Experience with Intraamniotic Thyroxine Treatment in Nonimmune Fetal Goitrous Hypothyroidism in 12 Cases

Ribault, V.; Castanet, Mireille; Bertrand, Anne-Marie; Gadrey, Jean; Vuillard, E.; Luton, Dominique; Polak, Michel

doi:10.1210/jc.2008-2681

Cited by 81 publications

(78 citation statements)

References 45 publications

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“…This is a major limitation in most reported cases, including our own. Additionally, well-described comprehensive, case series 16 confirm the limited utility of AF TSH alone as a marker of the evolution of such cases. On the other hand, more important to us is the first report so far about the use of 3DPD imaging by Nath et al, 17 in which the authors used 3D sonography and power Doppler angiography in the evaluation and management of a fetal goiter.…”

Section: Discussionmentioning

confidence: 83%

Use of 3-Dimensional Sonography for Prenatal Evaluation and Follow-up of Fetal Goitrous Hypothyroidism

Marín

Bello-Muñoz²,

Martínez³

et al. 2010

Journal of Ultrasound in Medicine

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Objective. Fetal goitrous hypothyroidism is a rare and potentially lethal condition. Consequently, its early diagnosis and treatment improve prognosis. Thyroid hormone measurement in either fetal serum or amniotic fluid implies important risks. Here we present a fetal goiter and the follow-up procedure, both done by the traditional method and by using 3-dimensional power Doppler (3DPD) imaging and virtual organ computer-aided analysis (VOCAL). Methods. A single well-documented case of fetal goiter was followed weekly from 22 weeks until delivery. Amniocentesis for thyrotropin (TSH) and free thyroxine (T 4 ) measurement as well as levothyroxine injections were performed at every control. In addition to amniocentesis, every control involved a sonographic evaluation, which included standard measurements of the gland and the capture of volume image sets in gray scale and 3DPD. Volume calculation of the gland was done using VOCAL software. Vascularization of the gland was evaluated by the vascularization index (VI) included in the software. Results. With treatment, TSH levels decreased progressively until normalization. Free T 4 levels increased toward the end of gestation. Sonographic measurements of the gland volume to estimated fetal weight ratio decreased across treatment as levels of TSH did. The VI clearly depicted the vascular regression of the goiter, decreasing throughout treatment in a consistent way until 24 hours before delivery. Conclusions. Gray scale and 3DPD evaluations of the thyroid gland have been validated under similar circumstances and might be reliable complements to the invasive methods used in the management of this fetal condition.

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Section: Discussionmentioning

confidence: 83%

Use of 3-Dimensional Sonography for Prenatal Evaluation and Follow-up of Fetal Goitrous Hypothyroidism

Marín

Bello-Muñoz²,

Martínez³

et al. 2010

Journal of Ultrasound in Medicine

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“…The [11,12]. In the biggest study, described by Ribault et al, 12 fetuses were treated antenatally with intraamniotic injections of L-thyroxine for goitrous hypothyroidism [10]. In all except one of these fetuses, goiter size decrease was observed after the therapy.…”

Section: Intrauterine Therapymentioning

confidence: 99%

“…Mainly, this is possible for diagnosis of fetal goitrous hypothyroidism. There are several reports on the successful intrauterine treatment of goitrous hypothyroidism with repeated intraamniotic injection of L-thyroxine [3][4][5][6][7][8][9][10]. Such a treatment must follow the precise ultrasound assessment of the mass and, importantly, an amniocentesis to obtain the results of TSH, fT3 and fT4 concentrations in the amniotic fluid.…”

Section: Intrauterine Therapymentioning

confidence: 99%

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Fetal neck tumors – antenatal and intrapartum management

Kornacki

Skrzypczak

2017

Ginekol Pol

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In this review article we describe the ante-and perinatal management of fetal neck tumors. Although there are rare congenital anomalies, the clinical consequences for the fetus may be fatal and include airways obstruction, heart insufficiency, pulmonary hypoplasia and cosmetic effect. The right management allows to decrease the fetal and neonatal mortality and morbidity associated with the disease. It includes intrauterine therapy in some cases, mostly in a goitrus hypothyroidism of the fetus, but firstly, an assessment of the fetal airways patency with a subsequent, eventual Ex-Utero Intrapartum Treatment (EXIT).

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“…In these cases, levothyroxine can be injected into the amniotic fluid, which is then swallowed by the fetus leading to a decrease in the size of the fetal thyroid and in the degree of hydramnios, allowing vaginal delivery [15]. Even if the decrease in the thyroid volume is paralleled by a certain degree of decrease in fetal TSH level, the exact role of the TSH in the thyroid volume development in utero remains to be fully understood [15]. A procedure that is even riskier than injections into the amniotic cavity, i.e.…”

Section: Fetal Hypothyroidismmentioning

confidence: 99%

Therapeutic Approach of Fetal Thyroid Disorders

Polak

Vliet

2010

Horm Res Paediatr

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Recent advances in fetal imaging techniques and fetal hormonology allow the identification in the fetus of thyroid function disorders that can potentially be treated in utero by giving drugs to the mother. In women with Graves’ disease (when fetal hyperthyroidism is present), it can generally be treated in a noninvasive way by optimizing treatment of the mother. For goitrous nonimmune fetal hypothyroidism leading to hydramnios, intra-amniotic injections of thyroxine have been reported to decrease the size of the fetal thyroid. Experience with such a procedure is limited and the risk of provoking premature labor or infections should be carefully evaluated. Thus, follow-up of the efficacy and the possible long-term undesired consequences of medical interventions administered to the fetus are of great importance. Such interventions should only be performed by specialized teams with extensive experience in perinatal care.

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Experience with Intraamniotic Thyroxine Treatment in Nonimmune Fetal Goitrous Hypothyroidism in 12 Cases

Cited by 81 publications

References 45 publications

Use of 3-Dimensional Sonography for Prenatal Evaluation and Follow-up of Fetal Goitrous Hypothyroidism

Use of 3-Dimensional Sonography for Prenatal Evaluation and Follow-up of Fetal Goitrous Hypothyroidism

Fetal neck tumors – antenatal and intrapartum management

Therapeutic Approach of Fetal Thyroid Disorders

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