Massive fetal goiter treated by intra-amniotic injection of levothyroxine: a case report
Author:
Tamura Nami1ORCID, Yamamoto Yuka1, Takeda Jun1, Ishigami Junpei2, Suganuma Hiroki2, Shimizu Toshiaki2, Itakura Atsuo1
Affiliation:
1. Department of Obstetrics and Gynecology , 2012847 Juntendo University Faculty of Medicine , Tokyo , Japan 2. Department of Pediatrics , 2012847 Juntendo University Faculty of Medicine , Tokyo , Japan
Abstract
Abstract
Objectives
Fetal dyshormonogenetic goiter is a rare condition associated with perinatal complications and sequelae in infants. Although prenatal management remains controversial, further evidence is required for optimal management.
Case presentation
A 30-year-old pregnant woman with no history of thyroid disease was referred to our hospital with polyhydramnios. Fetal ultrasonography revealed fetal goiter. Cordocentesis revealed increased thyroid-stimulating hormone (TSH) and low levels of free thyroxine 4 (fT4), which was the basis of diagnosis of fetal hypothyroidism. Intra-amniotic injections of levothyroxine were administered, resulting in a reduction in the goiter size, amount of amniotic fluid, and level of maternal TSH. The mother was euthyroid during pregnancy. The infant was delivered vaginally at full term with a normal thyroid size and no respiratory disorders except hypothyroidism. At 2 years of age, her neurodevelopment is normal.
Conclusions
Intra-amniotic injections of levothyroxine for fetal hypothyroidism with massive goiter and polyhydramnios may improve perinatal outcomes.
Publisher
Walter de Gruyter GmbH
Reference17 articles.
1. Corral, E, Reascos, M, Preiss, Y, Rompel, SM, Sepulveda, W. Treatment of fetal goitrous hypothyroidism: value of direct intramuscular L-thyroxine therapy. Prenat Diagn 2010;30:899–901. https://doi.org/10.1002/pd.2560. 2. Kim, MJ, Chae, YH, Park, SY, Kim, MY. Intra-amniotic thyroxine to treat fetal goiter. Obstet Gynecol Sci 2016;59:66–70. https://doi.org/10.5468/ogs.2016.59.1.66. 3. Perelman, AH, Johnson, RL, Clemons, RD, Finberg, HJ, Clewell, WH, Trujillo, L. Intrauterine diagnosis and treatment of fetal goitrous hypothyroidism. J Clin Endocrinol Metab 1990;71:618–21. https://doi.org/10.1210/jcem-71-3-618. 4. Nemescu, D, Tanasa, IA, Stoian, DL, Navolan, DB, Vinturache, AE. Conservative in utero treatment of fetal dyshormonogenetic goiter with levothyroxine, a systematic literature review. Exp Ther Med 2020;20:2434–8. https://doi.org/10.3892/etm.2020.8794. 5. Ribault, V, Castanet, M, Bertrand, AM, Guibourdenche, J, Vuillard, E, Luton, D, et al.. Experience with intraamniotic thyroxine treatment in nonimmune fetal goitrous hypothyroidism in 12 cases. J Clin Endocrinol Metab 2009;94:3731–9. https://doi.org/10.1210/jc.2008-2681.
|
|