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Administration of thyroxine into the amniotic fluid is effective therapy for goiter and hypothyroidism in fetuses
The background of the study. Hypothyroidism and thyroid enlargement (goiter) can occur during fetal life. This article describes the detection and treatment of goiter and hypothyroidism in a fetus and summarizes previous reports of treatment of similar fetuses.
Case report. A pregnant woman was seen because routine fetal ultrasonography revealed a mass in the neck . Repeat ultrasonography revealed diffuse symmetric enlargement of the fetal thyroid gland. The mother was well, and had no history of thyroid disease. She had a small goiter, and her thyroid function was normal. Amniotic fluid and umbilical cord blood samples were obtained at 32 weeks’ gestation. The amniotic fluid and umbilical cord serum thyrotropin (TSH) concentrations were high, and the umbilical cord serum free thyroxine (T4) concentration was low.
T4, 150 µg, was injected into the amniotic fluid four times from weeks 33 to 36 weeks, resulting in a decrease in the fetal goiter and amniotic fluid TSH concentration. Labor was induced at 37 weeks. The mother delivered a healthy boy who had a small goiter and normal serum TSH and free T4 concentrations. Growth and development were normal at two years.
Literature review. Nineteen fetuses with goiter and hypothyroidism confirmed by umbilical cord blood sampling have been treated with intra-amniotic administration of T4. Their gestational age at diagnosis ranged from 20 to 33 weeks. Eight mothers had hyperthyroidism and were taking an antithyroid drug. The other 11 mothers had no thyroid disease; the cause of the goiter hypothyroidism in these fetuses is not known. The intra-amniotic injection of T4 resulted in a decrease in goiter size in all the fetuses. There were no maternal or fetal complications of therapy.
The conclusions of the study. Fetuses found to have a goiter and hypothyroidism respond well to intra-amniotic injection of T4 with a decrease in goiter and amelioration of hypothyroidism.
The original article. Hashimoto H, Hashimoto K, Suehara N. Successful in utero treatment of fetal goitrous hypothyroidism: case report and review of the literature. Fetal Diagn Ther 2006;21:360-5.
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| Thyroid Digest Index | | | November 2006 Thyroid Digest |
