Rapid resolution of fetal goiter associated with maternal Grave's disease: a case report.
The incidence of abnormal fetal thyroid function with maternal Grave's disease is about 2-12%. The development of larger fetal goiters can complicate labor and precipitate life-threatening airway obstruction at delivery. A case is presented of a large stable goiter confirmed by sonography, which unexpectedly resolved by the time of parturition. A 3 x 6 cm fetal goiter was detected at 34 weeks gestation in a mother treated with propylthiouracil for Grave's disease. A repeat sonogram at 36 weeks showed no change in goiter size. Umbilical blood sampling showed the fetus to be markedly hyperthyroid. Planned Cesarean section took place 11 days after the final sonogram. A multi-disciplinary operative team was present including the Otolaryngology service with equipment for emergency intubation, bronchoscopy and tracheotomy. Upon delivery, the infant had no evidence of goiter and no airway compromise. Fetal goiter is a rare entity, and recent advances in the field of maternal-fetal medicine have enabled intra-uterine diagnosis and treatment of such conditions. A review of published case reports demonstrates two trends in treated fetuses: preterm progressive resolution of the goiter, or delivery with gross evidence of goiter. This reported case is unique, as a persistent goiter resolved completely in less than 2 weeks. Otolaryngologic response to and management of potential congenital airway compromise is discussed.
Friedland
D R
DR
Department of Otolaryngology, Pediatric Otolaryngology Service, Box 1189, Mount Sinai School of Medicine, Fifth Avenue and 100th Street, New York, NY 10029-6574, USA.
Rothschild
M A
MA
D000293:Adolescent; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D006042:Goiter / Q000000981:diagnostic imaging / Q000209:etiology*; D006111:Graves Disease / Q000188:drug therapy*; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D016216:Ultrasonography, Prenatal