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Goiter
Roya Sohaey, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Graves disease (GD)
            • Thyroid-stimulating hormone receptor antibodies (TRAbs)
            • Antithyroid drugs (ATDs)
          • Definitions

            • Enlarged fetal thyroid gland due to hyperthyroidism or hypothyroidism (85-90% due to maternal GD)
              • Fetal hyperthyroid state due to ↑ maternal TRAbs
              • Fetal hypothyroid state due to ↑ maternal ATDs or endemic iodine deficiency
              • Rarely, goiter may be present in euthyroid fetus

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • Associated Findings

                • Invasive Procedures May Be Necessary

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  • Recommendations for All Pregnant Women With Graves Disease or History of Graves Disease

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Iijima S: Current knowledge about the in utero and peripartum management of fetal goiter associated with maternal Graves' disease. Eur J Obstet Gynecol Reprod Biol X. 3:100027, 2019
                                        2. Panaitescu AM et al: Maternal autoimmune disorders and fetal defects. J Matern Fetal Neonatal Med. 31(13):1798-806, 2018
                                        3. Léger J: Management of fetal and neonatal Graves' disease. Horm Res Paediatr. 87(1):1-6, 2017
                                        4. Donnelly MA et al: Early severe fetal Graves disease in a mother after thyroid ablation and thyroidectomy. Obstet Gynecol. 125(5):1059-62, 2015
                                        5. Mastrolia SA et al: Antenatal diagnosis and treatment of hypothyroid fetal goiter in an euthyroid mother: a case report and review of literature. J Matern Fetal Neonatal Med. 1-7, 2014
                                        6. Polak M et al: Fetal thyroidology. Best Pract Res Clin Endocrinol Metab. 28(2):161-73, 2014
                                        7. Raymond J et al: Fetal and neonatal thyroid function: review and summary of significant new findings. Curr Opin Endocrinol Diabetes Obes. 17(1):1-7, 2010
                                        8. Stoppa-Vaucher S et al: Non-immune goiter and hypothyroidism in a 19-week fetus: a plea for conservative treatment. J Pediatr. 156(6):1026-9, 2010
                                        9. Hanono A et al: Antenatal treatment of fetal goiter: a therapeutic challenge. J Matern Fetal Neonatal Med. 22(1):76-80, 2009
                                        10. Huel C et al: Use of ultrasound to distinguish between fetal hyperthyroidism and hypothyroidism on discovery of a goiter. Ultrasound Obstet Gynecol. 33(4):412-20, 2009
                                        11. Jain V et al: Fetal euthyroid goiter. Indian J Pediatr. 76(12):1259-60, 2009
                                        12. Mayor-Lynn KA et al: Antenatal diagnosis and treatment of a dyshormonogenetic fetal goiter. J Ultrasound Med. 28(1):67-71, 2009
                                        13. Thomas Jde V et al: Perinatal goiter with increased iodine uptake and hypothyroidism due to excess maternal iodine ingestion. Horm Res. 72(6):344-7, 2009
                                        14. Lazarus JH: Thyroid disorders associated with pregnancy: etiology, diagnosis, and management. Treat Endocrinol. 4(1):31-41, 2005
                                        15. Polak M et al: Fetal and neonatal thyroid function in relation to maternal Graves' disease. Best Pract Res Clin Endocrinol Metab. 18(2):289-302, 2004
                                        16. Yanai N et al: Fetal hydrops, associated with maternal propylthiouracil exposure, reversed by intrauterine therapy. Ultrasound Obstet Gynecol. 23(2):198-201, 2004
                                        17. Cohen O et al: Serial in utero ultrasonographic measurements of the fetal thyroid: a new complementary tool in the management of maternal hyperthyroidism in pregnancy. Prenat Diagn. 23(9):740-2, 2003
                                        18. Nachum Z et al: Graves' disease in pregnancy: prospective evaluation of a selective invasive treatment protocol. Am J Obstet Gynecol. 189(1):159-65, 2003
                                        19. Ranzini AC et al: Ultrasonography of the fetal thyroid: nomograms based on biparietal diameter and gestational age. J Ultrasound Med. 20(6):613-7, 2001
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Graves disease (GD)
                                                  • Thyroid-stimulating hormone receptor antibodies (TRAbs)
                                                  • Antithyroid drugs (ATDs)
                                                • Definitions

