Agrawal P, Ogilvy-Stuart A, Lees C
University of Cambridge, School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK.
Ultrasound Obstet Gynecol. 2002 May;19(5):501-5. doi: 10.1046/j.1469-0705.2002.00717.x.
The intrauterine recognition and treatment of congenital goitrous hypothyroidism may not only reduce the obstetric complications associated with large goiters, but possibly improve the prognosis for normal growth and mental development of affected fetuses. We present a case of fetal goiter diagnosed at 29 weeks of gestation following routine ultrasound examination. Fetal blood sampling performed at this time confirmed the presence of fetal hypothyroidism. Treatment was performed using a series of intra-amniotic injections between 31 and 36 weeks, initially with tri-iodothyronine (T3) and subsequently with thyroxine. During this period, shrinkage of the fetal goiter, increasing neck flexion and resolution of the polyhydramnios was observed. Following birth, neonatal serum thyroid-stimulating hormone levels were within the normal range but thyroxine was reduced. The baby was started on daily oral thyroxine and, on examination 7 weeks following birth, he appeared clinically and chemically euthyroid. In the absence of maternal thyroid disease, fetal goiter is extremely rare, with only seven cases previously reported in the English literature to have used intra-amniotic thyroxine injections as a form of treatment. This report reviews the current literature regarding the diagnosis and intrauterine management of fetal goiter and considers the possibility of T3 therapy in future cases of congenital hypothyroidism.
先天性甲状腺肿性甲状腺功能减退症的宫内识别与治疗不仅可以减少与巨大甲状腺肿相关的产科并发症，还可能改善受影响胎儿正常生长和智力发育的预后。我们报告一例在妊娠29周常规超声检查时诊断出的胎儿甲状腺肿病例。此时进行的胎儿血样采集证实存在胎儿甲状腺功能减退。在31至36周期间进行了一系列羊膜腔内注射治疗，最初使用三碘甲状腺原氨酸（T3），随后使用甲状腺素。在此期间，观察到胎儿甲状腺肿缩小、颈部弯曲增加以及羊水过多情况得到缓解。出生后，新生儿血清促甲状腺激素水平在正常范围内，但甲状腺素水平降低。婴儿开始每日口服甲状腺素，出生7周后检查时，临床和生化检查显示甲状腺功能正常。在无母体甲状腺疾病的情况下，胎儿甲状腺肿极为罕见，英文文献中此前仅报道过7例使用羊膜腔内注射甲状腺素作为治疗方式的病例。本报告回顾了关于胎儿甲状腺肿诊断和宫内管理的当前文献，并考虑了在未来先天性甲状腺功能减退症病例中使用T3治疗的可能性。
