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2012-12-10-16 Goiter ©Jayprakash Shah


Jayprakash Shah MD; FICOG
Rajni Fetal Medicine center, Ahmedabad, India
Case report:

Mrs. ABC, 25 years old, G2P1, has a normal 2 year-old child. She has hyper thyroidism and was on Propylthiouracil for 1 ½ year, well controlled for 6 month, later had no follow up with treating physician. After conception she was under antenatal care from 4 ½ month. Previous malformation scan at 19 weeks was showing no abnormality. At 29 weeks she developed polyhydramnios and had a repeat scan – no fetal malformation was detectable. Her GTT was normal showing no gestational diabetes. She was referred to my center for further evaluation.
At our center, we found polyhydramnios and these ultrasound findings:
Figure 1-2 : 3D of face appears normal. Note a neck swelling anteriorly suggestive of thyroid goiter.

Figure 3: Thyroid goiter sagittal view.

Figure 4: Thyroid gland measurement.

Video clip 1, 2: Shows thyroid goiter in 2D & 4D

Patient was counseled in detail.
Patient’s thyroid function test was done – Severe hypothyroidism (Serum TSH 75 noted)
Cordocentesis was done – Fetal TSH more than 400 mcg was noted.
Ideally in utero injection Levothyroxine is indicated. Unfortunately it was not available at all major centers in India where I inquired. Endocrinologist was consulted. Alternatively, it was suggested to give high dose of maternal Thyroxine (400mcgm / day for 3 days) with explanation & risk of thyroid crisis. 
Crash therapy-Acute suppression therapy was given twice, week apart.
Patient responded well. Polyhydamnios turned back to less than 20 cm.
Size of thyroid gland almost became normal.

At term, 2.7 kg baby, male child was delivered. Immediate & 1 weeks serum TSH, Free T3, T4 level were normal.


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