p id="par0200" class="elsevierStylePara elsevierViewall">In 15&#8211;20&#37; of infants born to mothers treated with antithyroid medication&#46; It usually manifests in the first 4&#8211;5 days after birth&#44; and followup of hyperthyroidism may be indicated depending on TRAb levels&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;33&#44;37</span></a></p></li></ul></p></li></ul></p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Clinical management of infants born with neonatal hyperthyroidism</span><p id="par0205" class="elsevierStylePara elsevierViewall">At birth&#44; there may be overt manifestations of hyperthyroidism&#44; but in most cases the onset is delayed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">-</span><p id="par0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Laboratory tests&#58;</span> the presence of TRAb in cord blood is associated with a high risk of developing neonatal hyperthyroidism in the first 2 weeks of life&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">34</span></a> However&#44; the levels of TSH and FT<span class="elsevierStyleInf">4</span> in cord blood have no predictive value when it comes to neonatal hyperthyroidism&#44; as they simply reflect the thyroid function in the foetus&#46;<ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8226;</span><p id="par0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Low-risk newborns&#58;</span> they usually require no followup after 2 weeks post birth &#40;once it is verified that they are healthy and have a normal thyroid function&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a></p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">&#8226;</span><p id="par0220" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">High-risk newborns&#58;</span> in newborns whose mothers did not receive antithyroid medication&#44; the diagnosis is usually made between days 1 and 3 post birth&#44; compared to between days 5 and 15 post birth in newborns whose mothers received antithyroid drugs &#40;the duration of action of MMI is 3 days compared to 24<span class="elsevierStyleHsp" style=""></span>h for PTU&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;29&#44;32</span></a> Of all newborns that develop neonatal hyperthyroidism&#44; 95&#37; have onset in the first month of life &#40;most frequently in the first 2 weeks&#41;&#46;</p></li></ul></p></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0225" class="elsevierStylePara elsevierViewall">In newborns&#44; FT<span class="elsevierStyleInf">4</span> and TSH levels should be measured between days 3 and 5 post birth &#40;or before if patient is symptomatic&#41;&#44; and again between days 10 and 14 post birth &#40;use age-specific reference ranges&#41;&#46; If there are no abnormalities in the first 2 weeks of life&#44; performance of clinical assessments at 4 weeks&#44; 2 months and 3 months post birth &#40;with the option of additional biochemical assessment&#41; suffice for the detection of potential late-onset cases&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a><ul class="elsevierStyleList" id="lis0050"><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">-</span><p id="par0230" class="elsevierStylePara elsevierViewall">Indications for initiating treatment in newborns&#58;<ul class="elsevierStyleList" id="lis0055"><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">&#8226;</span><p id="par0235" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Subclinical biochemical hyperthyroidism&#58;</span> a significant proportion of at-risk newborns are asymptomatic&#46; There is no consensus as to whether they should or not be treated&#44; but it is recommended that they be closely monitored&#46; Some authors propose initiating treatment if FT<span class="elsevierStyleInf">4</span> levels exceed 35<span class="elsevierStyleHsp" style=""></span>pmol&#47;L between days 2 and 14 post birth to prevent neonatal hyperthyroidism&#46; Others consider that asymptomatic patients with FT<span class="elsevierStyleInf">4</span> levels between 43 and 154<span class="elsevierStyleHsp" style=""></span>pmol&#47;L should not be treated &#40;limiting treatment to patients with symptoms or goitre&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;29&#44;34</span></a></p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">&#8226;</span><p id="par0240" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Biochemical hyperthyroidism with clinically significant symptoms</span>&#58; there is widespread agreement that treatment should be initiated as soon as the patient develops symptoms to prevent heart failure and long-term sequelae such as intellectual disability&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;29&#44;35</span></a></p></li></ul></p></li></ul></p><p id="par0245" class="elsevierStylePara elsevierViewall">Treatment of neonatal hyperthyroidism&#58;<ul class="elsevierStyleList" id="lis0060"><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">-</span><p id="par0250" class="elsevierStylePara elsevierViewall">Both MMI and PTU inhibit thyroid peroxidase and therefore synthesis of thyroid hormones&#46; In addition&#44; PTU inhibits peripheral deiodination of T<span class="elsevierStyleInf">4</span> to T<span class="elsevierStyleInf">3</span>&#44; but due to the risk of liver failure&#44; it should only be offered as a short course in the case of thyroid storm&#44; intolerance to MMI treatment or severe complications such as agranulocytosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;33&#44;38</span></a> The clinical and biochemical effects of antithyroid medication may not be noticeable for a few days&#44; until thyroid hormone stores are depleted&#46; Initiate MMI when symptoms develop in the context of biochemical hyperthyroidism&#44; generally at 0&#46;2&#8211;0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day divided into two or three doses &#40;a maximum dose of 