Iatrogenic fetal goiter. Conservative management and spontaneous resolution

  1. Troyano Luque, Juan Mario 1
  2. Darias Garzón, Ricardo 2
  3. Rosales Aedo, Olga 1
  4. Padilla Pérez, Ana Isabel 1
  5. Alvarez de la Rosa, Margarita 1
  1. 1 Obstetrics and Gynecology Service , Hospital Universitario de Canarias , San Cristóbal de La Laguna Tenerife , Canary Islands , Spain
  2. 2 Endocrinology Service , Hospital Universitario Nuestra Señora de Candelaria , Tenerife , Spain
Revista:
Case Reports in Perinatal Medicine

ISSN: 2192-8959

Año de publicación: 2020

Volumen: 9

Número: 1

Tipo: Artículo

DOI: 10.1515/CRPM-2019-0074 GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Case Reports in Perinatal Medicine

Resumen

ObjectivesWe aim to report a case of a fetal goiter with postpartum spontaneous resolution. Fetal goiter can be secondary to maternal treatment and range from clinically asymptomatic or cause alterations in the fetus, from impaired swallowing to difficulty in vaginal delivery and even perinatal asphyxia due to the mass effect. The need for intrauterine treatment remains controversial.Case presentationWe present a case of fetal goiter with postpartum resolution. A 34-year-old multigravida presented to the emergency department with hiperemesis gravidarum at 10 weeks’ gestation. During evaluation for severe vomiting, Graves disease was diagnosed and treated with propylthiouracil. A routine ultrasound scan at 28 weeks gestation revealed a fetal anterior neck mass suggesting a fetal goiter. Cordocentesis showed fetal iatrogenic hypothyroidism. Conservative treatment was decided. Pregnancy concluded uneventful and the mass resolved spontaneously in the newborn.ConclusionsThe fetal thyroid gland is a structure that usually goes unnoticed during the process of prenatal diagnosis. In cases of maternal Graves diseases, fetal thyroid needs monitoring during pregnancy and conservative treatment is an option. Fetal goiter should be searched for secondary to thyroid alterations of the gravida, and in selected cases it can be managed without intrauterine treatment.

Referencias bibliográficas

  • Louw, JH. Congenital goitre. A review with a report of three cases of suffocative goitre in the newborn. S Afr Med J 1963;37:976–83. 14053852.
  • Namouz-Haddad, S, Koren, G. Fetal pharmacotherapy 4: fetal thyroid disorders. J Obstet Gynaecol Can 2014;36:60–3. https://doi.org/10.1016/s1701-2163(15)30684-8.
  • Delay, F, Dochez, V, Biquard, F, Cheve, MT, Gillard, P, Arthuis, C, et al. Management of fetal goiters: 6-year retrospective observational study in three prenatal diagnosis and treatment centers of the Pays de Loire perinatal network. J Matern Fetal Neonatal Med 2018;33:2561–9. 10.1080/14767058.2018.1555803. 30513035.
  • Lembet, A, Eroglu, D, Kinik, ST, Gurakan, B, Kuscu, E. Non-invasive management of fetal goiter during maternal treatment of hyperthyroidism in Grave’s disease. Fetal Diagn Ther 2005;20:254–7. https://doi.org/10.1159/000085080.
  • Fisher, DA. Fetal thyroid function: diagnosis and management of fetal thyroid disorders. Clin Obstet Gynecol 1997;40:16–31. https://doi.org/10.1097/00003081-199703000-00005.
  • Huel, C, Guibourdenche, J, Vuillard, E, Ouahba, J, Piketty, M, Oury, JF, et al. Use of ultrasound to distinguish between fetal hyperthyroidism and hypothyroidism on discovery of a goiter. Ultrasound Obstet Gynecol 2009;33:412–20. https://doi.org/10.1002/uog.6315.
  • Salerno, M, Di Maio, S, Pisaturo, L, Mariano, A, Macchia, V. Fetal goiter in a iodine-deficient area. J Endocrinol Invest 1998;21:721–2. https://doi.org/10.1007/bf03350804.
  • Medeiros-Neto, G, Bunduki, V, Tomimori, E, Gomes, S, Knobel, M, Martin, RT, et al. Prenatal diagnosis and treatment of dyshormonogenetic fetal goiter due to defective thyroglobulin synthesis. J Clin Endocrinol Metab 1997;82:4239–42. https://doi.org/10.1210/jcem.82.12.4407.
  • Alexander, EK, Pearce, EN, Brent, GA, Brown, RS, Chen, H, Dosiou, C, et al. 2017 Guidelines of the American thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017;27:315–89. https://doi.org/10.1089/thy.2016.0457.