Massive fetal goiter treated by intra-amniotic injection of levothyroxine: a case report.

IF 0.1 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Perinatal Medicine Pub Date : 2024-05-27 eCollection Date: 2024-01-01 DOI:10.1515/crpm-2024-0006

Nami Tamura, Yuka Yamamoto, Jun Takeda, Junpei Ishigami, Hiroki Suganuma, Toshiaki Shimizu, Atsuo Itakura

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引用次数: 0

Abstract

Objectives: Fetal dyshormonogenetic goiter is a rare condition associated with perinatal complications and sequelae in infants. Although prenatal management remains controversial, further evidence is required for optimal management.

Case presentation: A 30-year-old pregnant woman with no history of thyroid disease was referred to our hospital with polyhydramnios. Fetal ultrasonography revealed fetal goiter. Cordocentesis revealed increased thyroid-stimulating hormone (TSH) and low levels of free thyroxine 4 (fT4), which was the basis of diagnosis of fetal hypothyroidism. Intra-amniotic injections of levothyroxine were administered, resulting in a reduction in the goiter size, amount of amniotic fluid, and level of maternal TSH. The mother was euthyroid during pregnancy. The infant was delivered vaginally at full term with a normal thyroid size and no respiratory disorders except hypothyroidism. At 2 years of age, her neurodevelopment is normal.

Conclusions: Intra-amniotic injections of levothyroxine for fetal hypothyroidism with massive goiter and polyhydramnios may improve perinatal outcomes.

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羊膜内注射左甲状腺素治疗大量胎儿甲状腺肿1例。

目的：胎儿单性甲状腺肿是一种罕见的与围产期并发症和婴儿后遗症相关的疾病。尽管产前管理仍有争议，但需要进一步的证据来优化管理。病例介绍：一位无甲状腺病史的30岁孕妇因羊水过多而转诊至我院。胎儿超声检查显示胎儿甲状腺肿大。Cordocentesis显示促甲状腺激素（TSH）升高，游离甲状腺素4 （fT4）水平低，这是诊断胎儿甲状腺功能减退的基础。给予羊膜内左旋甲状腺素注射，导致甲状腺肿大、羊水量和母体促甲状腺激素水平的降低。母亲在怀孕期间甲状腺功能正常。婴儿足月顺产，甲状腺大小正常，除甲状腺功能减退外无呼吸系统疾病。2岁时，她的神经发育正常。结论：羊膜内注射左旋甲状腺素治疗甲状腺功能减退合并大量甲状腺肿和羊水过多的胎儿可改善围产儿结局。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Case Reports in Perinatal Medicine OBSTETRICS & GYNECOLOGY-

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期刊介绍： Case Reports in Perinatal Medicine is a double-blind peer-reviewed journal. The objective of the new journal is very similar to that of JPM. In addition to evidence-based studies, practitioners in clinical practice esteem especially exemplary reports of cases that reveal specific manifestations of diseases, its progress or its treatment. We consider case reports and series to be brief reports describing an isolated clinical case or a small number of cases. They may describe new or uncommon diagnoses, unusual outcomes or prognosis, new or infrequently used therapies and side effects of therapy not usually discovered in clinical trials. They represent the basic concept of experiences for studies on representative groups for further evidence-based research. The potential roles of case reports and case series are: Recognition and description of new diseases Detection of drug side effects (adverse or beneficial) Study of mechanisms of disease Medical education and audit Recognition of rare manifestations of disease.