title: Graves' disease in two pregnancies complicated by fetal goitrous hypothyroidism: successful in utero treatment with levothyroxine.
abstract: BACKGROUND
  Treatment of Graves' disease during pregnancy with antithyroid drugs (ATDs) poses a risk of inducing hypothyroidism and, thus, development of a goiter to the fetus.
  
  
  METHODS
  We report two patients referred to our department after discovery of a fetal goiter by ultrasound examination in the second trimester of pregnancy. The women receiving 400 mg/day propylthiouracil and 10 mg/day thiamizole, respectively, had thyrotropin and total thyroxine values within the normal reference range but a lowered free thyroxine level. Fetal blood sampling by cordocentesis revealed severe fetal hypothyroidism as the cause of goiter development. Reduction of maternal ATD dose and injection of levothyroxine intra-amniotically quickly reduced the goiter size, and both babies were born euthyroid and without goiters.
  
  
  CONCLUSIONS
  Two pregnant women with Graves' disease were overtreated with ATDs inducing iatrogenic goiter in the fetuses. Successful treatment with intra-amniotic levothyroxine injections rendered the babies euthyroid and nongoitrous at birth.
  
  
  CONCLUSIONS
  Correct interpretation of thyroid function tests during pregnancy in general--and during ATD therapy of Graves' disease in particular--is difficult. Awareness of pregnancy-related changes in maternal thyroid status, and a close teamwork among endocrinologists, obstetricians, and experts in fetal medicine, is pivotal in ensuring normal growth and development of the unborn child of these patients.
authors.affiliation: Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen University, Copenhagen, Denmark.
authors.forename: Sofie
authors.initials: S
authors.lastname: Bliddal
authors.forename: Åse Krogh
authors.initials: ÅK
authors.lastname: Rasmussen
authors.forename: Karin
authors.initials: K
authors.lastname: Sundberg
authors.forename: Vibeke
authors.initials: V
authors.lastname: Brocks
authors.forename: Peter
authors.initials: P
authors.lastname: Skovbo
authors.forename: Ulla
authors.initials: U
authors.lastname: Feldt-Rasmussen
mesh_terms: D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use*; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy*; D006042:Goiter / Q000150:complications* / Q000188:drug therapy*; D006111:Graves Disease / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy*; D007231:Infant, Newborn; D008297:Male; D008713:Methimazole / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011262:Pregnancy Trimester, Second; D011441:Propylthiouracil / Q000008:administration & dosage; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood / Q000627:therapeutic use*
chemical_list: D013956:Antithyroid Agents; D008713:Methimazole; D011441:Propylthiouracil; D013972:Thyrotropin; D013974:Thyroxine