Document Detail


Graves' disease in two pregnancies complicated by fetal goitrous hypothyroidism: successful in utero treatment with levothyroxine.
MedLine Citation:
PMID:  21162688     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
PATIENT FINDINGS: 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.
SUMMARY: 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:
Sofie Bliddal; Åse Krogh Rasmussen; Karin Sundberg; Vibeke Brocks; Peter Skovbo; Ulla Feldt-Rasmussen
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-12-16
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  21     ISSN:  1557-9077     ISO Abbreviation:  Thyroid     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-11     Completed Date:  2011-04-27     Revised Date:  2012-09-10    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  United States    
Other Details:
Languages:  eng     Pagination:  75-81     Citation Subset:  IM    
Affiliation:
Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen University, Copenhagen, Denmark.
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MeSH Terms
Descriptor/Qualifier:
Adult
Antithyroid Agents / therapeutic use*
Female
Fetal Diseases / drug therapy*
Goiter / complications*,  drug therapy*
Graves Disease / complications*,  drug therapy*
Humans
Hypothyroidism / drug therapy*
Infant, Newborn
Male
Methimazole / therapeutic use
Pregnancy
Pregnancy Complications / drug therapy*
Pregnancy Trimester, Second
Propylthiouracil / administration & dosage
Thyrotropin / blood
Thyroxine / blood,  therapeutic use*
Chemical
Reg. No./Substance:
0/Antithyroid Agents; 51-52-5/Propylthiouracil; 60-56-0/Methimazole; 7488-70-2/Thyroxine; 9002-71-5/Thyrotropin
Comments/Corrections
Comment In:
Thyroid. 2011 Aug;21(8):931; author reply 932-3   [PMID:  21745105 ]

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


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