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Centre de recherche
Wednesday, March 24 2010

Treating goiter in the fetus

Montreal, March 23, 2010 – A multidisciplinary team from the Sainte-Justine University Hospital Center has treated a fetal hypothyroid goiter before birth. Considering the rarity of this condition, the few reported studies described very aggressive therapeutic approaches. Specialists at the CHU Sainte-Justine demonstrated that with this case a less invasive approach allows normal child birth without jeopardizing the mother’s health or hindering the newborn’s future development. The study’s findings are published in the March 22nd online edition of The Journal of Pediatrics.

Recognition and Early Management
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 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 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.

This case therefore required a multidisciplinary approach involving a gynecologist (Dr. Diane Francoeur), a radiologist (Dr. Andrée Grignon) and endocrinologists (Drs. Sophie Stoppa-Vaucher, Nathalie Alos and Guy Van Vliet) under the leadership of Dr. Johnny Deladoëy. This is the first case treated by this method in Canada.

For information

Nicole Saint-Pierre
CHU Sainte-Justine
Téléphone : 514 345-4931, ext. 2555
nicole_saint-pierre@ssss.gouv.qc.ca

Notes

À propos de l’étude
L’article « Non-Immune Goiter and Hypothyroidism in 19-week Fetus: A Plea for Conservative Management », publiédans la revue The Journal of Pediatrics, est signé par Sophie Stoppa-Vaucher, Diane Francoeur, Andrée Grignon, Nathalie Alos, Joachim Pohlenz, Pia Hermanns, Guy Van Vliet et Johnny Deladoëy du CHU Sainte-Justine et du Département de l’Université de Montréal.

Sur le Web
Article paru dans The Journal of Pediatrics
http://www.jpeds.com

À propos du Centre de recherche du CHU Sainte-Justine
www.chu-sainte-justine.org/recherche/

À propos de la Faculté de médecine de l’Université de Montréal
www.med.umontreal.ca

À propos du CHU Sainte-Justine
Le Centre hospitalier universitaire Sainte-Justine est le plus grand centre mère-enfant au Canada et l’un des quatre plus importants centres pédiatriques en Amérique. Plus de 5 000 employés et médecins composent ses effectifs. Associé à l’Université de Montréal, le CHU Sainte-Justine est de loin le plus grand centre de formation en pédiatrie au Québec et un leader au Canada. Son centre de recherche regroupe plus de 200 chercheurs et compte près de 500 étudiants. Il exerce un leadership reconnu, particulièrement dans les domaines des maladies du cerveau, des maladies musculo-squelettiques et sciences du mouvement, des pathologies foeto-maternelles et néonatales,de la santé métabolique, des maladies virales, immunitaires et cancer et de l'avancement et du devenir en santé. En 2007, Le CHU Sainte-Justine a célébré son centenaire et a reçu le statut de « Hôpital promoteur de la santé » par l’Organisation mondiale de la Santé (OMS). Il est également membre du grand réseau d’excellence en santé de l’Université de Montréal (RUIS).

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Updated on 11/19/2014
Created on 11/19/2014
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