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a></p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">-</span><p id="par0255" class="elsevierStylePara elsevierViewall">Perform biochemical assessments weekly until the patient stabilises&#44; and every 1&#8211;2 weeks thereafter&#46;</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">-</span><p id="par0260" class="elsevierStylePara elsevierViewall">If the patient exhibits sympathetic hyperactivity &#40;tachycardia&#44; hypertension&#44; congestive heart failure or poor feeding&#41;&#44; add propranolol at 2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day administered in two doses for 1 or 2 weeks&#46; These infants need to be admitted to hospital for monitoring&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a></p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">-</span><p id="par0265" class="elsevierStylePara elsevierViewall">In severe or refractory cases&#44; add potassium iodide or Lugol solution&#46; The first dose must be administered at least 1<span class="elsevierStyleHsp" style=""></span>h after the first dose of MMI to prevent iodide from being used in the synthesis of new thyroid hormones &#40;Lugol solution &#91;0&#46;05<span class="elsevierStyleHsp" style=""></span>mL&#93;&#44; one drop every 8<span class="elsevierStyleHsp" style=""></span>h&#44; or potassium iodide solution&#44; 1 drop&#47;day&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">-</span><p id="par0270" class="elsevierStylePara elsevierViewall">In the case of haemodynamic instability&#44; respiratory distress or heart failure&#44; add a short course of oral glucocorticoids&#44; which inhibit thyroid hormone secretion and peripheral deiodination of T<span class="elsevierStyleInf">4</span> to T<span class="elsevierStyleInf">3</span> &#40;prednisolone at 2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day administered in 2 doses&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a></p></li></ul></p><p id="par0275" class="elsevierStylePara elsevierViewall">Side effects of MMI occur in 28&#37; of children&#44; and most are mild&#44; such as mild elevation of liver enzymes&#44; transient leukopenia&#44; gastrointestinal symptoms&#44; skin rashes&#44; arthralgia or myalgia&#46; Severe problems may develop in 0&#46;5&#37; of patients&#44; such as agranulocytosis&#44; Stevens-Johnson syndrome&#44; liver damage or vasculitis&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">38</span></a><ul class="elsevierStyleList" id="lis0065"><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">-</span><p id="par0280" class="elsevierStylePara elsevierViewall">Duration of treatment in neonatal hyperthyroidism&#58;</p></li></ul></p><p id="par0285" class="elsevierStylePara elsevierViewall">Neonatal hyperthyroidism is self-limiting&#44; as it only lasts for as long as it takes the body to clear the circulating antibodies&#44; whose half-life is 12 days&#46; Hormone levels have normalised by 6 months in most patients&#44; although there are cases that persist up to the age of 12 months&#46; The usual duration of the treatment is 1&#8211;2 months&#46; The dose must be tapered off based on the FT<span class="elsevierStyleInf">4</span> levels&#46; The decision to end treatment must take into account the clinical condition of the patient and the FT<span class="elsevierStyleInf">4</span> levels&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Clinical management of infants with neonatal hypothyroidism</span><p id="par0290" class="elsevierStylePara elsevierViewall">These cases are usually diagnosed between 4 and 30 days post birth&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">31&#44;33</span></a> Treatment with levothyroxine should be initiated at a dose of 10<span class="elsevierStyleHsp" style=""></span>mcg&#47;kg&#47;day&#44; with testing every 2&#8211;4 weeks to taper the dose&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Most patients improve gradually between ages 3 and 19 months&#44; although many authors prefer waiting until the age of 3 years to attempt discontinuation of treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;29</span></a></p><p id="par0300" class="elsevierStylePara elsevierViewall">Final recommendations are given in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of interest</span><p id="par0305" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:9 [
        0 => array:3 [
          "identificador" => "xres1089600"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1033012"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1089601"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1033013"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Infants born to mothers with HT"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Impact on the mother and foetus"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Impact on newborns"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Management of infants born to mothers with HT"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Infants born to mothers with Graves-Basedow disease"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Impact on the foetus"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Impact on newborns"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Clinical management of infants born with neonatal hyperthyroidism"
            ]
            3 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Clinical management of infants with neonatal hypothyroidism"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflicts of interest"
        ]
        8 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-06-25"
    "fechaAceptado" => "2018-07-19"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1033012"
          "palabras" => array:5 [
            0 => "Newborn"
            1 => "Gestational autoimmune thyroid disease"
            2 => "Hashimoto thyroiditis"
            3 => "Grave&#39;s disease"
