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Gómez-Lavín Fernández L, Comas Rovira M, Pina Pérez S, Moreno Baró A, Corripio Collado R, Zamora Lapiedra M, Lesmes Heredia C, Albert Fabregas L. Management of foetal hyperthyroidism in a mother with autoimmune hypothyroidism: A case report. ENDOCRINOL DIAB NUTR 2023; 70:511-516. [PMID: 37596010 DOI: 10.1016/j.endien.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/24/2023] [Indexed: 08/20/2023]
Abstract
Foetal hyperthyroidism is mediated by transplacental passage of thyroid stimulating antibodies (TSAbs) and affects mothers with autoimmune (AI) thyroid disease. We report a case of a 33-year-old woman with a history of AI hypothyroidism and raised TSI after 2 stillbirths with suspect foetal hyperthyroidism. At 20.5 gestational weeks (GW) of her third pregnancy, foetal tachycardia and goitre were detected. TSI levels were 30.9mUI/mL. Methimazole (MMI) was started and adjusted based on ultrasound signs (foetal heart rate and thyroid gland vascularisation). The neonate was born at 35GW and cord blood revealed decreased TSH and normal free T4. MMI was started in the neonate at 2 days of life due to the appearance of asymptomatic hyperthyroidism. This case illustrates a rare recurrence of foetal hyperthyroidism in a mother with AI hypothyroidism. Pregestational thyroidectomy, TSAbs determination, early ultrasound diagnosis and foetal therapy helped us to improve obstetric outcomes.
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Affiliation(s)
- Lucía Gómez-Lavín Fernández
- Obstetrics and Gynaecology Department, Maternal-Foetal Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Inovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Montserrat Comas Rovira
- Obstetrics and Gynaecology Department, Maternal-Foetal Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Inovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain.
| | - Silvia Pina Pérez
- Obstetrics and Gynaecology Department, Maternal-Foetal Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Inovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Anna Moreno Baró
- Obstetrics and Gynaecology Department, Maternal-Foetal Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Inovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Raquel Corripio Collado
- Paediatric Endocrinology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Marc Zamora Lapiedra
- Obstetrics and Gynaecology Department, Maternal-Foetal Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Inovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Cristina Lesmes Heredia
- Obstetrics and Gynaecology Department, Maternal-Foetal Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Inovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Lara Albert Fabregas
- Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
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Espinoza AF, Krispin E, Sun RC, Espinoza J, Nassr A, Shamshirsaz AA. Overtreatment of Transient Maternal Hyperthyroidism Resulting in Fetal Goiter. Neoreviews 2021; 22:e564-e569. [PMID: 34341166 DOI: 10.1542/neo.22-8-e564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Andres F Espinoza
- Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Eyal Krispin
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX
| | - Raphael C Sun
- Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX
| | - Jimmy Espinoza
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX
| | - Ahmed Nassr
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX
| | - Alireza A Shamshirsaz
- Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX
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Machado CM, Castro JM, Campos RA, Oliveira MJ. Graves' disease complicated by fetal goitrous hypothyroidism treated with intra-amniotic administration of levothyroxine. BMJ Case Rep 2019; 12:12/8/e230457. [PMID: 31420436 DOI: 10.1136/bcr-2019-230457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Fetal goitrous hypothyroidism is a rare entity and is caused mainly by maternal treatment of Graves' disease (GD). We report a case of a 22-year-old woman referred at 12 weeks of gestation due to hyperthyroidism subsequent to recently diagnosed GD. She started treatment with propylthiouracil and, at 21 weeks of gestation, fetal goitre was detected. A cordocentesis confirmed the diagnosis of fetal goitrous hypothyroidism, and intra-amniotic administration of levothyroxine (LT4) was performed and repeated through the pregnancy due to maintenance of fetal goitre. The pregnancy proceeded without further complications and a healthy female infant was born at 37 weeks of gestation, with visible goitre and thyroid function within the normal range at birth. Although there is no consensus on the optimal dose, the number of injections and the interval between them, intra-amniotic LT4 administration is recommended once fetal goitrous hypothyroidism is suspected, in order to prevent long-term complications of fetal hypothyroidism.
