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CASE REPORT
Graves’ disease complicated by fetal goitrous hypothyroidism treated with intra-amniotic administration of levothyroxine
  1. Catarina Martins Machado1,
  2. Jorge Manuel Castro2,
  3. Rosa Arménia Campos3 and
  4. Maria João Oliveira1
  1. 1 Endocrinology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
  2. 2 Gynecology and Obstetrics, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
  3. 3 Pediatrics, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
  1. Correspondence to Dr Catarina Martins Machado, catarina_mmachado{at}hotmail.com

Abstract

Fetal goitrous hypothyroidism is a rare entity and is caused mainly by maternal treatment of Graves’ disease (GD). We report a case of a 22-year-old woman referred at 12 weeks of gestation due to hyperthyroidism subsequent to recently diagnosed GD. She started treatment with propylthiouracil and, at 21 weeks of gestation, fetal goitre was detected. A cordocentesis confirmed the diagnosis of fetal goitrous hypothyroidism, and intra-amniotic administration of levothyroxine (LT4) was performed and repeated through the pregnancy due to maintenance of fetal goitre. The pregnancy proceeded without further complications and a healthy female infant was born at 37 weeks of gestation, with visible goitre and thyroid function within the normal range at birth. Although there is no consensus on the optimal dose, the number of injections and the interval between them, intra-amniotic LT4 administration is recommended once fetal goitrous hypothyroidism is suspected, in order to prevent long-term complications of fetal hypothyroidism.

  • thyroid disease
  • pregnancy
  • materno-fetal medicine
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Footnotes

  • Contributors CMM and MJO conceived the case report. CMM performed the literature search and wrote the first draft of the manuscript. JMC, RAC and MJO managed the case. All authors reviewed and approved the final version of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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