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

• Published in: Prenatal diagnosis Vol. 20; no. 10; pp. 799 - 806
• Main Authors: Volumenie, J. L., Polak, M., Guibourdenche, J., Oury, J. F., Vuillard, E., Sibony, O., Reyal, F., Raccah-Tebeka, B., Boissinot, C., Madec, A. M., Orgiazzi, J., Toubert, M. E., Leger, J., Blot, P., Luton, D.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-10-2000; Wiley
• Subjects: antenatal therapy; Biological and medical sciences; colour doppler; cordocentesis; Diseases of mother, fetus and pregnancy; Female; Fetal Diseases - diagnostic imaging; Fetal Diseases - therapy; fetal goitres; Goiter - embryology; Goiter - therapy; Graves' disease; Gynecology. Andrology. Obstetrics; Hospital Units; Humans; Hyperthyroidism - embryology; Hyperthyroidism - etiology; Hyperthyroidism - therapy; Hypothyroidism - embryology; Hypothyroidism - etiology; Hypothyroidism - therapy; Infant, Newborn; Medical sciences; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Pregnancy. Fetus. Placenta; Ultrasonography, Prenatal; Endocrinopathy; Human; Immunopathology; Antithyroid agent; Pregnancy disorders; Toxicity; Hyperthyroidism; Thyroid diseases; Cordocentesis; Autoimmune disease; Hypothyroidism; Maternal diseases; Prenatal; Fetal diseases; Treatment; Etiology; Goiter; Graves disease; Complication; Fetus; Diagnosis
• ISSN: 0197-3851; 1097-0223
• DOI: 10.1002/1097-0223(200010)20:10<799::AID-PD925>3.0.CO;2-V

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.