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Foetal goitrous hypothyroidism — easy to recognise, difficult to treat. Is combined intra-amniotic and intravenous L-thyroxine therapy an option?
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Abstract
Introduction: Foetal hypothyroidism negatively impacts somatic and neurological child development and can be the cause of serious obstetric and perinatal complications. We present a rare case of a large foetal dyshormonogenetic goitre, causing foetal neck hyperextension, oesophageal compression, and cardiac high-output failure.
Material and methods: A foetal goitre complicated by cardiomegaly and polyhydramnios was diagnosed at 23 weeks of gestation (WG) on a routine ultrasonographic (US) assessment in a healthy nullipara. Foetal blood sampling was performed and a severe foetal hypothyroidism was diagnosed. Treatment was undertaken with an intra-amniotic followed by combined intra-amniotic and intravenous injections of L-thyroxine (L–T4). A total of 11 doses of L–T4 were administered between 24–37 WG to the foetus.
Results: A complete regression of foetal goitre, cardiomegaly, and polyhydramnios was observed. At 38 WG the patient delivered vaginally a male infant with mild hypothyroidism and no signs of goitre or cardiomegaly on postnatal US. Neurological development of the one year old baby is normal.
Conclusions: The effective diminishing of serum TSH concentration and goitre size was reached after combined intra-amniotic and intravenous L–T4 injections were given. L–T4 requirement in the foetus is equal to or above 15 μg/kg daily and should be given in weekly intervals due to its rapid metabolism by the foetus and by placental type 3 deiodinase. Intra-amniotic L–T4 administration may be ineffective when a large goitre indisposes amniotic fluid swallowing by the foetus, so then the combined L–T4 injections into the umbilical vein and intra-amniotically in experienced hands seems to be a reasonable and effective option.
Abstract
Introduction: Foetal hypothyroidism negatively impacts somatic and neurological child development and can be the cause of serious obstetric and perinatal complications. We present a rare case of a large foetal dyshormonogenetic goitre, causing foetal neck hyperextension, oesophageal compression, and cardiac high-output failure.
Material and methods: A foetal goitre complicated by cardiomegaly and polyhydramnios was diagnosed at 23 weeks of gestation (WG) on a routine ultrasonographic (US) assessment in a healthy nullipara. Foetal blood sampling was performed and a severe foetal hypothyroidism was diagnosed. Treatment was undertaken with an intra-amniotic followed by combined intra-amniotic and intravenous injections of L-thyroxine (L–T4). A total of 11 doses of L–T4 were administered between 24–37 WG to the foetus.
Results: A complete regression of foetal goitre, cardiomegaly, and polyhydramnios was observed. At 38 WG the patient delivered vaginally a male infant with mild hypothyroidism and no signs of goitre or cardiomegaly on postnatal US. Neurological development of the one year old baby is normal.
Conclusions: The effective diminishing of serum TSH concentration and goitre size was reached after combined intra-amniotic and intravenous L–T4 injections were given. L–T4 requirement in the foetus is equal to or above 15 μg/kg daily and should be given in weekly intervals due to its rapid metabolism by the foetus and by placental type 3 deiodinase. Intra-amniotic L–T4 administration may be ineffective when a large goitre indisposes amniotic fluid swallowing by the foetus, so then the combined L–T4 injections into the umbilical vein and intra-amniotically in experienced hands seems to be a reasonable and effective option.
Keywords
foetal goitre, dyshormonogenesis, L-thyroxine in utero treatment
About this articleTitle
Foetal goitrous hypothyroidism — easy to recognise, difficult to treat. Is combined intra-amniotic and intravenous L-thyroxine therapy an option?
Journal
Issue
Article type
Case report
Pages
442-446
Published online
2018-06-29
Page views
2632
Article views/downloads
1085
DOI
Pubmed
Bibliographic record
Endokrynol Pol 2018;69(4):442-446.
Keywords
foetal goitre
dyshormonogenesis
L-thyroxine in utero treatment
Authors
Marzena Dębska
Małgorzata Gietka-Czernel
Piotr Kretowicz
Dagmara Filipecka-Tyczka
Łukasz Lewczuk
Joanna Dangel
Romuald Dębski
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