Graves' Disease in Two Pregnancies Complicated by Fetal Goitrous Hypothyroidism: Successful In Utero Treatment with Levothyroxine
Abstract
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.
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Addressing maternal diseases and LT4 replacement is necessary for preventing potential fetal tracheal compression or other developmental malformations.
“Addressing maternal diseases and LT4 replacement is necessary for preventing potential fetal tracheal compression or other developmental malformations (253).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [253]
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Levothyroxine: conventional and novel drug delivery formulations.
Liu, H., Li, W., Zhang, W., Sun, S., & Chen, C. (2023) · Endocrine Reviews · doi:10.1210/endrev/bnac030 · Cited by 63 · see citing works
- Authors
- Bliddal, S., Rasmussen, Å. K., Sundberg, K., Brocks, V., Skovbo, P., & Feldt-Rasmussen, U.
- Affiliations
- University of Copenhagen (DK)
- Aalborg University Hospital (DK)
- Copenhagen University Hospital
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2011-01
- Volume
- 21
- Issue
- 1
- Pages
- 75-81
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W2017146753
- Cited by
- 24
- References
- 43
- Citations by year
- 2026: 1 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 1 · 2015: 1 · 2014: 4 · 2013: 2 · 2012: 3
- FWCI
- 2.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- Arvid Nilssons Fond
- Sundhed og Sygdom, Det Frie Forskningsråd
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- Graves' disease, pregnancy, fetal goiter, fetal hypothyroidism, antithyroid drugs, propylthiouracil, methimazole, maternal thyroid function, cordocentesis, fetal thyroid function
- MeSH terms
- Adult, Female, Fetal Diseases, Goiter, Graves Disease, Humans, Hypothyroidism, Infant, Newborn, Male, Methimazole, Pregnancy, Pregnancy Complications, Pregnancy Trimester, Second, Propylthiouracil, Antithyroid Agents, Thyrotropin, Thyroxine
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