A fetal goitre 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 is different dependent 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 goitre may been seen as a relatively homogenous anterior fetal neck mass. There is also evidence of polyhydramnios. If the goitre is very large the neck may appear hyperextended.
Some investigators have attempted to assess the hyper or hypothyroid status dependant on sonographic features 7
- hypothyroid goitres
- more likely to have a peripheral vascular pattern on colour Doppler interrogation
- may have evidence of delayed bone maturation
- there may be an increase in fetal movement
- hyperthyroid goitres
- 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.
- hydrops fetalis: from increased vascular shunting within the goitre
- development of a fetal tachycardia
- cervical dystocia: from extended position of the fetal head in labour
- thyroid inflammatory disease
- thyroid neoplasms
- thyroid nodules
- assessment of thyroid lesions
- postoperative assessment after thyroid cancer surgery
- ultrasound-guided fine needle aspiration of the thyroid
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- 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