Background: Iodine is necessary for fetal thyroid development. Excess maternal intake of iodine can cause fetal hypothyroidism due to the inability to escape from the Wolff-Chaikoff effect in utero. Case Report: We report a case of fetal hypothyroid goiter secondary to inadvertent excess maternal iodine ingestion from infertility supplements. The fetus was successfully treated with intra-amniotic levothyroxine injections. Serial fetal blood sampling confirmed fetal escape from the Wolff-Chaikoff effect in the mid third trimester. Early hearing test and neurodevelopmental milestones were normal. Conclusion: Intra-amniotic treatment of fetal hypothyroidism may decrease the rate of impaired neurodevelopment and sensorineural hearing loss.

1.
Glorieux
J
,
Dussault
J
,
Van Vliet
G
.
Intellectual development at age 12 years of children with congenital hypothyroidism diagnosed by neonatal screening
.
J Pediatr
.
1992
Oct
;
121
(
4
):
581
4
.
[PubMed]
0022-3476
2.
Zhou
SJ
,
Anderson
AJ
,
Gibson
RA
,
Makrides
M
.
Effect of iodine supplementation in pregnancy on child development and other clinical outcomes: a systematic review of randomized controlled trials
.
Am J Clin Nutr
.
2013
Nov
;
98
(
5
):
1241
54
.
[PubMed]
0002-9165
3.
Leung
AM
,
Braverman
LE
.
Consequences of excess iodine
.
Nat Rev Endocrinol
.
2014
Mar
;
10
(
3
):
136
42
.
[PubMed]
1759-5029
4.
Thomas
JV
,
Collett-Solberg
PF
.
Perinatal goiter with increased iodine uptake and hypothyroidism due to excess maternal iodine ingestion
.
Horm Res
.
2009
;
72
(
6
):
344
7
.
[PubMed]
1423-0046
5.
Perry
RJ
,
Hollman
AS
,
Wood
AM
,
Donaldson
MD
.
Ultrasound of the thyroid gland in the newborn: normative data
.
Arch Dis Child Fetal Neonatal Ed
.
2002
Nov
;
87
(
3
):
F209
11
.
[PubMed]
1359-2998
6.
Mirsaeid Ghazi
AA
,
Ordookhani
A
,
Pourafkari
M
,
Fallahian
M
,
Bahar
A
,
Hedayati
M
et al.
.
Intrauterine diagnosis and management of fetal goitrous hypothyroidism: a report of an Iranian family with three consecutive pregnancies complicated by fetal goiter
.
Thyroid
.
2005
Dec
;
15
(
12
):
1341
7
.
[PubMed]
1050-7256
7.
Ribault
V
,
Castanet
M
,
Bertrand
AM
,
Guibourdenche
J
,
Vuillard
E
,
Luton
D
et al.;
French Fetal Goiter Study Group
.
Experience with intraamniotic thyroxine treatment in nonimmune fetal goitrous hypothyroidism in 12 cases
.
J Clin Endocrinol Metab
.
2009
Oct
;
94
(
10
):
3731
9
.
[PubMed]
0021-972X
8.
Ferianec
V
,
Papcun
P
,
Grochal
F
,
Schenková
K
,
Bártová
M
.
Prenatal diagnosis and successful intrauterine treatment of severe congenital hypothyroidism associated with fetal goiter
.
J Obstet Gynaecol Res
.
2017
Jan
;
43
(
1
):
232
7
.
[PubMed]
1341-8076
9.
Corbacioglu Esmer
A
,
Gul
A
,
Dagdeviren
H
,
Turan Bakirci
I
,
Sahin
O
.
Intrauterine diagnosis and treatment of fetal goitrous hypothyroidism
.
J Obstet Gynaecol Res
.
2013
Mar
;
39
(
3
):
720
3
.
[PubMed]
1341-8076
10.
Heyerdahl
S
,
Kase
BF
,
Lie
SO
.
Intellectual development in children with congenital hypothyroidism in relation to recommended thyroxine treatment
.
J Pediatr
.
1991
Jun
;
118
(
6
):
850
7
.
[PubMed]
0022-3476
11.
Derksen-Lubsen
G
,
Verkerk
PH
.
Neuropsychologic development in early treated congenital hypothyroidism: analysis of literature data
.
Pediatr Res
.
1996
Mar
;
39
(
3
):
561
6
.
[PubMed]
0031-3998
12.
Kempers
MJ
,
van der Sluijs Veer
L
,
Nijhuis-van der Sanden
MW
,
Kooistra
L
,
Wiedijk
BM
,
Faber
I
et al.
.
Intellectual and motor development of young adults with congenital hypothyroidism diagnosed by neonatal screening
.
J Clin Endocrinol Metab
.
2006
Feb
;
91
(
2
):
418
24
.
[PubMed]
0021-972X
13.
Ozguner
G
,
Sulak
O
.
