Antenatal diagnosis and treatment of fetal goitrous hypothyroidism

Abstract

Fetal goitre secondary to hypothyroidism is the leading cause of intellectual disability. Despite its rarity, many cases of fetal goitre are diagnosed and require prenatal management. We present a comprehensive review about the pre­na­tal diagnosis and treatment of fetal hypo­thy­roid goitre. Fetal thyroid size can be measured by transvaginal ultra­so­no­gra­phy from 14 weeks, and by trans­ab­do­mi­nal ultrasonography from 18 weeks of ges­ta­tion. The size of the fetal thyroid de­pends on ges­ta­tio­nal age. Because fetal goitre can lead to intra­ute­rine, perinatal and obstetrical complications, the op­ti­mal treat­ment is required. Fetal com­pli­cations are: fetal growth res­tric­tion, polyhydramnios, pleural effusion, preterm de­li­ve­ry, craniosynostosis, neuro­developmental disorders and neo­na­tal asphyxia or fetal death. The optimal intraamniotic L-thiroxine treatment did not normalize the thyroid hormonal le­vels, but these infants have normal neuromotor and psy­cho­­emo­­tio­nal development.