                                                  • Enlarged fetal thyroid gland due to hyperthyroidism or hypothyroidism (85-90% due to maternal GD)
                                                    • Fetal hyperthyroid state due to ↑ maternal TRAbs
                                                    • Fetal hypothyroid state due to ↑ maternal ATDs or endemic iodine deficiency
                                                    • Rarely, goiter may be present in euthyroid fetus

                                                IMAGING

                                                • General Features

                                                  • Ultrasonographic Findings

                                                    • Associated Findings

                                                      • Invasive Procedures May Be Necessary

                                                        • MR Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        • Recommendations for All Pregnant Women With Graves Disease or History of Graves Disease

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Iijima S: Current knowledge about the in utero and peripartum management of fetal goiter associated with maternal Graves' disease. Eur J Obstet Gynecol Reprod Biol X. 3:100027, 2019
                                                                              2. Panaitescu AM et al: Maternal autoimmune disorders and fetal defects. J Matern Fetal Neonatal Med. 31(13):1798-806, 2018
                                                                              3. Léger J: Management of fetal and neonatal Graves' disease. Horm Res Paediatr. 87(1):1-6, 2017
                                                                              4. Donnelly MA et al: Early severe fetal Graves disease in a mother after thyroid ablation and thyroidectomy. Obstet Gynecol. 125(5):1059-62, 2015
                                                                              5. Mastrolia SA et al: Antenatal diagnosis and treatment of hypothyroid fetal goiter in an euthyroid mother: a case report and review of literature. J Matern Fetal Neonatal Med. 1-7, 2014
                                                                              6. Polak M et al: Fetal thyroidology. Best Pract Res Clin Endocrinol Metab. 28(2):161-73, 2014
                                                                              7. Raymond J et al: Fetal and neonatal thyroid function: review and summary of significant new findings. Curr Opin Endocrinol Diabetes Obes. 17(1):1-7, 2010
                                                                              8. Stoppa-Vaucher S et al: Non-immune goiter and hypothyroidism in a 19-week fetus: a plea for conservative treatment. J Pediatr. 156(6):1026-9, 2010
                                                                              9. Hanono A et al: Antenatal treatment of fetal goiter: a therapeutic challenge. J Matern Fetal Neonatal Med. 22(1):76-80, 2009
                                                                              10. Huel C et al: Use of ultrasound to distinguish between fetal hyperthyroidism and hypothyroidism on discovery of a goiter. Ultrasound Obstet Gynecol. 33(4):412-20, 2009
                                                                              11. Jain V et al: Fetal euthyroid goiter. Indian J Pediatr. 76(12):1259-60, 2009
                                                                              12. Mayor-Lynn KA et al: Antenatal diagnosis and treatment of a dyshormonogenetic fetal goiter. J Ultrasound Med. 28(1):67-71, 2009
                                                                              13. Thomas Jde V et al: Perinatal goiter with increased iodine uptake and hypothyroidism due to excess maternal iodine ingestion. Horm Res. 72(6):344-7, 2009
                                                                              14. Lazarus JH: Thyroid disorders associated with pregnancy: etiology, diagnosis, and management. Treat Endocrinol. 4(1):31-41, 2005
                                                                              15. Polak M et al: Fetal and neonatal thyroid function in relation to maternal Graves' disease. Best Pract Res Clin Endocrinol Metab. 18(2):289-302, 2004
                                                                              16. Yanai N et al: Fetal hydrops, associated with maternal propylthiouracil exposure, reversed by intrauterine therapy. Ultrasound Obstet Gynecol. 23(2):198-201, 2004
                                                                              17. Cohen O et al: Serial in utero ultrasonographic measurements of the fetal thyroid: a new complementary tool in the management of maternal hyperthyroidism in pregnancy. Prenat Diagn. 23(9):740-2, 2003
                                                                              18. Nachum Z et al: Graves' disease in pregnancy: prospective evaluation of a selective invasive treatment protocol. Am J Obstet Gynecol. 189(1):159-65, 2003
                                                                              19. Ranzini AC et al: Ultrasonography of the fetal thyroid: nomograms based on biparietal diameter and gestational age. J Ultrasound Med. 20(6):613-7, 2001