Antenatal diagnosis and treatment of hypothyroid fetal goiter in an euthyroid mother: a case report and review of literature

Abstract

Fetal goiter is an extremely rare complication of pregnancy. Its incidence is 1 in 40,000 deliveries. Antithyroid maternal therapy is responsible for 10-15% of fetal congenital hypothyroidism and can be considered as the most frequent underlying cause for this condition. The frequency of fetal goiter that is associated with fetal hypothyroidism and normal maternal thyroid function, as in our case, is even less frequent. Fetal goiter is associated with increased rate of perinatal complications and long-term morbidity, due to peripartum complications including labor dystocia due to its mass effect, as well as neonatal airway obstruction that may lead to hypoxic-ischemic brain injury and death. We present, in this study, a case report of late antenatal fetal goiter in an euthyroid woman and a literature review of the diagnosis and treatment of these cases.

Prenatal diagnosis and successful intrauterine treatment of severe congenital hypothyroidism associated with fetal goiter

“…As repeated invasive procedures needed for exact diagnosis and treatment are associated with risk of severe complications, such as fetal bradycardia, bleeding, infection, preterm delivery, and rupture of the membranes (0.5–9% complication rate), the risk–benefit ratio is not clear and cannot be generally stated. Only a few reports on goitrous hypothyroidism treated in utero have been published, and most of them are reported or cited by Ribault . The reports vary markedly in data complexity, diagnostic management, treatment methods and outcomes, therefore reproducibility is limited and no management guidelines exist so far.…”

“…As only a limited number of cases of congenital hypothyroidism and even fewer cases of goitrous hypothyroidism have been published, treatment of fetal hypothyroidism remains unstandardized. We present a case of severe fetal goitrous hypothyroidism successfully treated by intra‐amniotic administration of L‐thyroxin.…”

Iodine-Induced Fetal Hypothyroidism: Diagnosis and Treatment with Intra-Amniotic Levothyroxine

“…Esophageal compression leads to the decreased ability of the fetus to swallow amniotic fluid, resulting in polyhydramnios, which increases the risk for preterm delivery [32, 33]. Tracheal compression can lead to asphyxia after birth [32, 33]. Intrathyroidal arteriovenous shunting can cause high-output cardiac failure of the fetus and secondary hydrops [34].…”

“…Potential pregnancy- and delivery-related complications associated with the fetal goiter are multiple. Esophageal compression leads to the decreased ability of the fetus to swallow amniotic fluid, resulting in polyhydramnios, which increases the risk for preterm delivery [32, 33]. Tracheal compression can lead to asphyxia after birth [32, 33].…”

Fetal Goitrous Hypothyroidism and Polyhydramnios in a Patient with Compound Heterozygous <b><i>DUOXA2</i></b> Mutations

“…Transplacental transfer of excessive thyroid-stimulating antibody can cause fetal hyperthyroidism with goiter, while transfer of anti-thyroid drug may cause fetal hypothyroidism with goiter. Because of the potential obstetric complications due to fetal goiter (e.g., polyhydramnios, preterm delivery, and face presentation), antenatal treatment for the condition is under investigation [23, 24]. Fetal goiter in mothers without Graves’ disease is even rarer.…”