P311: Fetal hydrops, associated with maternal PTU exposure, reversed by intra-uterine therapy. A case report and review of the literature

Abstract

Thyroid hormone is essential for the fetal neurological development. Among other etiologies, fetal hypothyroidism may be caused by maternal exposure to antithyroid drugs. The most common presentation of fetal hypothyroidism is fetal goiter, which can cause dystocia, as well as airway obstruction in the newborn. Intra-amniotic treatment with levothyroxine, was proved to normalize fetal thyroid status and reduce goiter size. We present a case of fetal hypothyroidism, diagnosed in a patient who was treated with propylthiouracil (PTU), for Grave's disease. The fetus had a remarkable hydrops fetalis, as well as a large goiter. In addition, anal stenosis, vesico-vaginal fistula, bilateral pyelectasis and polydactyly were diagnosed in the newborn. Intra-amniotic treatment with levothyroxine, resulted in a regression of the hydrops and a reduction in the goiter size. An euthyroid, non-edematous, non-goiterous newborn was born, with a normal psychomotor development, to date. Hydrops fetalis is an unusual manifestation of fetal hypothyroidism, caused by intrauterine exposure to maternal antithyroid drugs. The hydrops can be resolved by intraamniotic treatment with levothyroxine.