Intrauterine treatment of fetal goitrous hypothyroidism controlled by determination of thyroid-stimulating hormone in fetal serum - A case report andreview of the literature

We report a rare case of fetal goitrous hypothyroidism complicated by polyh ydramnios and preterm labor in a mother without thyroid gland pathology, Th e diagnosis was made in the 26th week by ultrasound and cordocentesis [TSH 170 muU/ml, free T-4 0.2 ng/dl], The therapeutic regime required repeated f etal blood sampling for determination of thyroid hormones, Five intra-amnio tic administrations of 250 mug levothyroxine (LT4) weekyl were initiated, B ecause of the persisting goiter and the elevated level of TSH (128 muU/ml i n 32 weeks) in the fetal serum the dosage had to be adjusted to 500 mug LT4 in the next five injections. TSH in fetal serum declined to 49.2 muU/ml in 36 weeks. Normal fetal growth and an uncomplicated course of pregnancy bet ween the 27th and 37th week of gestation were observed, Monitoring of intra uterine therapy by determination of TSH in fetal serum may provide more rel iable data than measuring TSH in amniotic fluid. A review of 15 cases of fe tal goitrous hypothyroidism in the English literature is presented. Copyrig ht (C) 2001 S. Karger AG, Basel.