Johnson R L, Finberg H J, Perelman A H, Clewell W H
Good Samaritan Medical Center, Phoenix, Ariz.
Fetal Ther. 1989;4(2-3):141-5.
We present a first case in whom fetal hypothyroidism with goiter was both successfully diagnosed and treated in utero. An obstetrical sonogram at 33 weeks revealed a bilobed fetal neck mass, compatible with enlarged thyroid gland, associated with neck hyperextension, reduced gastric fluid, and polyhydramnios. Umbilical blood sampling after volume reduction amniocentesis confirmed fetal hypothyroidism with a euthyroid mother. Fetal T4 measured 1.3 micrograms/dl, free T4 0.3 ng/dl, and thyroid-stimulating hormone 186 microU. Intraamniotic levothyroxine, 500 micrograms, was given twice with a 14-day interval. The head flexed, gastric fluid increased, and amniotic fluid levels returned to normal. Prenatal (36 weeks) and neonatal blood sampling demonstrated return to euthyroid indices. Ultrasonic estimates of thyroid volume decreased by over 50%. Vaginal delivery at 39 weeks was uncomplicated. The newborn appeared normal and is being maintained on thyroid replacement therapy.
我们报告了首例在子宫内成功诊断并治疗胎儿甲状腺功能减退伴甲状腺肿的病例。孕33周时的产科超声检查发现胎儿颈部有一个分叶状肿块，与甲状腺肿大相符，伴有颈部过度伸展、胃液减少和羊水过多。在羊水减量穿刺术后进行脐血采样，证实胎儿甲状腺功能减退，而母亲甲状腺功能正常。胎儿T4测量值为1.3微克/分升，游离T4为0.3纳克/分升，促甲状腺激素为186微单位。间隔14天两次给予羊膜腔内左旋甲状腺素500微克。胎儿头部屈曲，胃液增加，羊水水平恢复正常。产前（36周）和新生儿血样采集显示甲状腺功能指标恢复正常。超声估计甲状腺体积减少超过50%。孕39周时经阴道分娩，过程顺利。新生儿外观正常，正在接受甲状腺替代治疗。
