A Neonate Is Found to Have Increased TSH and Low

A neonate is found to have increased TSH and low thyroxine (T4) on routine screening.  He was born by vaginal delivery to a 32-year-old woman at 39 weeks gestation.  Apgar scores were 8 and 9 at 1 and 5 minutes, respectively.  Physical examination reveals an enlarged thyroid gland in the normal position.  Neck ultrasound confirms thyroid enlargement.  Which of the following is the most likely cause of this patient's findings?

A) Maternal intake of levothyroxine
B) Maternal intake of propranolol
C) Maternal intake of propylthiouracil
D) Transplacental passage of thyroglobulin
E) Transplacental passage of TSH receptor-stimulating antibodies

Correct Answer:

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