Prenatal diagnosis and early in utero management of fetal dyshormonogenetic goiter

We present a case of a fetal dyshormonogenetic goiter diagnosed by ultrasou nd examination at 34 weeks of gestation, in a woman with no past history of thyroid disease or goitrogen treatment and with normal thyroid tests, incl uding absence of auto-antibodies. In this situation, fetal goiter may only he associated With fetal hypothyroidism. therefore cord blood sampling was not performed but early treatment was initiated. Amniotic fluid instillatio n of thyroid hormone led to a rapid decrease in amniotic fluid volume and a clear reduction in thyroid goiter. However, fetal thyroid volume did not t otally normalise. and cord blood analysis at birth showed elevated fetal TS H level. As prenatal treatment of fetal hypothyroidism remains controversia l in euthyroid mothers, the main objective is to prevent obstetrical compli cations of large goiters. Therefore. in some selected cases with no materna l history of thyroid disease and normal thyroid function tests, cordocentes is is not necessary to confirm fetal thyroid status or to adjust fetal trea tment. (C) 2001 Elsevier Science ireland Ltd. All rights reserved.