Intrauterine Treatment of Fetal Goitrous Hypothyroidism Controlled by Determination of Thyroid-Stimulating Hormone in Fetal Serum

Grüner, Christian; Kollert, A; Wildt, L.; Dörr, H. G.; Beinder, Ernst; Lang, N.

doi:10.1159/000053880

Cited by 58 publications

(48 citation statements)

References 10 publications

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“…The above potential complications depend on several factors: 1) poor control of hyperthyroidism throughout pregnancy may induce transient central hypothyroidism (103,104); 2) excessive amounts of ATDs are responsible for fetal and neonatal hypothyroidism (105), and 3) high titers of serum TRAb between 22 and 26 weeks gestation are risk factors for fetal or neonatal hyperthyroidism (106)(107)(108)(109). TRAb are present in over 95% of patients with active Graves' hyperthyroidism and high titers may remain still elevated following ablation therapy (79).…”

Section: And Recommendation 30mentioning

confidence: 99%

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Alexander

Pearce

Brent

et al. 2017

Thyroid

1,993

2,716

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INTRODUCTION Pregnancy has a profound impact on the thyroid gland and thyroid function. The gland increases 10% in size during pregnancy in iodine-replete countries and by 20%-40% in areas of iodine deficiency. Production of thyroxine (T 4 ) and triiodothyronine (T 3 ) increases by 50%, along with a 50% increase in the daily iodine requirement. These physiological changes may result in hypothyroidism in the later stages of pregnancy in iodine-deficient women who were euthyroid in the first trimester. The range of thyrotropin (TSH), under the impact of placental human chorionic gonadotropin (hCG), is decreased throughout pregnancy with the lower normal TSH level in the first trimester being poorly defined and an upper limit of 2.5 mIU/L. Ten percent to 20% of all pregnant women in the first trimester of pregnancy are thyroid peroxidase (TPO) or thyroglobulin (Tg) antibody positive and euthyroid. Sixteen percent of the women who are euthyroid and positive for TPO or Tg antibody in the first trimester will develop a TSH that exceeds 4.0 mIU/L by the third trimester, and 33%-50% of women who are positive for TPO or Tg antibody in the first trimester will develop postpartum thyroiditis. In essence, pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency, and postpartum thyroiditis in women with underlying Hashimoto's disease who were euthyroid prior to conception.Knowledge regarding the interaction between the thyroid and pregnancy/the postpartum period is advancing at a rapid pace. Only recently has a TSH of 2.5 mIU/L been accepted as the upper limit of normal for TSH in the first trimester. This has important implications in regards to interpretation of the literature as well as a critical impact for the clinical diagnosis of hypothyroidism. Although it is well accepted that overt hypothyroidism and overt hyperthyroidism have a deleterious impact on pregnancy, studies are now focusing on the potential impact of subclinical hypothyroidism and subclinical hyperthyroidism on maternal and fetal health, the association between miscarriage and preterm delivery in euthyroid women positive for TPO and/or Tg antibody, and the prevalence and long-term impact of postpartum thyroiditis. Recently completed prospective randomized studies have begun to produce critically needed data on the impact of treating thyroid disease on the mother, fetus, and the future intellect of the unborn child.It is in this context that the American Thyroid Association (ATA) charged a task force with developing clinical guidelines on the diagnosis and treatment of thyroid disease during pregnancy and the postpartum. The task force consisted of international experts in the field of thyroid disease and pregnancy, and included representatives from the ATA, Asia and Oceania Thyroid Association, Latin American Thyroid Society, American College of Obstetricians and Gynecologists, and the Midwives Alliance of North America. Inclusion of thyroidologists, obstetricians, and midwives ...

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Section: And Recommendation 30mentioning

confidence: 99%

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Alexander

Pearce

Brent

et al. 2017

Thyroid

1,993

2,716

View full text Add to dashboard Cite

show abstract

“…On the other hand, Gruner et al tried five weekly doses of 250 µg L-T 4 from 26 weeks of gestation in a case with fetal goitrous hypothyroidism caused by defect in thyroid hormone synthesis. Furthermore, the dosage was increased to 500 µg in the subsequent five injections because of the persistent goiter and the elevated TSH in the cord blood [23]. To determine the appropriate dose of L-T 4 and interval of administration, sufficient pharmacokinetic data of human fetal uptake and absorption of L-T 4 from the amniotic fluid will be necessary.…”

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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“…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%

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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Intrauterine Treatment of Fetal Goitrous Hypothyroidism Controlled by Determination of Thyroid-Stimulating Hormone in Fetal Serum

Cited by 58 publications

References 10 publications

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Successful Intrauterine Therapy for Fetal Goitrous Hypothyroidism during Late Gestation

Fetal neck tumors – antenatal and intrapartum management

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