            4 => "Thyroid antibodies in pregnancy"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1033013"
          "palabras" => array:5 [
            0 => "Reci&#233;n nacido"
            1 => "Patolog&#237;a tiroidea autoinmune gestacional"
            2 => "Tiroiditis de Hashimoto"
            3 => "Enfermedad de Graves"
            4 => "Anticuerpos antitiroideos en el embarazo"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The objective of this document is to review the current recommendations in the management of the foetus and the newborn child born to mothers with autoimmune thyroid disease&#46; In 2017&#44; the American Thyroid Association published guidelines for the diagnosis and management of thyroid disease during pregnancy and post-partum&#46; In this guide&#44; 97 recommendations were made&#44; and an algorithm for the diagnosis and treatment of gestational hypothyroidism was proposed&#46; Also&#44; in the last year&#44; a wide review was published on the foetal and neonatal approach of the child of a mother with Graves&#8217; disease&#46; The importance of the determination of maternal antibodies against thyrotropin receptor in the second half of pregnancy is stressed&#44; in order to adequately stratify the risk in the neonate&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este documento es revisar las recomendaciones actuales en el manejo del hijo de madre con patolog&#237;a autoinmune tiroidea&#46; En este 2017 se ha publicado la gu&#237;a de la Asociaci&#243;n Americana de Tiroides para el diagn&#243;stico y manejo de la enfermedad tiroidea durante el embarazo y el posparto&#46; En dicha gu&#237;a se establecen 97 recomendaciones y se propone un algoritmo de diagn&#243;stico y tratamiento del hipotiroidismo gestacional&#46; Tambi&#233;n en este &#250;ltimo a&#241;o se ha publicado una amplia revisi&#243;n sobre el abordaje foetal y neonatal del hijo de madre con enfermedad de Graves&#46; Se insiste en la trascendencia de la determinaci&#243;n de anticuerpos maternos frente al receptor de TSH en la segunda mitad del embarazo para estratificar adecuadamente el riesgo en el neonato&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ares Segura S&#44; Temboury Molina C&#44; Chueca Guindulain MJ&#44; Grau Bolado G&#44; Alija Merillas MJ&#44; Caimari Jaume M&#44; et al&#46; Recomendaciones para el diagn&#243;stico y seguimiento del feto y del reci&#233;n nacido hijo de madre con patolog&#237;a tiroidea autoinmune&#46; Ann Pediatr &#40;Barc&#41;&#46; 2018&#59;89&#58;255&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1777
            "Ancho" => 1760
            "Tamanyo" => 339015
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Approach to the management of an infant born to a mother with GD or hyperthyroidism &#40;current or past&#41;&#46; Pregnant mother&#58; measure TRAb levels in the second to third trimester of pregnancy&#46; Inform the neonatologist of results&#46; If TRAb status positive or unknown&#58; high-risk NB&#46; If TRAb status negative&#58; low-risk NB&#46; Newborn &#40;NB&#41;&#58; measure TRAb in cord blood &#40;hormone levels not useful&#41; and monitor&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Since a high percentage of pregnant women have autoimmune thyroid disease&#44; we recommend getting information from the mother or requesting previous records on the disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TPOAb and TgAb do not seem to block the child&#39;s thyroid gland&#46; Newborns of mothers with thyroid autoantibodies and hypothyroidism treated with levothyroxine do not require a thyroid evaluation other than neonatal screening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">In newborns of mothers with HT&#44; the neonatal screen for congenital hypothyroidism at 48<span class="elsevierStyleHsp" style=""></span>h of life is a non-invasive test that suffices to ensure normal thyroid function in the newborn&#46; Consequently&#44; the presence of hypothyroidism in the pregnant mother does not require a different approach to assess thyroid function in the newborn&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Children of mothers with GD&#44; past or present&#44; are at risk of developing foetal or neonatal hyperthyroidism&#44; which may have severe consequences on future health&#46; They may also develop transient hypothyroidism or congenital defects secondary to exposure to maternal medication&#46; These cases require careful followup during pregnancy and in the first months of life&#46; Measurement of TRAb levels during pregnancy or in cord blood is very useful to discriminate between newborns at high risk and at low risk of hyperthyroidism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Followup is indicated in all children born to mothers with GD&#44; past or current&#44; treated or untreated&#44; especially if antibodies persist&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Initiation and maintenance of breastfeeding must be promoted in all newborns of mothers with autoimmune thyroid disorders&#44; even if the mother is currently being treated with MMI&#44; PTU or levothyroxine&#46; The sole contraindication is maternal treatment with radioactive iodine during pregnancy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1862809.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Recommendations&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:38 [
            0 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;K&#46; Alexander"
                            1 => "E&#46;N&#46; Pearce"
                            2 => "G&#46;A&#46; Brent"
                            3 => "R&#46;S&#46; Brown"
                            4 => "H&#46; Chen"
                            5 => "C&#46; Dosiou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/thy.2016.0457"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thyroid"
