title: Experience with intraamniotic thyroxine treatment in nonimmune fetal goitrous hypothyroidism in 12 cases.
abstract: BACKGROUND
  Nonimmune fetal goitrous hypothyroidism is a rare condition that can induce obstetrical and/or neonatal complications and neurodevelopmental impairments such as those still seen in some patients with congenital hypothyroidism. Prenatal treatment to prevent these adverse outcomes is appealing, but experience is limited and the risk to benefit ratio controversial.
  
  
  OBJECTIVE
  The objective of the study was to evaluate the feasibility, safety, and effectiveness of intrauterine l-thyroxine treatment in a large cohort with nonimmune fetal goitrous hypothyroidism.
  
  
  METHODS
  This was a retrospective study of 12 prenatally treated fetuses diagnosed between 1991 and 2005 in France.
  
  
  METHODS
  During pregnancy, goiter size and thyroid hormone levels were compared before and after prenatal treatment. At birth, clinical, laboratory, and ultrasound data were evaluated.
  
  
  RESULTS
  Prenatal treatment varied widely in terms of l-thyroxine dosage (200-800 microg/injection), number of injections (one to six), and frequency (every 1-4 wk). No adverse events were recorded. During pregnancy, thyroid size decreased in eight of nine cases and amniotic-fluid TSH levels decreased in the six investigated cases, returning to normal in four. However, at birth, all babies had hypothyroidism, indicating that intraamniotic TSH levels did not reliably reflect fetal thyroid function.
  
  
  CONCLUSIONS
  Our data confirm the feasibility and safety of intraamniotic l-thyroxine treatment for nonimmune fetal goitrous hypothyroidism. Although goiter size reduction is usually obtained, thyroid hormone status remains deficient at birth. Amniocentesis seems inadequate for monitoring fetal thyroid function. Further studies are needed to determine the optimal management of this disorder.
authors.affiliation: Department of Pediatrics, Clemenceau Hospital, Caen, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Ribault
authors.forename: Mireille
authors.initials: M
authors.lastname: Castanet
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Bertrand
authors.forename: Jean
authors.initials: J
authors.lastname: Guibourdenche
authors.forename: Edith
authors.initials: E
authors.lastname: Vuillard
authors.forename: Dominique
authors.initials: D
authors.lastname: Luton
authors.forename: Michel
authors.initials: M
authors.lastname: Polak
mesh_terms: D000650:Amnion; D000653:Amniotic Fluid / Q000378:metabolism; D003409:Congenital Hypothyroidism / Q000517:prevention & control*; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy* / Q000378:metabolism; D006042:Goiter / Q000188:drug therapy*; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy* / Q000378:metabolism; D007267:Injections; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D013960:Thyroid Function Tests; D013972:Thyrotropin / Q000378:metabolism; D013974:Thyroxine / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
chemical_list: D013972:Thyrotropin; D013974:Thyroxine