Non-invasive management of fetal goiter during maternal treatment of hyperthyroidism in Grave's disease.
There is an increased risk of fetal goiter in patients who have a history of Grave's disease and undergo propylthiouracil (PTU) treatment during pregnancy. In this report, we describe a case of a fetal goiter detected by antenatal ultrasound at the 26th week of gestation in a mother treated with PTU for Grave's disease. A 32 x 38 x 20 mm fetal goiter was detected, each lobe measured 30 x 18 x 18 mm and estimated volume was 10 cm3. Subsequently, fetal thyroid function was assessed by umbilical fetal blood sampling. Cord blood showed elevated serum TSH (40.2 mU/l) and normal concentrations of free T4 (9.5 pmol/l) and free T3 (2.6 pmol/l). There were no other ultrasonographic signs of fetal hypothyroidism. Based on the above findings, the mother's PTU dosage was reduced to 50 mg daily from a total of 150 mg and weekly ultrasonographic examinations were performed. Six weeks after the initial ultrasound, a complete regression of the fetal goiter was noted. At the 34th week of gestation, the patient was delivered due to intrauterine growth restriction and oligohydramnios and gave birth to a male, weighing 1,920 g. The newborn thyroid was not palpable and thyroid ultrasonography was normal. Cord blood TSH was normal (8.4 mU/l) and free T4 was within lower normal limit (9.03 pmol/l). Ten days later, newborn thyroid function was normal and the baby did well afterwards. In conclusion, after the evaluation of fetal thyroid status, selected cases with fetal goiter can be initially managed without intrauterine treatment.
Department of Obstetrics and Gynecology, Baskent University School of Medicine, Ankara, Turkey.
Arda
A
Lembet
Derya
D
Eroglu
Sibel Tulgar
ST
Kinik
Berkan
B
Gurakan
Esra
E
Kuscu
D000328:Adult; D013956:Antithyroid Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005315:Fetal Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D006042:Goiter / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D006111:Graves Disease / Q000188:drug therapy*; D006801:Humans; D011247:Pregnancy; D011441:Propylthiouracil / Q000008:administration & dosage / Q000009:adverse effects*; D012074:Remission Induction; D016216:Ultrasonography, Prenatal
D013956:Antithyroid Agents; D011441:Propylthiouracil