Cited by 24Thyroid Disorders and TreatmentsPregnancy and Medication ImpactThyroid and Parathyroid Surgery

Graves' Disease in Two Pregnancies Complicated by Fetal Goitrous Hypothyroidism: Successful In Utero Treatment with Levothyroxine

Bliddal, Sofie, Rasmussen, Åse Krogh, Sundberg, Karin, Brocks, Vibeke, Skovbo, Peter, Feldt-Rasmussen, Ulla·2011·Thyroid

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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Crossref · 10.1089/thy.2010.0286

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43 of 43 references verified0 citation errors · 0 not checkable

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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).”

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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
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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