A fetal goiter is an enlargement of the thyroid gland in utero. It can occur with either hyper- or hypothyroidism (and in isolated cases of euthyroidism 8).
The mechanism depends on whether the underlying cause is hyper- or hypothyroidism.
- maternal Graves disease with propylthiouracil (PTU) treatment 1
- Pendred syndrome
- polyhydramnios: from impaired swallowing 2
While antenatal detection is rare, once detected, it is important to evaluate fetal thyroid function in order for early treatment to be initiated if necessary.
A fetal goiter may be seen as a relatively homogenous anterior fetal neck mass. There is also evidence of polyhydramnios. If the goiter is very large the neck may appear hyperextended.
Some investigators have attempted to assess the hyper- or hypothyroid status relying on sonographic features 7:
- hypothyroid goiters
- more likely to have a peripheral vascular pattern on color Doppler
- may have evidence of delayed bone maturation
- may be accompanied by increased fetal movement
- hyperthyroid goiters
- more likely to have central vascularization
- may have evidence of a fetal tachycardia
- may have evidence of advanced bone maturity
Treatment and prognosis
Treatment will, again, depend on whether the fetus is hyper- or hypothyroid.
- 1. Lembet A, Eroglu D, Kinik ST et-al. Non-invasive management of fetal goiter during maternal treatment of hyperthyroidism in Grave's disease. Fetal. Diagn. Ther. 20 (4): 254-7. doi:10.1159/000085080 - Pubmed citation
- 2. Göktolga U, Karaşahin KE, Gezginç K et-al. Intrauterine fetal goiter: diagnosis and management. Taiwan J Obstet Gynecol. 2008;47 (1): 87-90. doi:10.1016/S1028-4559(08)60061-3 - Pubmed citation
- 3. Rosenfeld H, Ornoy A, Shechtman S et-al. Pregnancy outcome, thyroid dysfunction and fetal goitre after in utero exposure to propylthiouracil: a controlled cohort study. Br J Clin Pharmacol. 2009;68 (4): 609-17. doi:10.1111/j.1365-2125.2009.03495.x - Free text at pubmed - Pubmed citation
- 4. Avni EF, Rodesch F, Vandemerckt C et-al. Detection and evaluation of fetal goitre by ultrasound. Br J Radiol. 1992;65 (772): 302-5. doi:10.1259/0007-1285-65-772-302 - Pubmed citation
- 5. Weiner S, Scharf JI, Bolognese RJ et-al. Antenatal diagnosis and treatment of a fetal goiter. J Reprod Med. 1980;24 (1): 39-42. - Pubmed citation
- 6. Abuhamad AZ, Fisher DA, Warsof SL et-al. Antenatal diagnosis and treatment of fetal goitrous hypothyroidism: case report and review of the literature. Ultrasound Obstet Gynecol. 1995;6 (5): 368-71. doi:10.1046/j.1469-0705.1995.06050368.x - Pubmed citation
- 7. Huel C, Guibourdenche J, Vuillard E et-al. Use of ultrasound to distinguish between fetal hyperthyroidism and hypothyroidism on discovery of a goiter. Ultrasound Obstet Gynecol. 2009;33 (4): 412-20. doi:10.1002/uog.6315 - Pubmed citation
- 8. Jain V, Sharma R, Verma S et-al. Fetal euthyroid goiter. Indian J Pediatr. 2009;76 (12): 1259-60. doi:10.1007/s12098-009-0331-7 - Pubmed citation
- 9. Entezami M, Albig M, Knoll U et-al. Ultrasound Diagnosis of Fetal Anomalies. Thieme. (2003) ISBN:1588902129. Read it at Google Books - Find it at Amazon
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