Obstet Gynecol Sci.  2016 Jan;59(1):66-70. 10.5468/ogs.2016.59.1.66.

Intra-amniotic thyroxine to treat fetal goiter

• Kim MJ
• Chae YH
• Park SY
• Kim MY

• KMID: 2152648
• DOI: http://doi.org/10.5468/ogs.2016.59.1.66

Abstract

A 35-year-old pregnant woman visited our department and had been treated with 100 microg of daily oral levothyroxine for hypothyroidism. An ultrasonography screening was performed at 25 weeks gestation and revealed a fetal goiter and an increased amniotic fluid volume. Fetal hypothyroidism was confirmed by cordocentesis and amniotic hormone levels at 26 weeks gestation. We treated the mother with 200 microg of daily oral levothyroxine to optimize the transplacental transfer. A total of four intra-amniotic injections of levothyroxine were administered, resulting in progressive reduction in the fetal thyroid volume of goiter as measured by 3D ultrasonography and increased amniotic fluid volume. Following birth, neonatal serum thyroid stimulating hormone level was within the normal range, but free T4 was reduced. Based on this case, we suggest that monitoring amniotic fluid thyroid hormone concentration and intra-amniotic levothyroxine injection can be used to reduce the thyroid volume of goiters and to prevent polyhydramnios.

Keyword

3D ultrasonography; Goiter; Hypothyroidism; Intra-amniotic thyroxine

MeSH Terms

Adult
Amniotic Fluid
Cordocentesis
Female
Goiter*
Humans
Hypothyroidism
Mass Screening
Mothers
Parturition
Polyhydramnios
Pregnancy
Pregnant Women
Reference Values
Thyroid Gland
Thyrotropin
Thyroxine*
Ultrasonography
Thyrotropin
Thyroxine

Figure

• 

  Fig. 1 Measurement of fetal goiter volume change using 2D and 3D ultrasonography. (A) Fetal goiter size at 25 weeks using 2D ultrasonography. Right (Rt) lobe (21×14) and left (Lt) lobe (26×22). (B) Fetal thyroid volume (6.6 cm3) at 29 weeks' gestation using 3D ultrasonography. (C) Fetal thyroid volume (4.9 cm3) at 37 weeks' gestation using 3D ultrasonography.

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