Use of ultrasound to distinguish between fetal hyperthyroidism and hypothyroidism on discovery of a goiter

Huel, C.; Gadrey, Jean; Vuillard, E.; Ouahba, J; Piketty, Marie-Liesse; Oury, Jean‐François; Luton, Dominique

doi:10.1002/uog.6315

Cited by 116 publications

(79 citation statements)

References 51 publications

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“…Fetal thyroid dysfunction precedes neonatal hyperthyroidism. Optimal management of GD during pregnancy is crucial to prevent fetal death or permanent neurological impairments (8,9,10,11,12,13,14,15,16,17,18,19). Neonatal hyperthyroidism has been evaluated in several studies (2,3,7) but recent case reports (20,21,22) indicate that this transient disease is still overlooked by clinicians, leading to severe complications that could have been prevented.…”

Section: Introductionmentioning

confidence: 99%

Management of neonates born to women with Graves' disease: a cohort study

Besançon

Beltrand

Gac

et al. 2014

European Journal of Endocrinology

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Objective: Hyperthyroidism in neonates born to mothers with Graves' disease (GD) can be associated with significant morbidity and mortality, but is still overlooked by clinicians. Management of neonatal hyperthyroidism would be improved by a better understanding of the predictive factors involved. The aim of this study was to evaluate the course of thyroid function and clinical outcomes during the first postnatal month in babies born to mothers with GD. Design: Prospective observational study. Methods: Sixty-eight neonates born to mothers with GD were managed from birth and divided into three groups based on thyrotropin receptor antibody (TRAb) and anti-thyroid drug (ATD) status in the mother: TRAb /ATDCve neonates, 24 (72.7%) had positive TRAb on cord blood assays, and seven of these developed neonatal hyperthyroidism. FT 4 elevation between days 3 and 7 but not at birth was predictive of the development of hyperthyroidism. Conclusions: TRAb status should be checked in the third trimester in mothers with GD and on cord blood in their neonates; if positive, it indicates a high risk of neonatal hyperthyroidism. FT 4 measurement at birth should be repeated between days 3 and 5 (and by day 7 at the latest); rapid FT 4 elevation during the first postnatal week is predictive of hyperthyroidism and warrants ATD therapy.

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Section: Introductionmentioning

confidence: 99%

Management of neonates born to women with Graves' disease: a cohort study

Besançon

Beltrand

Gac

et al. 2014

European Journal of Endocrinology

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“…This reduction somehow showed a linear correlation with AF TSH levels. In a very complete case series, Huel et al 15 described the utility of some sonographic markers in assessing the thyroid status in fetuses with goiters. They described a significant difference in the circulatory pattern as seen with a color Doppler signal, showing a peripheral pattern of vascularization in hypothyroid goiters, which is the kind of vascularization pattern we have described here.…”

Section: Discussionmentioning

confidence: 99%

“…In other disciplines, 3DPD sonography has been used extensively for such vascularity-quantifying tasks. 14,15 This possibility encouraged us to measure these vascular branches in a given volume and to use them as markers of the progression (or regression) of vascular patterns inside the fetal thyroid gland.…”

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confidence: 99%

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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“…Ten percent of the mother's level is transferred to the fetus in the [17][18][19][20][21][22] th gestational week and 50% is transferred to the fetus in the 28 th -32 nd weeks. Subsequently, the level in the fetus gradually increases and exceeds the mother's level in the term newborn (14).…”

Section: Treatment Approachesmentioning

confidence: 99%

“…If the blood supply is more intense in the periphery, the Turk Pediatri Ars 2017; 52: 1-9 Kurtoğlu and Özdemir. Fetal neonatal hyperthyroidism possibility of hypothyroidism is higher (17). The fetal bone age is interpreted with knee epiphysis nuclei.…”

Section: Treatment Approachesmentioning

confidence: 99%

Fetal neonatal hyperthyroidism: diagnostic and therapeutic approachment

Kurtoğlu¹,

Özdemır²

2017

Turk Pediatri Ars

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Fetal and neonatal hyperthyroidism may occur in mothers with Graves' disease. Fetal thyrotoxicosis manifestation is observed with the transition of TSH receptor stimulating antibodies to the fetus from the 17th-20th weeks of pregnancy and with the fetal TSH receptors becoming responsive after 20 weeks. The diagnosis is confirmed by fetal tachycardia, goiter and bone age advancement in pregnancy and maternal treatment is conducted in accordance. The probability of neonatal hyperthyroidism is high in the babies of mothers that have ongoing antithyroid requirement and higher antibody levels in the last months of pregnancy. Clinical manifestation may be delayed by 7-17 days because of the antithyroid drugs taken by the mother. Neonatal hyperthyroidism symptoms can be confused with sepsis and congenital viral infections. Herein, the diagnosis and therapeutic approach are reviewed in cases of fetal neonatal hyperthyroidism. (Turk Pediatri Ars 2017; 52: 1-9)

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Use of ultrasound to distinguish between fetal hyperthyroidism and hypothyroidism on discovery of a goiter

Abstract: Objectives

Cited by 116 publications

References 51 publications

Management of neonates born to women with Graves' disease: a cohort study

Management of neonates born to women with Graves' disease: a cohort study

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

Fetal neonatal hyperthyroidism: diagnostic and therapeutic approachment

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