                        "fecha" => "2017"
                        "volumen" => "27"
                        "paginaInicial" => "315"
                        "paginaFinal" => "389"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28056690"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2014 European Thyroid Association Guidelines for the management of subclinical hypothyroidism in pregnancy and in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Lazarus"
                            1 => "R&#46;S&#46; Brown"
                            2 => "C&#46; Daumerie"
                            3 => "A&#46; Hubalewska-Dydejczyk"
                            4 => "R&#46; Negro"
                            5 => "B&#46; Vaidya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000362597"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Thyroid J"
                        "fecha" => "2014"
                        "volumen" => "3"
                        "paginaInicial" => "76"
                        "paginaFinal" => "94"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25114871"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0165178114005277"
                          "estado" => "S300"
                          "issn" => "01651781"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Detecci&#243;n de la disfunci&#243;n tiroidea en la poblaci&#243;n gestante&#58; &#191;est&#225; justificado el cribado universal&#63;"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Grupo de Trabajo de Trastornos por Deficiencia de Yodo y Disfunci&#243;n Tiroidea de la Sociedad Espa&#241;ola de Endocrinolog&#237;a y Nutrici&#243;n&#59; Sociedad Espa&#241;ola de Ginecolog&#237;a y Obstetricia"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Vila"
                            1 => "I&#46; Velasco"
                            2 => "S&#46; Gonz&#225;lez"
                            3 => "F&#46; Morales"
                            4 => "E&#46; S&#225;nchez"
                            5 => "J&#46;M&#46; Lailla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2012"
                        "volumen" => "139"
                        "paginaInicial" => "509e1"
                        "paginaFinal" => "509e11"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "CD011263"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Spencer"
                            1 => "T&#46; Bubner"
                            2 => "E&#46; Bain"
                            3 => "P&#46; Middleton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2015"
                        "volumen" => "21"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal early pregnancy and newborn thyroid hormone parameters&#58; the Generation R study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Medici"
                            1 => "Y&#46;B&#46; de Rijke"
                            2 => "R&#46;P&#46; Peeters"
                            3 => "W&#46; Visser"
                            4 => "S&#46;M&#46; de Muinck Keizer-Schrama"
                            5 => "V&#46;V&#46; Jaddoe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2011-2398"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2012"
                        "volumen" => "97"
                        "paginaInicial" => "646"
                        "paginaFinal" => "652"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22162477"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of thyroid dysfunction during pregnancy and postpartum&#58; an Endocrine Society clinical practice guideline"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; DeGroot"
                            1 => "M&#46; Abalovich"
                            2 => "E&#46; Alexander"
                            3 => "N&#46; Amino"
                            4 => "L&#46; Barbour"
                            5 => "R&#46; Cobin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2011-2803"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2012"
                        "volumen" => "97"
                        "paginaInicial" => "2543"
                        "paginaFinal" => "2565"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22869843"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S016517811630796X"
                          "estado" => "S300"
                          "issn" => "01651781"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal thyroid hormones early in pregnancy and fetal brain development"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;M&#46; De Escobar"
                            1 => "M&#46;J&#46; Obreg&#243;n"
                            2 => "F&#46;E&#46; del Rey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.beem.2004.03.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Best Pract Res Clin Endocrinol Metab"
                        "fecha" => "2004"
                        "volumen" => "18"
                        "paginaInicial" => "225"
                        "paginaFinal" => "248"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15157838"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Burren C&#46; Guideline for the management of infant of mother with thyroid disease&#46; NHS&#59; 2016&#46; Available from&#58; <a id="intr0010" class="elsevierStyleInterRef" href="http://www.swneonatalnetwork.co.uk/media/89839/swnn-guideline-management-of-infant-of-mother-with-thyroid-disease-final-january-2016-version-03.pdf">http&#58;&#47;&#47;www&#46;swneonatalnetwork&#46;co&#46;uk&#47;media&#47;89839&#47;swnn-guideline-management-of-infant-of-mother-with-thyroid-disease-final-january-2016-version-03&#46;pdf</a>"
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dynamics and predictors of serum TSH and fT4 reference limits in early pregnancy&#58; a study within the Danish National Birth Cohort"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Laurberg"
                            1 => "S&#46;L&#46; Andersen"
