Treatment of fetal goitrous hypothyroidism: value of direct intramuscular L‐thyroxine therapy

Corral, Edgardo; Reascos, Mauricio; Preiss, Yudith; Rompel, Shanna M.; Sepúlveda, Waldo

doi:10.1002/pd.2560

Cited by 22 publications

(25 citation statements)

References 7 publications

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“…It is currently unknown if long-term developmental outcomes are altered by initiating hormone replacement therapy in the prenatal period, as compared with postnatal replacement only. Successful fetal intramuscular injection has been reported in a case of failed intra-amniotic therapy, where initial treatment failure was attributed to severe esophageal obstruction impeding swallowing (Corral et al ., 2010). …”

Section: Treatment For Fetal Thyroid Disordersmentioning

confidence: 99%

Prenatal pharmacotherapy for fetal anomalies: a 2011 update

Hui

Bianchi

2011

Prenatal Diagnosis

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Fetal therapy can be defined as any prenatal treatment administered to the mother with the primary indication to improve perinatal or long-term outcomes for the fetus or newborn. This review provides an update of the pharmacological therapies that are solely directed at the fetus with anomalies and outlines a future transcriptomic approach. Fetal anomalies targeted with prenatal pharmacotherapy are a heterogeneous group of structural, endocrine, and metabolic conditions, including congenital cystic adenomatoid malformation (CCAM), congenital adrenal hyperplasia, congenital heart block, fetal tachyarrhythmias, inborn errors of metabolism, fetal thyroid disorders, and polyhydramnios. To date, the majority of pharmacotherapies for fetal anomalies have been evaluated only in retrospective, uncontrolled studies. The way forward will be with an evidence-based approach to prenatal pharmacological interventions.

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Section: Treatment For Fetal Thyroid Disordersmentioning

confidence: 99%

Prenatal pharmacotherapy for fetal anomalies: a 2011 update

Hui

Bianchi

2011

Prenatal Diagnosis

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“…Fetal goiter is a very rare pathology with an incidence of one in every 40 000 deliveries 1 . It can be diagnosed during the second or third trimester of gestation with the triad of anterior cervical mass, hyperextension of head and polyhydramnios 1 .…”

Section: Introductionmentioning

confidence: 99%

“…It can be diagnosed during the second or third trimester of gestation with the triad of anterior cervical mass, hyperextension of head and polyhydramnios 1 . Fetal goiter may cause: hyperextension of head leading to malpresentation during delivery; 2 high‐output cardiac failure due to intrathyroid arteriovenous shunting; 3 esophageal and tracheal compression which may cause polyhydramnios, preterm labor, and neonatal asphyxia and death; 4 and motor or cognitive deficits or impaired intellectual development in cases of fetal hypothyroisim 1,2 . Fetal goiter may be associated with hyperthyroidism, hypothyroidism or euthyroid state, hence, the assessment of fetal thyroid function is necessary to start early treatment 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Prenatal treatment of fetal hypothyroidism requires the direct administration of thyroid hormones to the fetus as the placenta is relatively impermeable to thyroxin (T4) and triodothyronine (T3) in the mother's blood 6 . Even though intravascular and intramuscular administration are available for direct delivery of medication to the fetus, intra‐amniotic injection of L‐thyroxin, with the aim of reaching the fetal circulation through the fetal gastrointestinal tract, has become the standard therapy for fetal goitrous hypothyroidism due to its ease, low rate of complications and administration at long intervals 1,6 …”

Section: Introductionmentioning

confidence: 99%

“…Fetal goiter is a very rare pathology with an incidence of one in every 40 000 deliveries. 1 It can be diagnosed during the second or third trimester of gestation with the triad of anterior cervical mass, hyperextension of head and polyhydramnios. 1 Fetal goiter may cause: hyperextension of head leading to malpresentation during delivery; 2 high-output cardiac failure due to intrathyroid arteriovenous shunting; 3 esophageal and tracheal compression which may cause polyhydramnios, preterm labor, and neonatal asphyxia and death; 4 and motor or cognitive deficits or impaired intellectual development in cases of fetal hypothyroisim.…”

Section: Introductionmentioning

confidence: 99%

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Intrauterine diagnosis and treatment of fetal goitrous hypothyroidism

Esmer

Gül

Dağdeviren

et al. 2012

J of Obstet and Gynaecol

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We present two cases of fetal hypothyroidism with goiter which were successfully diagnosed and treated in utero. In both cases, ultrasonographic examination demonstrated a bilobed solid anterior neck mass with increased vascularity compatible with enlarged thyroid gland. Fetal blood sampling revealed hypothyroidism. Intra-amniotic injection of L-thyroxin caused a reduction in thyroid gland size and enabled vaginal delivery without complication. In the first case, maternal thyroid hormone levels and autoantibodies were normal and the neonate had hypothyroidism suggesting the diagnosis of dyshormonogenesis. In the second case, the fetus had transient hypothyroidism, which resolved spontaneously after delivery. Maternal thyroid function tests and autoantibodies were normal and both the mother and neonate had normal urinary iodine, excluding the diagnosis of iodine deficiency or excess. Thus, we believe that transplacental transfer of undetermined factors might be a cause of transient congenital hypothyroidism. Also, we reviewed the literature and described controversial issues regarding the management of fetal goiter.

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