Neonatal goiter caused by expectorant usage

A female newborn was admitted with the symptoms of mild respiratory distres s, protruding tongue, hypotonicity, cutis marmorata, sclerema, myxedema, ab dominal distension, and feeding problems on the first day of life. She had a huge neck mass, a large anterior and posterior fontanel, and hoarse cry. She had no umbilical hernia or jaundice. A history of maternal potassium io dine (expectorant) usage without doctor's advice was obtained; the mother h ad not attended a clinic throughout the pregnancy. On ultrasonographic exam ination, the thyroid right lobe was 53x31 mm and the left lobe was 34x31 mm . The results of thyroid hormone tests on the first day were as follows: T- 3 20 ng/dl (normal: 32-216 ng/dl), T-4 0.9 mug/dl (11.8-22.6 mug/dl), TSH 1 20 mIU/l (2.5-13.3 mIU/l). This patient is presented to emphasize the role of hypothyroidism in drug-induced neonatal goiter and to discuss the possib ility of a life-threatening effect of congenital goiter, i.e. respiratory t ract obstruction.