Management of fetal thyroid goitres: a report of 11 cases in a single perinatal unit

Abstract

Fetal thyroid goitres may reveal hormonal imbalance. This can jeopardize neurological development and fetal outcome even when early postnatal treatment is provided. We report a series of 11 goitres diagnosed antenatally in women with past or present thyroid disorders or discovered fortuitously on ultrasound scan. Fetuses presented with hyperthyroidism in three cases and hypothyroidism in eight. Hypothyroidism was iatrogenic in five cases, due to maternal anti‐thyroid drugs. Hyperthyroidism was induced by transplacental transfer of thyroid stimulating antibodies (TSHrab). Accurate diagnosis of fetal thyroid status was obtained by fetal blood sampling but this invasive method was deemed necessary only in four cases as maternal clinical and biological data and ultrasound signs provided sufficient information to infer the type of thyroid disorder in the remaining patients. Fetal therapy relied on reduction of maternal antithyroid medication and, in selected cases, intra‐amniotic injection of levothyroxin in hypothyroidism, and on administration of antithyroid drugs in hyperthyroidism. All newborns were healthy and none displayed consequences of severe thyroid imbalance. No caesarean section was performed for dystocia. Fetal thyroid goitres can be managed successfully with selected use of invasive diagnostic and therapeutic techniques. Copyright © 2000 John Wiley & Sons, Ltd.

Successful Intrauterine Therapy for Fetal Goitrous Hypothyroidism during Late Gestation

“…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.…”

“…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.…”

Spectrum and outcome of prenatally diagnosed fetal tumors

“…Also, tumors may progress in size and therefore compress cervical or mediastinal structures 5 -7 . Intrauterine therapy might be an option in some cases, such as in the transplacental treatment of a fetal goiter 8,9 or drainage of pericardial effusion in cases with pericardial teratoma. More rarely, laser ablation of arteriovenous malformations or tumor decompression in utero has been reported 10,11 .…”

Nadczynność tarczycy w ciąży — rola oznaczania przeciwciał przeciwko receptorowi TSH i ultrasonograficznego monitorowania płodu

“…Foetal thyroid measurements above the 95 th percentile were indicative of foetal goitre. In line with previous reports, colour Doppler ultrasonography was also used to assess foetal thyroid vascularisation [32,33].…”

“…The mean age of the studied group of 77 pregnant women was 30.9 years (range: [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. Sixty one patients presented with hyperthyroidism: gestational hyperthyroidism (n = 35) or Graves' disease (n = 26).…”