Size and location of thyroid gland in the fetal period
.
Surg Radiol Anat
.
2014
May
;
36
(
4
):
359
67
.
[PubMed]
0930-1038
14.
Andersson
M
,
de Benoist
B
,
Delange
F
,
Zupan
J
;
WHO Secretariat
.
Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old: conclusions and recommendations of the Technical Consultation
.
Public Health Nutr
.
2007
Dec
;
10
12A
:
1606
11
.
[PubMed]
1368-9800
15.
Alexander
EK
,
Pearce
EN
,
Brent
GA
,
Brown
RS
,
Chen
H
,
Dosiou
C
et al.
.
2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum
.
Thyroid
.
2017
Mar
;
27
(
3
):
315
89
.
[PubMed]
1050-7256
16.
Leung
AM
,
Avram
AM
,
Brenner
AV
,
Duntas
LH
,
Ehrenkranz
J
,
Hennessey
JV
et al.
.
Potential risks of excess iodine ingestion and exposure: statement by the american thyroid association public health committee
.
Thyroid
.
2015
Feb
;
25
(
2
):
145
6
.
[PubMed]
1050-7256
17.
Trumbo
P
,
Yates
AA
,
Schlicker
S
,
Poos
M
.
Dietary reference intakes: vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc
.
J Am Diet Assoc
.
2001
Mar
;
101
(
3
):
294
301
.
[PubMed]
0002-8223
18.
Thorpe-Beeston
JG
,
Nicolaides
KH
,
McGregor
AM
.
Fetal thyroid function
.
Thyroid
.
1992
;
2
(
3
):
207
17
.
[PubMed]
1050-7256
19.
Polak
M
.
Human fetal thyroid function
.
Endocr Dev
.
2014
;
26
:
17
25
.
[PubMed]
1421-7082
20.
Perelman
AH
,
Johnson
RL
,
Clemons
RD
,
Finberg
HJ
,
Clewell
WH
,
Trujillo
L
.
Intrauterine diagnosis and treatment of fetal goitrous hypothyroidism
.
J Clin Endocrinol Metab
.
1990
Sep
;
71
(
3
):
618
21
.
[PubMed]
0021-972X
21.
Davidson
KM
,
Richards
DS
,
Schatz
DA
,
Fisher
DA
.
Successful in utero treatment of fetal goiter and hypothyroidism
.
N Engl J Med
.
1991
Feb
;
324
(
8
):
543
6
.
[PubMed]
0028-4793
22.
Schmaltz
C
.
Thyroid hormones in the neonate: an overview of physiology and clinical correlation
.
Adv Neonatal Care
.
2012
Aug
;
12
(
4
):
217
22
.
[PubMed]
1536-0903
23.
Kim
G
,
Nandi-Munshi
D
,
Di Blasi
CC
.
98. Disorders of the Thyroid Gland. Avery’s Diseases of the Newborn
. 10th ed.
Elsevier Inc
;
2018
. pp.
1388
402
.
24.
Markou
K
,
Georgopoulos
N
,
Kyriazopoulou
V
,
Vagenakis
AG
.
Iodine-Induced hypothyroidism
.
Thyroid
.
2001
May
;
11
(
5
):
501
10
.
[PubMed]
1050-7256
25.
Wolff
J
,
Chaikoff
IL
.
Plasma inorganic iodide, a chemical regulator of normal thyroid function
.
Endocrinology
.
1948
Jun
;
42
(
6
):
468
71
.
[PubMed]
0013-7227
26.
Koukkou
EG
,
Roupas
ND
,
Markou
KB
.
Effect of excess iodine intake on thyroid on human health
.
Minerva Med
.
2017
Apr
;
108
(
2
):
136
46
.
[PubMed]
1827-1669
27.
Eng
PH
,
Cardona
GR
,
Fang
SL
,
Previti
M
,
Alex
S
,
Carrasco
N
et al.
.
Escape from the acute Wolff-Chaikoff effect is associated with a decrease in thyroid sodium/iodide symporter messenger ribonucleic acid and protein
.
Endocrinology
.
1999
Aug
;
140
(
8
):
3404
10
.
[PubMed]
0013-7227
28.
Wolff
J
,
Chaikoff
IL
,
Goldberg
RC
,
Meier
JR
.
The temporary nature of the inhibitory action of excess iodine on organic iodine synthesis in the normal thyroid
.
Endocrinology
.
1949
Nov
;
45
(
5
):
504
13
.
[PubMed]
0013-7227
29.
Fisher
DA
,
Klein
AH
.
Thyroid development and disorders of thyroid function in the newborn
.
N Engl J Med
.
1981
Mar
;
304
(
12
):
702
12
.
[PubMed]
0028-4793
30.
Theodoropoulos
T
,
Braverman
LE
,
Vagenakis
AG
.
Iodide-induced hypothyroidism: a potential hazard during perinatal life
.