                            2 => "P&#46; Hindersson"
                            3 => "E&#46;A&#46; Nohr"
                            4 => "J&#46; Olsen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2016-1387"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2016"
                        "volumen" => "101"
                        "paginaInicial" => "2484"
                        "paginaFinal" => "2492"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27115059"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anti-TPO antibodies diffusion through the placental barrier during pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Seror"
                            1 => "G&#46; Amand"
                            2 => "J&#46; Guibourdenche"
                            3 => "P&#46;F&#46; Ceccaldi"
                            4 => "D&#46; Luton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0084647"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS ONE"
                        "fecha" => "2014"
                        "volumen" => "9"
                        "paginaInicial" => "e84647"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24497920"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Stagnaro-Green"
                            1 => "S&#46;H&#46; Roman"
                            2 => "R&#46;H&#46; Cobin"
                            3 => "E&#46; el-Harazy"
                            4 => "M&#46; Alvarez-Marfany"
                            5 => "T&#46;F&#46; Davies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1990"
                        "volumen" => "264"
                        "paginaInicial" => "14225"
                        "paginaFinal" => "21425"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of thyroid peroxidase antibodies in the outcome of pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Ghafoor"
                            1 => "M&#46; Mansoor"
                            2 => "T&#46; Malik"
                            3 => "M&#46;S&#46; Malik"
                            4 => "A&#46;U&#46; Khan"
                            5 => "R&#46; Edwards"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "7.2006/JCPSP.468471"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Coll Physicians Surg Pak"
                        "fecha" => "2006"
                        "volumen" => "16"
                        "paginaInicial" => "468"
                        "paginaFinal" => "471"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16827958"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Significance of &#40;sub&#41;clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Van den Boogaard"
                            1 => "R&#46; Vissenberg"
                            2 => "J&#46;A&#46; Land"
                            3 => "M&#46; van Wely"
                            4 => "J&#46;A&#46; van der Post"
                            5 => "M&#46; Goddijn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/humupd/dmr024"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Reprod Update"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "605"
                        "paginaFinal" => "619"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21622978"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;E&#46; Haddow"
                            1 => "G&#46;E&#46; Palomaki"
                            2 => "W&#46;C&#46; Allan"
                            3 => "J&#46;R&#46; Williams"
                            4 => "G&#46;J&#46; Knight"
                            5 => "J&#46; Gagnon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199908193410801"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1999"
                        "volumen" => "341"
                        "paginaInicial" => "549"
                        "paginaFinal" => "555"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10451459"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal thyroid peroxidase antibodies during pregnancy&#58; a marker of impaired child development&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46;J&#46; Pop"
                            1 => "E&#46; de Vries"
                            2 => "A&#46;L&#46; van Baar"
                            3 => "J&#46;J&#46; Waelkens"
                            4 => "H&#46;A&#46; de Rooy"
                            5 => "M&#46; Horsten"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "1995"
                        "volumen" => "80"
                        "paginaInicial" => "6"
                        "paginaFinal" => "3561"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood IQ&#44; hearing loss&#44; and maternal thyroid autoimmunity in the Baltimore Collaborative Perinatal Project"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;E&#46; Wasserman"
                            1 => "J&#46;P&#46; Pillion"
                            2 => "A&#46; Duggan"
                            3 => "K&#46; Nelson"
                            4 => "C&#46; Rohde"
                            5 => "E&#46;C&#46; Seaberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/pr.2012.117"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatr Res"
                        "fecha" => "2012"
                        "volumen" => "72"
                        "paginaInicial" => "525"
                        "paginaFinal" => "530"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22918523"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0165178115304157"
                          "estado" => "S300"
                          "issn" => "01651781"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of mild thyroid hormone deficiency in pregnancy on cognitive function in children&#58; lessons from the Generation R study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Ghassabian"
                            1 => "J&#46; Henrichs"
