Document Detail


Experience with intraamniotic thyroxine treatment in nonimmune fetal goitrous hypothyroidism in 12 cases.
MedLine Citation:
PMID:  19737924     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: 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. DESIGN: 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. CONCLUSION: 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:
Virginie Ribault; Mireille Castanet; Anne-Marie Bertrand; Jean Guibourdenche; Edith Vuillard; Dominique Luton; Michel Polak;
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2009-09-08
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  94     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-07     Completed Date:  2009-10-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3731-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, Clemenceau Hospital, Caen, France.
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MeSH Terms
Descriptor/Qualifier:
Amnion
Amniotic Fluid / metabolism
Congenital Hypothyroidism / prevention & control*
Female
Fetal Diseases / drug therapy*,  metabolism
Goiter / drug therapy*
Humans
Hypothyroidism / drug therapy*,  metabolism
Injections
Male
Pregnancy
Retrospective Studies
Thyroid Function Tests
Thyrotropin / metabolism
Thyroxine / administration & dosage,  therapeutic use*
Treatment Outcome
Ultrasonography, Prenatal
Chemical
Reg. No./Substance:
7488-70-2/Thyroxine; 9002-71-5/Thyrotropin
Investigator
Investigator/Affiliation:
Hélène Thibault / ; Nourredine Idres / ; Hélène Bony-Triffunovic / ; Franck Perrotin / ; Sylvie Cabrol / ; Muriel Houang / ; Catherine Naud-Saudreau / ; Hélène Crosnier /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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