Treatment of Congenital Iodine-Deficiency in Fetal Hypothyroidism with a Large Fetal Goiter Associated with Hydramnios or Tracheal Occlusion

This protocol covers a specific prenatal scenario in which congenital iodine-deficiency manifests as fetal hypothyroidism with a large fetal goiter, while the pregnant woman is herself euthyroid. When the goiter is complicated by hydramnios and/or tracheal occlusion, a targeted fetal intervention is indicated.

Clinical scenario: A euthyroid pregnant woman carries a fetus with hypothyroidism and a large goiter. The goiter is associated with hydramnios and/or tracheal occlusion. Because the mother is not hypothyroid, treatment is directed at the fetus rather than at the mother.

Treatment approach: Management involves a direct fetal intervention performed by a multidisciplinary specialist team. The intervention targets the fetal thyroid gland with the goal of reducing goiter size. The complete regimen — including the specific agent, dose, route, and schedule — is detailed in the full structured protocol.

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References

DOI: 10.1089/thy.2020.0333

We strongly recommend fetal treatment by intra-amniotic LT4 injections in a euthyroid pregnant woman with a large fetal goiter associated with hydramnios and/or tracheal occlusion; in a hypothyroid pregnant woman, we recommend to treat the woman (rather the fetus) with LT4.

For goitrous nonimmune fetal hypothyroidism leading to hydramnios, we recommend intra-amniotic injections of LT4 to decrease the size of the fetal thyroid gland.

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