                            2 => "H&#46; Tiemeier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.beem.2013.04.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Best Pract Res Clin Endocrinol Metab"
                        "fecha" => "2014"
                        "volumen" => "28"
                        "paginaInicial" => "221"
                        "paginaFinal" => "232"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24629863"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal hypothyroxinemia in early pregnancy predicts reduced performance in reaction time tests in 5- to 6-year-old offspring"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;J&#46; Finken"
                            1 => "M&#46; van Eijsden"
                            2 => "E&#46;M&#46; Loomans"
                            3 => "T&#46;G&#46; Vrijkotte"
                            4 => "J&#46; Rotteveel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2012-3389"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2013"
                        "volumen" => "98"
                        "paginaInicial" => "1417"
                        "paginaFinal" => "1426"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23408575"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Downstream effects of maternal hypothyroxinemia in early pregnancy&#58; nonverbal IQ and brain morphology in school-age children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;E&#46; Ghassabian"
                            1 => "H&#46; Marroun"
                            2 => "R&#46;P&#46; Peeters"
                            3 => "V&#46;W&#46; Jaddoe"
                            4 => "A&#46; Hofman"
                            5 => "F&#46;C&#46; Verhulst"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2013-4281"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2014"
                        "volumen" => "99"
                        "paginaInicial" => "2383"
                        "paginaFinal" => "2390"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24684462"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antenatal thyroid screening and childhood cognitive function"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;H&#46; Lazarus"
                            1 => "J&#46;P&#46; Bestwick"
                            2 => "S&#46; Channon"
                            3 => "R&#46; Paradice"
                            4 => "A&#46; Maina"
                            5 => "R&#46; Rees"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1106104"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2012"
                        "volumen" => "366"
                        "paginaInicial" => "493"
                        "paginaFinal" => "501"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22316443"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;M&#46; Casey"
                            1 => "E&#46;A&#46; Thom"
                            2 => "A&#46;M&#46; Peaceman"
                            3 => "M&#46;W&#46; Varner"
                            4 => "Y&#46; Sorokin"
                            5 => "D&#46;G&#46; Hirtz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1606205"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2017"
                        "volumen" => "376"
                        "paginaInicial" => "815"
                        "paginaFinal" => "825"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28249134"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A moderate and transient deficiency of maternal thyroid function at the beginning of fetal neocorticogenesis alters neuronal migration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Aus&#243;"
                            1 => "R&#46; Lavado-Autric"
                            2 => "E&#46; Cuevas"
                            3 => "F&#46;E&#46; del Rey"
                            4 => "G&#46; Morreale De Escobar"
                            5 => "P&#46; Berbel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/en.2004-0274"
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocrinology"
                        "fecha" => "2004"
                        "volumen" => "145"
                        "paginaInicial" => "4037"
                        "paginaFinal" => "4047"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15087434"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Newborn of mothers affected by autoimmune thyroiditis&#58; the importance of thyroid function monitoring in the first months of life"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Rovelli"
                            1 => "M&#46;C&#46; Vigone"
                            2 => "C&#46; Giovanettoni"
                            3 => "A&#46; Passoni"
                            4 => "L&#46; Maina"
                            5 => "A&#46; Corrias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1824-7288-36-24"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ital J Pediatr"
                        "fecha" => "2010"
                        "volumen" => "36"
                        "paginaInicial" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20219125"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal autoimmune thyroid disease&#58; relevance for the newborn"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;C&#46; Temboury Molina"
                            1 => "M&#46;J&#46; Rivero Mart&#237;n"
                            2 => "J&#46; de Juan Ruiz"
                            3 => "S&#46; Ares Segura"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2015"
                        "volumen" => "144"
                        "paginaInicial" => "297"
                        "paginaFinal" => "303"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "317&#46;e2"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transient neonatal hypothyroidism is associated with elevated serum anti-thyroglobulin antibody levels in newborns and their mothers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Ordookhani"
