Prenatal diagnosis and early in utero management of fetal dyshormonogenetic goiter

Perrotin, F.; Sembély-Taveau, C.; Haddad, Georges; Lyonnais, Corine; Lansac, J.; Body, G.

doi:10.1016/s0301-2115(00)00346-8

Cited by 43 publications

(55 citation statements)

References 19 publications

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“…Additionally, Agrawal et al point out the significance of initial fetal diagnosis using fetal blood sampling because direct quantification of fetal thyroid hormones allows an accurate determination of the fetal thyroid state [20]. It is important to note that the measurement of amniotic fluid TSH levels using amniocentesis has proven to be unreliable in predicting fetal thyroid status [21,22]. Therefore, [17].…”

Section: Discussionmentioning

confidence: 99%

Successful Intrauterine Therapy for Fetal Goitrous Hypothyroidism during Late Gestation

et al. 2007

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Abstract. We experienced a case of fetal goitrous hypothyroidism in an infant delivered by a 33-year-old woman receiving 300 mg/day of propylthiouracil (PTU) for hyperthyroidism due to Graves' disease. A large fetal goiter (maximum diameter, 60 mm) was detected by magnetic resonance imaging (MRI) at 36 weeks of gestation. Initial fetal blood sampling revealed hypothyroidism with a serum thyroid-stimulating hormone (TSH) of 99 µIU/mL, free triiodothyronine (T 3 ) of 1.97 pg/mL, and free thyroxine (T 4 ) of 0.29 ng/dL. Consequently, a diagnosis of fetal goitrous hypothyroidism due to transplacental passage of maternal PTU was made. To reduce the risk of perinatal complications, 300 µg of levothyroxine sodium (L-T 4 ) was administered into the maternal amniotic fluid twice between 37 and 38 weeks of gestation. Subsequent fetal MRI showed that the size of goiter had decreased. At 38 weeks and 5 days of gestation, a 3042-g male infant was born by cesarean section. There were no severe complications at delivery, although mild tachypnea was observed and the infant's thyroid gland was slightly enlarged. He was treated with L-T 4 for two weeks. At present, his growth and neurological development are normal. This case indicates that intrauterine therapy by the intraamniotic administration of L-T 4 can be effective in treating fetal goitrous hypothyroidism even during late gestation.

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Section: Discussionmentioning

confidence: 99%

Successful Intrauterine Therapy for Fetal Goitrous Hypothyroidism during Late Gestation

et al. 2007

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“…The dose of L -thyroxine used by authors varied from 200 to 800 g/injections which was comparable to our doses. There are 5 cases in the literature in which early treatment was undertaken, the earliest at 23 weeks [1,[6][7][8][9][10] . In our case the treatment was initiated at 21 weeks, as the previous fetus had full-blown hydrops by 29 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment with intra-amniotic injections of 100 g L -thyroxine was started at 21 weeks' gestation (150 g/kg of estimated fetal weight) and increased to 300 g at 23 weeks for increasing goiter size (200-800 g/injection) [1,2] .…”

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confidence: 99%

A Rare Case of Recurrent Fetal Goiter

Kornacki

Mroziński²,

Skrzypczak³

2011

Fetal Diagn Ther

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We report the case of fetal goiter which occurred in two consecutive pregnancies in the same patients. The first one, due to too late diagnosis and no intrauterine treatment, contributed to the immediate postnatal death of the newborn; the second one was properly diagnosed at 19 weeks and then effectively treated prenatally which allowed to avoid the fatal complications for the fetus and the newborn.

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“…Because fetal tachycardia, heart failure, growth restriction, and perinatal death may occur due to fetal thyrotoxicosis in case of thyroxine overdose [33][34][35][36][37] , it is preferable to start with a lower dose to prevent such adverse effects. In 2 previous cases, the initial dose was as low as 150 g [17,26] . In the present case, we adopted 150 g as an initial dose, and it succeeded in regressing the fetal goiter and allowing the fetus to grow normally, without maternal and fetal adverse effects.…”

Section: Discussionmentioning

confidence: 99%

Successful in utero Treatment of Fetal Goitrous Hypothyroidism: Case Report and Review of the Literature

Hashimoto

Hashimoto²,

Suehara³

2006

Fetal Diagn Ther

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In this report, we present a case of fetal goiter with overdistended fetal neck and mild polyhydramnios. Amniocentesis and cordocentesis were conducted at 32 weeks’ gestation and fetal goitrous hypothyroidism was diagnosed. Intra-amniotic injection of l-thyroxine (T4) was performed with a weekly dose of 150 µg four times between 33 and 36 weeks’ gestation. In response to this in utero treatment, the goiter was reduced and polyhydramnios was improved. The mother gave birth to a healthy live male infant with normal thyroid function. From our case report and review of previous literature, we recommend that the amount of l-thyroxine start as low as 150 µg, and that repeat cordocentesis be avoided as long as other clinical and laboratory parameters indicate improvement of the fetal conditions.

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Prenatal diagnosis and early in utero management of fetal dyshormonogenetic goiter

Cited by 43 publications

References 19 publications

Successful Intrauterine Therapy for Fetal Goitrous Hypothyroidism during Late Gestation

Successful Intrauterine Therapy for Fetal Goitrous Hypothyroidism during Late Gestation

A Rare Case of Recurrent Fetal Goiter

Successful in utero Treatment of Fetal Goitrous Hypothyroidism: Case Report and Review of the Literature

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