Therapeutic Approach of Fetal Thyroid Disorders

Recent advances in fetal imaging techniques and fetal hormonology allow the identification in the fetus of thyroid function disorders that can potentially be treated in utero by giving drugs to the mother. In women with Graves’ disease (when fetal hyperthyroidism is present), it can generally be treated in a noninvasive way by optimizing treatment of the mother. For goitrous nonimmune fetal hypothyroidism leading to hydramnios, intra-amniotic injections of thyroxine have been reported to decrease the size of the fetal thyroid. Experience with such a procedure is limited and the risk of provoking premature labor or infections should be carefully evaluated. Thus, follow-up of the efficacy and the possible long-term undesired consequences of medical interventions administered to the fetus are of great importance. Such interventions should only be performed by specialized teams with extensive experience in perinatal care.

[1]  D. Francoeur,et al.  Non-immune goiter and hypothyroidism in a 19-week fetus: a plea for conservative treatment. , 2010, The Journal of pediatrics.

[2]  D. Luton,et al.  Experience with intraamniotic thyroxine treatment in nonimmune fetal goitrous hypothyroidism in 12 cases. , 2009, The Journal of clinical endocrinology and metabolism.

[3]  F. Karlsson,et al.  Thyroid blocking antibodies in thyroiditis. , 2009, Acta medica Scandinavica.

[4]  M. Polak,et al.  Clinical Description of Infants with Congenital Hypothyroidism and Iodide Organification Defects , 2008, Hormone Research in Paediatrics.

[5]  D. Glinoer The importance of iodine nutrition during pregnancy , 2007, Public Health Nutrition.

[6]  A. Pinchera,et al.  The sodium‐iodide symporter expression in placental tissue at different gestational age: an immunohistochemical study , 2006, Clinical endocrinology.

[7]  J. Franklyn,et al.  Monocarboxylate transporter 8 expression in the human placenta: the effects of severe intrauterine growth restriction. , 2006, The Journal of endocrinology.

[8]  C. Garel,et al.  Management of Graves' disease during pregnancy: the key role of fetal thyroid gland monitoring. , 2005, The Journal of clinical endocrinology and metabolism.

[9]  W. Holzgreve,et al.  Intrauterine therapy of goitrous hypothyroidism in a boy with a new compound heterozygous mutation (Y453D and C800R) in the thyroid peroxidase gene. A long-term follow-up. , 2005, American journal of obstetrics and gynecology.

[10]  R. Gaiser Timing and Magnitude of Increases in Levothyroxine Requirements During Pregnancy in Women With Hypothyroidism , 2005 .

[11]  F. Elmslie,et al.  Carbimazole embryopathy: An emerging phenotype , 2005, American journal of medical genetics. Part A.

[12]  D. Luton,et al.  Fetal thyroid goiter after massive iodine exposure , 2004, Prenatal diagnosis.

[13]  Dingcai Cao,et al.  Fetal loss associated with excess thyroid hormone exposure. , 2004, JAMA.

[14]  D. Luton,et al.  Fetal and neonatal thyroid function in relation to maternal Graves' disease. , 2004, Best practice & research. Clinical endocrinology & metabolism.

[15]  C. Deal,et al.  Cognition and behavior at school entry in children with congenital hypothyroidism treated early with high-dose levothyroxine. , 2004, The Journal of pediatrics.

[16]  E. Jauniaux,et al.  Fetal tissues are exposed to biologically relevant free thyroxine concentrations during early phases of development. , 2002, The Journal of clinical endocrinology and metabolism.

[17]  C. Ananth,et al.  Ultrasonography of the fetal thyroid: nomograms based on biparietal diameter and gestational age. , 2001, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[18]  B. de Benoist,et al.  Iodine deficiency in the world: where do we stand at the turn of the century? , 2001, Thyroid : official journal of the American Thyroid Association.

[19]  D. Glinoer,et al.  The potential repercussions of maternal, fetal, and neonatal hypothyroxinemia on the progeny. , 2000, Thyroid : official journal of the American Thyroid Association.

[20]  Arvin,et al.  Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. , 1999, The New England journal of medicine.

[21]  W. Wiersinga,et al.  Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy , 1999, Clinical endocrinology.

[22]  P. Kopp,et al.  Congenital hyperthyroidism caused by a solitary toxic adenoma harboring a novel somatic mutation (serine281-->isoleucine) in the extracellular domain of the thyrotropin receptor. , 1997, The Journal of clinical investigation.

[23]  M. Polak,et al.  A neomutation of the thyroid-stimulating hormone receptor in a severe neonatal hyperthyroidism. , 1996, The Journal of clinical endocrinology and metabolism.

[24]  J. Martial,et al.  The prenatal role of thyroid hormone evidenced by fetomaternal Pit-1 deficiency. , 1995, The Journal of clinical endocrinology and metabolism.

[25]  Rosalind S. Brown,et al.  Outcome in three siblings with antibody-mediated transient congenital hypothyroidism. , 1995, The Journal of pediatrics.

[26]  J. Parma,et al.  Brief report: congenital hyperthyroidism caused by a mutation in the thyrotropin-receptor gene. , 1995, The New England journal of medicine.

[27]  G. Delong,et al.  Timing of vulnerability of the brain to iodine deficiency in endemic cretinism. , 1994, The New England journal of medicine.

[28]  A. Allgeier,et al.  Germline mutations in the thyrotropin receptor gene cause non–autoimmune autosomal dominant hyperthyroidism , 1994, Nature Genetics.

[29]  D. Schatz,et al.  Successful in utero treatment of fetal goiter and hypothyroidism. , 1991, The New England journal of medicine.

[30]  M. Obregon,et al.  Congenital hypothyroidism, as studied in rats. Crucial role of maternal thyroxine but not of 3,5,3'-triiodothyronine in the protection of the fetal brain. , 1990, The Journal of clinical investigation.

[31]  J. D. Vijlder,et al.  Maternal-fetal transfer of thyroxine in congenital hypothyroidism due to a total organification defect or thyroid agenesis. , 1989, The New England journal of medicine.

[32]  J. Mckenzie,et al.  Pregnancy-associated changes in the thyroid-stimulating antibody of Graves' disease and the relationship to neonatal hyperthyroidism. , 1983, The Journal of clinical endocrinology and metabolism.

[33]  A. Fanaroff Experience with Intraamniotic Thyroxine Treatment in Nonimmune Fetal Goitrous Hypothyroidism in 12 Cases , 2010 .

[34]  F. Richer,et al.  Outcome of severe congenital hypothyroidism: closing the developmental gap with early high dose levothyroxine treatment. , 1996, The Journal of clinical endocrinology and metabolism.