                            1 => "P&#46; Mirmiran"
                            2 => "P&#46;G&#46; Walfish"
                            3 => "F&#46; Azizi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jpeds.2006.11.034"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2007"
                        "volumen" => "150"
                        "paginaInicial" => "315"
                        "paginaFinal" => "317"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17307555"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of a follow up protocol of infants born to mothers with antithyroid antibodies during pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Fernandez Rodriguez"
                            1 => "A&#46;J&#46; Perez Diaz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/14767058.2017.1285886"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Matern Fetal Neonatal Med"
                        "fecha" => "2017"
                        "volumen" => "14"
                        "paginaInicial" => "1"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14563084"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enfermedades frecuentes del tiroides en la infancia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Ares Segura"
                            1 => "J&#46; Quero Jim&#233;nez"
                            2 => "G&#46; Morreale de Escobar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Pediatr Aten Primaria"
                        "fecha" => "2009"
                        "volumen" => "11"
                        "numero" => "Supl&#46; 16"
                        "paginaInicial" => "s173"
                        "paginaFinal" => "s204"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Do we need to assess the thyroid function in the infants of mothers with Hashimoto&#39;s thyroiditis&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Habeb"
                            1 => "M&#46; Zubier"
                            2 => "P&#46; Pairaudeau"
                            3 => "V&#46; Mathew"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Arch Dis Child Fetal Neonatal"
                        "fecha" => "2003"
                        "volumen" => "88"
                        "paginaInicial" => "F258"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of neonates born to mothers with Graves&#8217; disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;C&#46; Van der Kaay"
                            1 => "J&#46;D&#46; Wasserman"
                            2 => "M&#46;R&#46; Palmert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2015-1878"
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2016"
                        "volumen" => "137"
                        "paginaInicial" => "e20151878"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26980880"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neonatal hyperthyroidism&#58; neonatal clinical course of two brothers born to a mother with Graves-Basedow disease&#44; before and after total thyroidectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;A&#46; Zuppa"
                            1 => "P&#46; Sindico"
                            2 => "I&#46; Savarese"
                            3 => "V&#46; d&#8217;Andrea"
                            4 => "A&#46; Fracciolla"
                            5 => "F&#46; Cota"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Endocrinol Metab"
                        "fecha" => "2007"
                        "volumen" => "20"
                        "paginaInicial" => "535"
                        "paginaFinal" => "539"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17550218"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Loss of integrity of thyroid morphology and function in children born to mothers with inadequately treated Graves&#8217; disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;J&#46;E&#46; Kempers"
                            1 => "A&#46;S&#46;P&#46; van Trosenburg"
                            2 => "R&#46;R&#46; van Rijn"
                            3 => "A&#46;M&#46;J&#46;B&#46; Smets"
                            4 => "B&#46;J&#46; Smit"
                            5 => "J&#46;J&#46;M&#46; de Vijlder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2006-2042"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2007"
                        "volumen" => "92"
                        "paginaInicial" => "2984"
                        "paginaFinal" => "2991"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17504907"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thyroid disorders of neonates born to mothers with Graves&#8217; disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Papendieck"
                            1 => "A&#46; Chiesa"
                            2 => "L&#46; Prieto"
                            3 => "L&#46; Gru&#241;eiro-Papendieck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Endocrinol Metab"
                        "fecha" => "2009"
                        "volumen" => "22"
                        "paginaInicial" => "547"
                        "paginaFinal" => "553"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19694202"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of hyperthyroidism during pregnancy and lactation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46; Azizi"
                            1 => "A&#46; Amouzegar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1530/EJE-10-1030"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Endocrinol"
                        "fecha" => "2011"
                        "volumen" => "164"
                        "paginaInicial" => "871"
                        "paginaFinal" => "876"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21389085"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Follow-up of newborns of mothers with Graves&#8217; disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46; Levy-Shraga"