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Affiliation(s)
| | - Jorge Manuel Castro
- Gynecology and Obstetrics, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Rosa Arménia Campos
- Pediatrics, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Maria João Oliveira
- Endocrinology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
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Mastrolia SA, Mandola A, Mazor M, Hershkovitz R, Mesner O, Beer-Weisel R, Besser L, Shelef I, Loewenthal N, Golan A, Gruzman I, Erez O. Antenatal diagnosis and treatment of hypothyroid fetal goiter in an euthyroid mother: a case report and review of literature. J Matern Fetal Neonatal Med 2014; 28:2214-20. [PMID: 25363013 DOI: 10.3109/14767058.2014.983062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Fetal goiter is an extremely rare complication of pregnancy. Its incidence is 1 in 40,000 deliveries. Antithyroid maternal therapy is responsible for 10-15% of fetal congenital hypothyroidism and can be considered as the most frequent underlying cause for this condition. The frequency of fetal goiter that is associated with fetal hypothyroidism and normal maternal thyroid function, as in our case, is even less frequent. Fetal goiter is associated with increased rate of perinatal complications and long-term morbidity, due to peripartum complications including labor dystocia due to its mass effect, as well as neonatal airway obstruction that may lead to hypoxic-ischemic brain injury and death. We present, in this study, a case report of late antenatal fetal goiter in an euthyroid woman and a literature review of the diagnosis and treatment of these cases.
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Affiliation(s)
- Salvatore Andrea Mastrolia
- a Department of Obstetrics and Gynecology , Azienda Ospedaliera-Universitaria Policlinico di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy
| | | | | | | | | | | | | | | | | | | | - Igor Gruzman
- h Department of Anesthesiology and Critical Care, Faculty of Health Sciences , Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Offer Erez
- c Department of Obstetrics and Gynecology
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Namouz-Haddad S, Koren G. Fetal Pharmacotherapy 4: Fetal Thyroid Disorders. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:60-63. [DOI: 10.1016/s1701-2163(15)30684-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Corbacioglu Esmer A, Gul A, Dagdeviren H, Turan Bakirci I, Sahin O. Intrauterine diagnosis and treatment of fetal goitrous hypothyroidism. J Obstet Gynaecol Res 2012; 39:720-3. [DOI: 10.1111/j.1447-0756.2012.02003.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ahmet Gul
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital, Istanbul, Turkey
| | - Hediye Dagdeviren
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital, Istanbul, Turkey
| | - Isil Turan Bakirci
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital, Istanbul, Turkey
| | - Orhan Sahin
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital, Istanbul, Turkey
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Shoham I, Aricha-Tamir B, Weintraub AY, Mazor M, Wiznitzer A, Holcberg G, Sheiner E. Fetal heart rate tracing patterns associated with congenital hypothyroidism. Am J Obstet Gynecol 2009; 201:48.e1-4. [PMID: 19467638 DOI: 10.1016/j.ajog.2009.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 01/17/2009] [Accepted: 03/04/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study was undertaken to determine fetal heart rate (FHR) tracing patterns associated with congenital hypothyroidism. STUDY DESIGN FHR patterns of 59 women whose babies were diagnosed with congenital hypothyroidism were retrospectively compared with tracings of 78 of their siblings. Tracings were interpreted during the first stage of labor. Multivariable analysis was used to control for confounders. RESULTS Neonates with congenital hypothyroidism had significantly higher rates of reduced variability in FHR tracing patterns as compared with those without congenital hypothyroidism (49.2% vs 3.8%; odds ratio, 24.1; 95% confidence interval, 6.8-85.3; P < .001). No significant differences were noted between the groups regarding decelerations or baseline abnormalities. The significant association between congenital hypothyroidism and reduced variability persisted after controlling for confounders such as treatment with pethidine, MgSO4, and gestational age (odds ratio, 14.1; 95% confidence interval, 1.1-190.7; P = .046). CONCLUSION Congenital hypothyroidism is significantly and independently associated with reduced variability in FHR tracing patterns.
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Affiliation(s)
- Iris Shoham
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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