胎儿甲状腺肿的产前超声诊断及其预后:5例病例分析  

Prenatal ultrasound diagnosis and prognosis of fetal goiter: analysis of five cases

作　　者：于冬梅[1] 孙慧[2] 张楠[1] 刘美新[3] 万伟[1] 苏晓婷[1] Yu Dongmei;Sun Hui;Zhang Nan;Liu Meixin;Wan Wei;Su Xiaoting(Department of Obstetrics,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Ultrasonography,Qingdao Women and Children's Hospital,Qingdao 266034,China;Department of Echocardiography,the Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院产科,青岛266000 [2]青岛大学附属妇女儿童医院超声科,青岛266034 [3]青岛大学附属医院心脏超声科,青岛266000

出　　处：《中华围产医学杂志》2023年第12期1002-1006,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的总结胎儿甲状腺肿的产前超声诊断要点及预后。方法回顾性分析2018年8月至2022年10月青岛大学附属医院及青岛大学附属妇女儿童医院收治的5例胎儿甲状腺肿病例的产前超声特点及临床资料,总结其超声表现和伴发征象,并分析其预后。采用描述性统计分析。结果5例胎儿甲状腺肿病例首诊胎龄为25~35周。(1)胎儿期超声表现:均表现为胎儿颈前区中低回声。1例胎儿表现为中央型血流信号,股骨远端骨化中心提前出现,心率过快,心胸比增大,出生后甲状腺功能亢进;3例胎儿表现为周边型血流信号,其中1例股骨远端骨化中心延迟出现并心胸比增大,3例出生后甲状腺功能减低;1例胎儿表现为周边型血流信号,出生后甲状腺功能正常。5例病例中,1例气管受压并羊水过多;3例颈部过伸;3例经治疗后甲状腺肿无增长或较之前缩小,1例随孕周增大,1例发现较晚,且伴心胸比增大,遂行剖宫产,未予治疗。2例于35周行剖宫产,1例足月剖宫产,2例足月经阴道分娩。(2)新生儿期甲状腺功能:1例甲状腺功能亢进,为母体促甲状腺素受体抗体滴度过高引发;3例甲状腺功能减低,为母体服用抗甲状腺药物引起,给予补充甲状腺素,停药后甲状腺功能恢复;1例甲状腺功能正常。(3)随访结果:至末次随访时(9个月至4岁11个月),5例患儿智力及运动方面发育均未见明显异常。结论胎儿甲状腺肿产前超声表现为颈前中低回声,根据不同血流模式及骨化中心出现情况可评估胎儿甲状腺功能。经产前积极治疗,胎儿甲状腺肿预后良好。Objective To summarize the prenatal ultrasound features and prognosis of fetal goiter.Methods The prenatal ultrasound findings and clinical data of five cases of fetal goiter in the Affiliated Hospital of Qingdao University from August 2018 to October 2022 were retrospectively analyzed regarding the sonographic features,concomitant signs,and prognosis using descriptive statistical method.Results The five cases were first diagnosed as fetal goiter at 25-35 weeks of gestation,with all of them showing hypoechoic or medium echoic masses in the fetal anterior neck area.One case exhibited a central blood flow signal,early appearance of the distal femoral ossification center,tachycardia,increased cardiothoracic ratio during pregnancy,and developed postnatal hyperthyroidism.Three cases showed peripheral blood flow signals and had postnatal hypothyroidism,one of which had delayed appearance of distal femoral ossification center and increased cardiothoracic ratio.One case showed a peripheral blood flow signal with normal thyroid function after birth.Among the five cases,tracheal compression and polyhydramnios were found in one case;neck hyperextension was found in three cases.After treatment,the size of goiters did not change or shrunk in three cases and increased with the gestations in one case.One case did not receive any prenatal treatment and was born through cesarean section due to late detection and increased cardiothoracic ratio.Two cases underwent cesarean section at 35 gestational weeks,one had full-term cesarean section,and two delivered vaginally at term.Hyperthyroidism in one neonate was caused by excessively elevated maternal thyrotropin receptor antibody.Three cases of hypothyroidism occurred due to maternal antithyroid medication whose thyroid function recovered after supplementation of thyroxine.The thyroid function was normal in the rest of the baby.During the follow-up from 9 months to 4 years and 11 months old,no abnormalities in the intellectual and motor development of the five children were found.Conc

关 键 词：产前超声 胎儿 甲状腺肿 甲状腺功能亢进 甲状腺功能减低 

分 类 号：R714.5[医药卫生—妇产科学]