                            1 => "L&#46; Tamir-Hostovsky"
                            2 => "V&#46; Boyko"
                            3 => "L&#46; Lerner-Geva"
                            4 => "O&#46; Pinhas-Hamiel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/thy.2013.0489"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thyroid"
                        "fecha" => "2014"
                        "volumen" => "24"
                        "paginaInicial" => "1032"
                        "paginaFinal" => "1039"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24472020"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severity of birth defects after propylthiouracil exposure in early pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;L&#46; Andersen"
                            1 => "J&#46; Olsen"
                            2 => "C&#46;S&#46; Wu"
                            3 => "P&#46; Laurberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/thy.2014.0150"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thyroid"
                        "fecha" => "2014"
                        "volumen" => "24"
                        "paginaInicial" => "1533"
                        "paginaFinal" => "1540"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24963758"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of neonates born to women with Graves&#8217; disease&#58; a cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Besan&#231;on"
                            1 => "J&#46; Beltrand"
                            2 => "I&#46; Le Gac"
                            3 => "D&#46; Luton"
                            4 => "M&#46; Polak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1530/EJE-13-0994"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Endocrinol"
                        "fecha" => "2014"
                        "volumen" => "170"
                        "paginaInicial" => "855"
                        "paginaFinal" => "862"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24670885"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transient congenital hypothyroidism due to thyroid-stimulating hormone receptor blocking antibodies&#58; a case series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Evans"
                            1 => "J&#46;W&#46; Gregory"
                            2 => "J&#46; Barton"
                            3 => "C&#46; Bidder"
                            4 => "J&#46; Gibbs"
                            5 => "R&#46; Pryce"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1258/acb.2011.011007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Clin Biochem"
                        "fecha" => "2011"
                        "volumen" => "48"
                        "paginaInicial" => "386"
                        "paginaFinal" => "390"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21606073"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Methimazole associated neutropenia in a preterm neonate treated for hyperthyroidism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Angelis"
                            1 => "R&#46;A&#46; Kubicky"
                            2 => "A&#46;B&#46; Zubrow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1155/2015/680191"
                      "Revista" => array:5 [
                        "tituloSerie" => "Case Rep Endocrinol"
                        "fecha" => "2015"
                        "volumen" => "2015"
                        "paginaInicial" => "680191"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25810932"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23412879/0000008900000004/v1_201810020628/S2341287918301546/v1_201810020628/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "33443"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Spanish Association of Paediatrics"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008900000004/v1_201810020628/S2341287918301546/v1_201810020628/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301546?idApp=UINPBA00005H"
]

Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2018.08.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	2	15	17
2024 October	38	47	85
2024 September	44	39	83
2024 August	48	69	117
2024 July	30	35	65
2024 June	43	38	81
2024 May	42	28	70
2024 April	43	32	75
2024 March	37	27	64
2024 February	34	29	63
2024 January	45	26	71
2023 December	30	21	51
2023 November	35	42	77
2023 October	39	35	74
2023 September	32	21	53
2023 August	36	32	68
2023 July	41	37	78
2023 June	49	35	84
2023 May	69	30	99
2023 April	38	16	54
2023 March	85	20	105
2023 February	51	17	68
2023 January	51	21	72
2022 December	82	25	107
2022 November	78	32	110
2022 October	85	52	137
2022 September	57	34	91
2022 August	56	52	108
2022 July	53	40	93
2022 June	37	33	70
2022 May	46	60	106
2022 April	59	31	90
2022 March	74	47	121
2022 February	97	43	140
2022 January	180	57	237
2021 December	87	65	152
2021 November	70	44	114
2021 October	149	76	225
2021 September	82	46	128
2021 August	69	43	112
2021 July	79	33	112
2021 June	74	33	107
2021 May	84	51	135
2021 April	209	70	279
2021 March	123	41	164
2021 February	90	34	124
2021 January	120	52	172
2020 December	93	20	113
2020 November	162	19	181
2020 October	175	17	192
2020 September	94	38	132
2020 August	216	47	263
2020 July	244	52	296
2020 June	303	33	336
2020 May	200	34	234
2020 April	202	30	232
2020 March	175	32	207
2020 February	106	28	134
2020 January	105	29	134
2019 December	71	26	97
2019 November	65	24	89
2019 October	72	26	98
2019 September	115	42	157
2019 August	58	20	78
2019 July	63	35	98
2019 June	56	33	89
2019 May	82	26	108
2019 April	79	28	107
2019 March	44	13	57
2019 February	23	9	32
2019 January	28	17	45
2018 December	47	24	71
2018 November	34	21	55
2018 October	70	43	113

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter