胎儿甲状腺肿大合并甲状腺功能减退的产前诊断及干预:3例分析  

Prenatal diagnosis and intervention of fetal goiter complicated by hypothyroidism:an analysis of three cases

作　　者：李琴[1] 李亮[2] 贺小进[3] 袁静[1] Li Qin;Li Liang;He Xiaojin;Yuan Jing(Prenatal Diagnosis Center,the First Affiliated Hospital of Anhui Medical University,Hefei 230031,China;Department of Ultrasonography,the First Affiliated Hospital of Anhui Medical University,Hefei 230031,China;Reproductive Center,the First Affiliated Hospital of Anhui Medical University,Hefei 230031,China)

机构地区：[1]安徽医科大学第一附属医院产前诊断中心,合肥230031 [2]安徽医科大学第一附属医院超声科,合肥230031 [3]安徽医科大学第一附属医院生殖中心,合肥230031

出　　处：《中华围产医学杂志》2023年第9期760-765,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的总结胎儿甲状腺肿大合并甲状腺功能减退的产前诊断、临床干预及妊娠结局。方法回顾性纳入2021年1月至2022年12月安徽医科大学第一附属医院产前诊断的3例甲状腺肿大合并甲状腺功能减退胎儿。产前超声发现胎儿甲状腺肿大后,行脐血甲状腺功能检测评估胎儿甲状腺功能;诊断胎儿甲状腺肿大合并甲状腺功能减退后给予孕妇口服左甲状腺素,并监测胎儿甲状腺超声影像学和脐血甲状腺功能的变化情况。总结临床表现、妊娠结局及生后随访情况。采用描述性统计分析。结果病例1、2和3分别在孕24、21和23周^(+5)通过产前超声检查发现胎儿甲状腺肿大,且伴丰富血流信号;脐血甲状腺功能检测提示促甲状腺激素异常升高,诊断为先天性胎儿甲状腺功能减退。给予孕妇口服左甲状腺素,复查产前超声未提示胎儿肿大的甲状腺明显缩小,但是血流丰富度较前明显减轻;脐血甲状腺功能尤其是促甲状腺激素明显降低。除病例2孕34周^(+)因社会因素外院引产终止妊娠外;病例1和3均足月分娩。新生儿出生时以及生后随访(分别为12和18月龄)甲状腺功能均在正常范围内。结论超声结合脐血甲状腺功能检测有助于胎儿甲状腺肿大合并甲状腺功能减退的产前诊断;通过给予孕妇口服左甲状腺素可能有助于改善胎儿甲状腺功能。Objective To explore the prenatal diagnosis,clinical intervention and pregnancy outcome of fetal goiter complicated by hypothyroidism.Methods Three fetuses diagnosed with goiter and hypothyroidism in the First Affiliated Hospital of Anhui Medical University from January 2021 to December 2022 were retrospectively included.Thyroid function tests were performed using umbilical cord blood samples after the fetuses were diagnosed with goiter by prenatal ultrasound.Oral L-thyroxine was given to pregnant women diagnosed with fetal goiter complicated by hypothyroidism,and the changes in fetal thyroid ultrasound imaging and serological indexes were monitored.Clinical manifestations,pregnancy outcomes and postnatal follow-up were summarized using descriptive statistical analysis.Results Case 1,2 and 3 were diagnosed as having fetal goiter with rich blood flow signals in the thyroid by ultrasound at 24,21 and 23^(+5)weeks of gestation,respectively.Thyroid function tests showed abnormal increase of thyrotropin in umbilical cord blood and the fetuses were diagnosed with congenital hypothyroidism.Oral administration of L-thyroxine to pregnant women had no significant impact on the sizes of the enlarged thyroid glands,but the blood flow richness was significantly reduced.Moreover,the level of thyrotropin in umbilical cord blood decreased significantly after intervention.Case 2 was terminated due to social factors in another hospital at 34^(+)weeks of gestation.Cases 1 and 3 were full-term deliveries and followed up for 12 or 18 months.The thyroid function of both neonates were normal at birth and during follow-up.Conclusions Ultrasound combined with thyroid function tests using umbilical cord blood are helpful in the prenatal diagnosis of fetal goiter complicated by hypothyroidism.Oral administration of L-thyroxine to pregnant women may have practical clinical significance in improving fetal thyroid function.

关 键 词：甲状腺肿 先天性甲状腺功能减退症 胎儿疾病 产前诊断 甲状腺素 

分 类 号：R714.5[医药卫生—妇产科学]