Prenatal Treatment of Fetal Hypothyroidism: Is There More Than One Option?

Nicolini, Umberto; Venegoni, E.; Acaia, Barbara; Cortelazzi, Donatella; Beck‐Peccoz, Paolo

doi:10.1002/(sici)1097-0223(199605)16:5<443::aid-pd892>3.0.co;2-2

Cited by 30 publications

(17 citation statements)

References 27 publications

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“…One disadvantage of this technique is that it requires multiple invasive procedures. Another alternative is maternal TRIAC therapy (15,40). Our results on transplacental passage of TRIAC confirm that TRIAC administered to the mother does cross the placenta.…”

Section: Discussionsupporting

confidence: 71%

“…A recent report suggests that 3,5,3 0 -triiodothyroacetic acid (TRIAC) given to propylthiouracil (PTU)-treated hyperthyroid mothers might be useful in the treatment of fetal goiter (15). TRIAC is a thyroid hormone analog that results from the oxidative deamination and decarboxylation of the alanine side-chain of T3 and is present in low concentration in normal subjects (16).…”

Section: Introductionmentioning

confidence: 99%

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Maternal compound W serial measurements for the management of fetal hypothyroidsm

Cortelazzi

Morpurgo

Zamperini

et al. 1999

European Journal of Endocrinology

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Objective: The diagnosis of fetal hypothyroidism is based at present on measurements of TSH and free thyroxine (FT4) in fetal blood samples obtained by cordocentesis. The measurement of maternal serum and urinary concentrations of compound W, immunologically similar to but chromatographically distinct from diiodothyronine sulfate (T2S), has been advocated as a new possible marker for fetal hypothyroidism. Design: In this paper, we measured serum compound W levels in 84 pregnant women, 20 with and 64 without thyroid disorders before and during specific treatment. Compound W was also assessed in fetal blood obtained by cordocentesis from 49 normal fetuses and 4 fetuses with suspected hypothyroidism due to transplacental passage of propylthiouracil (PTU). Compound W levels were measured by T2S RIA in maternal and fetal serum. To assess the possible usefulness of 3,5,3 0 -triiodothyroacetic acid (TRIAC) for therapy of fetal hypothyroidism we evaluated the transplacental passage of TRIAC by administering the drug to four pregnant women before therapeutic abortion. Results: In normal pregnancies, both maternal and fetal compound W levels increased progressively during gestation with a significant direct correlation (P < 0.001, in both mothers and fetuses). Moreover, a significant positive correlation was observed between fetal compound W and fetal FT4 values (P < 0.005), whereas no correlation was observed between maternal serum compound W and maternal FT4 in either euthyroid or hyperthyroid women, suggesting the fetal origin of compound W. The hypothyroid fetuses of PTU-treated mothers showed low compound W levels, and maternal compound W values were in the low normal range and did not show the typical increase during progression of gestation. A significant increase of maternal compound W was observed when the PTU dose was reduced. TRIAC was documented to cross the placental barrier and the treatment of a hyperthyroid pregnant woman on PTU caused the high fetal TSH levels and goiter to normalize. Conclusions: Serial measurements of 3,3 0 -T2S crossreactive materials (compound W and 3,3 0 -diiodothyroacetic acid sulfate) in maternal blood and the administration of TRIAC to the mother may represent a useful and safe alternative to invasive techniques for the diagnosis and therapy of fetal hypothyroidism.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Maternal compound W serial measurements for the management of fetal hypothyroidsm

Cortelazzi

Morpurgo

Zamperini

et al. 1999

European Journal of Endocrinology

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“…Cortelazzi and coworkers (Cortelazzi et al 1999) showed that TA 3 administration (2100-2800 µg/day) between 26 and 39 weeks of gestation to a hyperthyroid pregnant woman treated with PTU effectively reduced fetal goiter size within 15 days. A similar case was reported by Nicolini and coworkers (Nicolini et al 1996). In addition, Asteria and coworkers (Asteria et al 1999) reported on the use of TA 3 in the treatment of a pregnant woman with RTHβ because of suspected hypothyroidism in the fetus carrying the same heterozygous mutation in TRβ.…”

Section: Brain and Neurogenesissupporting

confidence: 73%

Triiodothyroacetic acid in health and disease

Groeneweg

Peeters

Visser

et al. 2017

Journal of Endocrinology

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Thyroid hormone (TH) is crucial for development and metabolism of many tissues. The physiological relevance and therapeutic potential of TH analogs have gained attention in the field for many years. In particular, the relevance and use of 3,3′,5-triiodothyroacetic acid (Triac, TA 3 ) has been explored over the last decades. Although TA 3 closely resembles the bioactive hormone T 3 , differences in transmembrane transport and receptor isoformspecific transcriptional activation potency exist. For these reasons, the application of TA 3 as a treatment for resistance to TH (RTH) syndromes, especially MCT8 deficiency, is topic of ongoing research. This review is a summary of all currently available literature about the formation, metabolism, action and therapeutic applications of TA 3 .

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“…The first intrauterine treatment of fetal goitrous hypothyroidism due to the transplacental passage of maternal PTU was successfully performed in 1980 by injecting L-T 4 into the amniotic fluid [11]. To date, 8 similar cases, including the present case, have been reported in the English literature [2,[15][16][17][18]. Intrauterine L-T 4 therapy was considered to be effective for both the fetal goiter and the hypothyroidism in all reported cases.…”

Section: Discussionmentioning

confidence: 64%

“…Van Herle et al recommended the intraamniotic injection of L-T 4 beginning at 32 weeks of gestation [24], while Sagot et al suggested the intrauterine treatment of thyroid goiters at late ages of gestation up to 36 weeks [25]. Regarding fetal goitrous hypothyroidism due to maternal PTU, intrauterine therapy was initiated between 25 and 35 weeks of gestation [2,[15][16][17][18]. In the present case, the diagnosis made late at 36 weeks of gestation.…”

Section: Discussionmentioning

confidence: 72%

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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Prenatal Treatment of Fetal Hypothyroidism: Is There More Than One Option?

Cited by 30 publications

References 27 publications

Maternal compound W serial measurements for the management of fetal hypothyroidsm

Maternal compound W serial measurements for the management of fetal hypothyroidsm

Triiodothyroacetic acid in health and disease

Successful Intrauterine Therapy for Fetal Goitrous Hypothyroidism during Late Gestation

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