| Antenatal treatment of fetal goiter: a therapeutic challenge. | |
| | |
MedLine Citation:
|
PMID: 19085636 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: Pre-natal ultrasonography presents an opportunity for in-utero therapy of a fetal goiter. Because of the morbidity associated with a large goiter and the risks of repeated intra-amniotic injections, controversy arose about the precise indications of this mode of treatment. We describe our observations in treating a 22-week-old fetus with a large goiter because of dyshormogenesis, monitored with serial 3D high frequency, high resolution ultrasonography and amniotic hormonal measurements. Fetal hypothyroidism was confirmed by cordocentesis and amniotic hormone levels. After assessment of relevant risk factors and the criteria for in-utero intervention, including goiter volume, amniotic fluid index, polyhydramnios and tracheal compression, we determined that hormonal therapy was warranted. Levothyroxine was injected every 7-10 days, and its efficacy monitored by ultrasound changes and amniotic hormone sampling. RESULTS: Reduction in goiter volume restored normal neck flexion relieving the pressure on the trachea, polyhydramnios was prevented and amniotic hormone levels were normalised. The infant was euthyroid at birth, however, by age 4 days hypothyroidism was diagnosed, and treatment with l-thyroxine started. CONCLUSION: Advances in fetal ultrasonography permit judicious therapy of an enlarging goiter in a hypothyroid fetus, which may contribute to enhancing cognitive development. We discuss the value of amniotic hormone sampling, the objectives and risks of in-utero intervention in the light of recent literature and our own observations. |
| | |
Authors:
|
Anat Hanono; Bina Shah; Raphael David; Irving Buterman; Daniel Roshan; Shetal Shah; Leslie Lam; Ilan Timor-Tritsch |
Related Documents
:
|
4087096 - The role of amniotic fluid in fetal nutrition. 6154546 - Amniotic fluid acetylcholinesterase isoenzyme patterns in the diagnosis of neural tube ... 10521766 - A role for the novel cytokine rantes in pregnancy and parturition. 15301296 - Alteration of the amniotic fluid and neonatal outcome. 21291506 - The early external cephalic version (ecv) 2 trial: an international multicentre randomi... 6615966 - Further quantification of human spermatogenesis: germ cell loss during postprophase of ... |
Publication Detail:
|
Type: Case Reports; Journal Article |
Journal Detail:
|
Title: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Volume: 22 ISSN: 1476-4954 ISO Abbreviation: J. Matern. Fetal. Neonatal. Med. Publication Date: 2009 Jan |
Date Detail:
|
Created Date: 2009-01-23 Completed Date: 2009-03-18 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 101136916 Medline TA: J Matern Fetal Neonatal Med Country: United States |
Other Details:
|
Languages: eng Pagination: 76-80 Citation Subset: IM |
Affiliation:
|
Department of Pediatrics, New York University Medical Center, New York, NY 10016, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Amniotic Fluid Congenital Hypothyroidism / diagnosis, prevention & control Female Fetal Diseases / diagnosis, drug therapy* Fetal Therapies / methods* Goiter / congenital, diagnosis, drug therapy* Humans Pregnancy Thyroxine / administration & dosage* Ultrasonography, Prenatal |
| Chemical | |
Reg. No./Substance:
|
7488-70-2/Thyroxine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Intrapancreatic rupture of a splenic artery aneurysm during pregnancy - a rare case report with feta...
Next Document: First trimester combined screening for Trisomy 21 in Hong Kong: outcome of the first 10,000 cases.