Fetal goitrous hypothyroidism treated by intra-amniotic levothyroxine administration: case report and review of the literature

J Pediatr Endocrinol Metab. 2017 Aug 28;30(9):1001-1005. doi: 10.1515/jpem-2017-0094.

Abstract

Background: Fetal goitrous hypothyroidism is mainly caused by maternal treatment of Graves' disease. Fetal goiter sometimes compresses the trachea and esophagus and may cause polyhydramnios, preterm labor, complications of labor and delivery, and neonatal respiratory disorder.

Case presentation: We report a case of fetal goitrous hypothyroidism in which the mother had Graves' disease, which was treated with propylthiouracil. Intra-amniotic levothyroxine (L-T4) administration was performed, and the fetal goiter decreased in size. A female infant was delivered without goiter and complications. Thyroid function was within the normal range.

Conclusions: Previous reports on fetal goitrous hypothyroidism that was treated with intra-amniotic L-T4 showed that patients who had intra-amniotic L-T4 administration were likely to have a good outcome compared with patients who did not have L-T4. Thyroid function of the mother and fetus should be carefully monitored and treated appropriately.

Keywords: fetal goiter; intra-amniotic levothyroxine administration; maternal Graves’ disease.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antithyroid Agents / adverse effects
  • Female
  • Fetal Diseases / chemically induced
  • Fetal Diseases / diagnostic imaging
  • Fetal Diseases / drug therapy*
  • Goiter / chemically induced
  • Goiter / diagnostic imaging
  • Goiter / drug therapy*
  • Graves Disease / drug therapy
  • Humans
  • Hypothyroidism / chemically induced
  • Hypothyroidism / diagnostic imaging
  • Hypothyroidism / drug therapy*
  • Pregnancy
  • Pregnancy Complications / drug therapy
  • Propylthiouracil / adverse effects
  • Thyroxine / administration & dosage
  • Thyroxine / therapeutic use*
  • Treatment Outcome
  • Ultrasonography, Prenatal

Substances

  • Antithyroid Agents
  • Propylthiouracil
  • Thyroxine