Fetal Hyperthyroidism with Maternal Hypothyroidism: Two Cases of Intrauterine Therapy

Hong, Lu; Tang, Mary Hoi Yin; Cheung, Ka Wang; Luo, Libing; Cheung, Cindy Ka Yee; Dai, Xiaoying; Li, Yanyan; Xiong, Chuqin; Liang, Wei; Xiang, Wei; Wang, Liangbing; Chan, Kelvin Yuen Kwong; Lin, Shengmou

doi:10.3390/diagnostics14010102

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Fetal Hyperthyroidism with Maternal Hypothyroidism: Two Cases of Intrauterine Therapy

by

Lu Hong

^1,†,

Mary Hoi Yin Tang

^1,†,

Ka Wang Cheung

²,

Libing Luo

¹,

Cindy Ka Yee Cheung

¹,

Xiaoying Dai

¹,

Yanyan Li

¹,

Chuqin Xiong

³,

Wei Liang

⁴,

Wei Xiang

⁴,

Liangbing Wang

⁵,

Kelvin Yuen Kwong Chan

^6,*

and

Shengmou Lin

^1,*

¹

Prenatal Diagnosis Centre, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China

²

Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong 999077, China

³

Department of Ultrasound, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China

⁴

Department of Endocrinology, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China

⁵

Neonatal Intensive Care Unit, The University of Hong Kong—Shenzhen Hospital, Shenzhen 518053, China

⁶

Department of Applied Science, School of Science and Technology, Hong Kong Metropolitan University, Hong Kong 999077, China

^*

Authors to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Diagnostics 2024, 14(1), 102; https://doi.org/10.3390/diagnostics14010102

Submission received: 7 November 2023 / Revised: 27 December 2023 / Accepted: 28 December 2023 / Published: 3 January 2024

(This article belongs to the Special Issue Fetal Medicine: From Basic Science to Prenatal Diagnosis and Therapy)

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Abstract

Fetal hyperthyroidism can occur secondary to maternal autoimmune hyperthyroidism. The thyroid-stimulating hormone receptor antibody (TRAb) transferred from the mother to the fetus stimulates the fetal thyroid and causes fetal thyrotoxicosis. Fetuses with this condition are difficult to detect, especially after maternal Graves disease therapy. Here, we present two cases of fetal hyperthyroidism with maternal hypothyroidism and review the assessment and intrauterine therapy for fetal hyperthyroidism. Both women were referred at 22⁺ and 23⁺ weeks of gestation with abnormal ultrasound findings, including fetal heart enlargement, pericardial effusion, and fetal tachycardia. Both women had a history of Graves disease while in a state of hypothyroidism with a high titer of TRAb. A sonographic examination showed a diffusely enlarged fetal thyroid with abundant blood flow. Invasive prenatal testing revealed no significant chromosomal aberration. Low fetal serum TSH and high TRAb levels were detected in the cord blood. Fetal hyperthyroidism was considered, and maternal oral methimazole (MMI) was administered as intrauterine therapy, with the slowing of fetal tachycardia, a reduction in fetal heart enlargement, and thyroid hyperemia. During therapy, maternal thyroid function was monitored, and the dosage of maternal levothyroxine was adjusted accordingly. Both women delivered spontaneously at 36⁺ weeks of gestation, and neonatal hyperthyroidism was confirmed in both newborns. After methimazole and propranolol drug treatment with levothyroxine for 8 and 12 months, both babies became euthyroid with normal growth and development.

Keywords: fetal hyperthyroidism; thyroid-stimulating hormone receptor antibody (TRAb); intrauterine therapy

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MDPI and ACS Style

Hong, L.; Tang, M.H.Y.; Cheung, K.W.; Luo, L.; Cheung, C.K.Y.; Dai, X.; Li, Y.; Xiong, C.; Liang, W.; Xiang, W.; et al. Fetal Hyperthyroidism with Maternal Hypothyroidism: Two Cases of Intrauterine Therapy. Diagnostics 2024, 14, 102. https://doi.org/10.3390/diagnostics14010102

AMA Style

Hong L, Tang MHY, Cheung KW, Luo L, Cheung CKY, Dai X, Li Y, Xiong C, Liang W, Xiang W, et al. Fetal Hyperthyroidism with Maternal Hypothyroidism: Two Cases of Intrauterine Therapy. Diagnostics. 2024; 14(1):102. https://doi.org/10.3390/diagnostics14010102

Chicago/Turabian Style

Hong, Lu, Mary Hoi Yin Tang, Ka Wang Cheung, Libing Luo, Cindy Ka Yee Cheung, Xiaoying Dai, Yanyan Li, Chuqin Xiong, Wei Liang, Wei Xiang, and et al. 2024. "Fetal Hyperthyroidism with Maternal Hypothyroidism: Two Cases of Intrauterine Therapy" Diagnostics 14, no. 1: 102. https://doi.org/10.3390/diagnostics14010102

APA Style

Hong, L., Tang, M. H. Y., Cheung, K. W., Luo, L., Cheung, C. K. Y., Dai, X., Li, Y., Xiong, C., Liang, W., Xiang, W., Wang, L., Chan, K. Y. K., & Lin, S. (2024). Fetal Hyperthyroidism with Maternal Hypothyroidism: Two Cases of Intrauterine Therapy. Diagnostics, 14(1), 102. https://doi.org/10.3390/diagnostics14010102

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Fetal Hyperthyroidism with Maternal Hypothyroidism: Two Cases of Intrauterine Therapy

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