胎儿甲状腺功能减退。一种新的诊断和治疗方法。

Fetal therapy Pub Date : 1989-01-01
R L Johnson, H J Finberg, A H Perelman, W H Clewell
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引用次数: 0

摘要

我们提出了第一例在子宫内成功诊断和治疗甲状腺肿大的胎儿甲状腺功能减退症。孕33周的产科超声检查显示胎儿颈部肿块呈双叶状,伴甲状腺肿大,伴有颈部过伸、胃液减少和羊水过多。羊膜穿刺术后脐血取样证实胎儿甲状腺功能减退,母亲甲状腺功能正常。胎儿T4测定1.3微克/分升,游离T4 0.3纳克/分升,促甲状腺激素186微克/分升。羊膜内左旋甲状腺素500微克,两次,间隔14天。头部弯曲,胃液增多,羊水水平恢复正常。产前(36周)和新生儿血样显示甲状腺功能恢复正常。超声估计甲状腺体积下降超过50%。39周阴道分娩并不复杂。新生儿表现正常,目前正在接受甲状腺替代治疗。
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Fetal goitrous hypothyroidism. A new diagnostic and therapeutic approach.

We present a first case in whom fetal hypothyroidism with goiter was both successfully diagnosed and treated in utero. An obstetrical sonogram at 33 weeks revealed a bilobed fetal neck mass, compatible with enlarged thyroid gland, associated with neck hyperextension, reduced gastric fluid, and polyhydramnios. Umbilical blood sampling after volume reduction amniocentesis confirmed fetal hypothyroidism with a euthyroid mother. Fetal T4 measured 1.3 micrograms/dl, free T4 0.3 ng/dl, and thyroid-stimulating hormone 186 microU. Intraamniotic levothyroxine, 500 micrograms, was given twice with a 14-day interval. The head flexed, gastric fluid increased, and amniotic fluid levels returned to normal. Prenatal (36 weeks) and neonatal blood sampling demonstrated return to euthyroid indices. Ultrasonic estimates of thyroid volume decreased by over 50%. Vaginal delivery at 39 weeks was uncomplicated. The newborn appeared normal and is being maintained on thyroid replacement therapy.

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