Stoppa-Vaucher S, Van Vliet G, Deladoëy J. Discovery of a fetal goiter on prenatal ultrasound in women treated for Graves’ disease: First, do not harm. Thyroid 2011; 21: 931.

This article reports on the monitoring of a pregnant woman whose 19-week-old fetus presented a goiter revealed by ultrasound. The mother’s thyroid function was normal, whereas the fetus was diagnosed with hypothyroidism. The team of specialists agreed to monitor the fetus by ultrasound every two weeks and only to intervene if there were signs of tracheooesophageal compression by goiter, which leads to a strong increase in the quantity of amniotic fluid. For the team of specialists, the primary objective was to be able to allow the mother to have natural childbirth while ensuring the subsequent normal development of the infant.

Primary Aim: To Cause No Harm

Although thyroid hormone balance is important for fetal development, any correction of fetal hypothyroidism using repeated thyroid hormone injections into the uterine cavity that is too aggressive is unnecessary and causes more risks than benefits. In the described case, three amniotic injections were sufficient to control the situation. The newborn’s treatment began on the first day of its life with thyroid hormones and its neurological development has been normal.

This is why when fetal goiter is diagnosed it is important to monitor the condition throughout pregnancy. The ultrasound gives clinicians an accurate definition of the fetus’ condition, which allows early intervention and an easy assessment of the effects of the treatment.