Document Detail

Successful intrauterine therapy for fetal goitrous hypothyroidism during late gestation.
MedLine Citation:
PMID:  17917306     Owner:  NLM     Status:  MEDLINE    
We experienced a case of fetal goitrous hypothyroidism in an infant delivered by a 33-year-old woman receiving 300 mg/day of propylthiouracil (PTU) for hyperthyroidism due to Graves' disease. A large fetal goiter (maximum diameter, 60 mm) was detected by magnetic resonance imaging (MRI) at 36 weeks of gestation. Initial fetal blood sampling revealed hypothyroidism with a serum thyroid-stimulating hormone (TSH) of 99 microIU/mL, free triiodothyronine (T(3)) of 1.97 pg/mL, and free thyroxine (T(4)) of 0.29 ng/dL. Consequently, a diagnosis of fetal goitrous hypothyroidism due to transplacental passage of maternal PTU was made. To reduce the risk of perinatal complications, 300 microg of levothyroxine sodium (L-T(4)) was administered into the maternal amniotic fluid twice between 37 and 38 weeks of gestation. Subsequent fetal MRI showed that the size of goiter had decreased. At 38 weeks and 5 days of gestation, a 3042-g male infant was born by cesarean section. There were no severe complications at delivery, although mild tachypnea was observed and the infant's thyroid gland was slightly enlarged. He was treated with L-T(4) for two weeks. At present, his growth and neurological development are normal. This case indicates that intrauterine therapy by the intraamniotic administration of L-T(4) can be effective in treating fetal goitrous hypothyroidism even during late gestation.
Ichiro Miyata; Noriko Abe-Gotyo; Asako Tajima; Hideki Yoshikawa; Satoshi Teramoto; Masami Seo; Kei-Ichi Kanno; Kentaro Sugiura; Tadao Tanaka; Yoshikatsu Eto
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2007-10-03
Journal Detail:
Title:  Endocrine journal     Volume:  54     ISSN:  1348-4540     ISO Abbreviation:  Endocr. J.     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-12-20     Completed Date:  2008-03-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9313485     Medline TA:  Endocr J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  813-7     Citation Subset:  IM    
Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan.
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MeSH Terms
Amniotic Fluid / drug effects
Antithyroid Agents / adverse effects,  therapeutic use
Congenital Hypothyroidism / chemically induced,  complications,  drug therapy*
Fetal Diseases / drug therapy*
Fetal Therapies*
Gestational Age
Goiter / chemically induced,  complications,  drug therapy*
Graves Disease / complications,  drug therapy
Hyperthyroidism / drug therapy,  etiology
Infant, Newborn
Maternal-Fetal Exchange / drug effects
Pregnancy Trimester, Third
Propylthiouracil / adverse effects,  therapeutic use
Thyroxine / administration & dosage*
Treatment Outcome
Reg. No./Substance:
0/Antithyroid Agents; 51-52-5/Propylthiouracil; 7488-70-2/Thyroxine

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