Science
.
1979
Aug
;
205
(
4405
):
502
3
.
[PubMed]
0036-8075
31.
Heymann
WR
.
Potassium iodide and the wolff-chaikoff effect: relevance for the dermatologist
.
J Am Acad Dermatol
.
2000
Mar
;
42
(
3
):
490
2
.
[PubMed]
0190-9622
32.
Barone
CM
,
Van Natta
FC
,
Kourides
IA
,
Berkowitz
RL
.
Sonographic detection of fetal goiter, an unusual cause of hydramnios
.
J Ultrasound Med
.
1985
Nov
;
4
(
11
):
625
7
.
[PubMed]
0278-4297
33.
Mastrolia
SA
,
Mandola
A
,
Mazor
M
,
Hershkovitz
R
,
Mesner
O
,
Beer-Weisel
R
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
.
2015
;
28
(
18
):
2214
20
.
[PubMed]
1476-7058
34.
Morine
M
,
Takeda
T
,
Minekawa
R
,
Sugiyama
T
,
Wasada
K
,
Mizutani
T
et al.
.
Antenatal diagnosis and treatment of a case of fetal goitrous hypothyroidism associated with high-output cardiac failure
.
Ultrasound Obstet Gynecol
.
2002
May
;
19
(
5
):
506
9
.
[PubMed]
0960-7692
35.
Blumenfeld
YJ
,
Davis
A
,
Milan
K
,
Chueh
J
,
Hudgins
L
,
Barth
RA
et al.
.
Conservatively managed fetal goiter: an alternative to in utero therapy
.
Fetal Diagn Ther
.
2013
;
34
(
3
):
184
7
.
[PubMed]
1015-3837
36.
Hanono
A
,
Shah
B
,
David
R
,
Buterman
I
,
Roshan
D
,
Shah
S
et al.
.
Antenatal treatment of fetal goiter: a therapeutic challenge
.
J Matern Fetal Neonatal Med
.
2009
Jan
;
22
(
1
):
76
80
.
[PubMed]
1476-7058
37.
Polak
M
,
Van Vliet
G
.
Therapeutic approach of fetal thyroid disorders
.
Horm Res Paediatr
.
2010
;
74
(
1
):
1
5
.
[PubMed]
1663-2818
38.
Burrow
GN
,
Fisher
DA
,
Larsen
PR
.
Maternal and fetal thyroid function
.
N Engl J Med
.
1994
Oct
;
331
(
16
):
1072
8
.
[PubMed]
0028-4793
39.
Calvo
RM
,
Jauniaux
E
,
Gulbis
B
,
Asunción
M
,
Gervy
C
,
Contempré
B
et al.
.
Fetal tissues are exposed to biologically relevant free thyroxine concentrations during early phases of development
.
J Clin Endocrinol Metab
.
2002
Apr
;
87
(
4
):
1768
77
.
[PubMed]
0021-972X
40.
Overcash
RT
,
Marc-Aurele
KL
,
Hull
AD
,
Ramos
GA
.
Maternal Iodine Exposure: A Case of Fetal Goiter and Neonatal Hearing Loss
.
Pediatrics
.
2016
Apr
;
137
(
4
):
137
.
[PubMed]
0031-4005
41.
Debruyne
F
,
Vanderschueren-Lodeweyckx
M
,
Bastijns
P
.
Hearing in congenital hypothyroidism
.
Audiology
.
1983
;
22
(
4
):
404
9
.
[PubMed]
0020-6091
42.
Lichtenberger-Geslin
L
,
Dos Santos
S
,
Hassani
Y
,
Ecosse
E
,
Van Den Abbeele
T
,
Léger
J
.
Factors associated with hearing impairment in patients with congenital hypothyroidism treated since the neonatal period: a national population-based study
.
J Clin Endocrinol Metab
.
2013
Sep
;
98
(
9
):
3644
52
.
[PubMed]
0021-972X
43.
Bruno
R
,
Aversa
T
,
Catena
M
,
Valenzise
M
,
Lombardo
F
,
De Luca
F
et al.
.
Even in the era of congenital hypothyroidism screening mild and subclinical sensorineural hearing loss remains a relatively common complication of severe congenital hypothyroidism
.
Hear Res
.
2015
Sep
;
327
:
43
7
.
[PubMed]
0378-5955
44.
Fisher
DA
,
Brown
RS
. The Maturation of Thyroid Function in the Perinatal Period and During Childhood. In:
Braverman
LE
,
Cooper
DS
, editors
.
Werner & Ingbar’s The Thyroid: A Fundamental and Clinical Text
. 10th ed.
Lippincott Williams & Wilkins
;
2013
. pp.
775
87
.
45.
Lahoti
A
,
Frank
GR
.
Laboratory thyroid function testing: do abnormalities always mean pathology
.
Clin Pediatr (Phila)
.
2013
Apr
;
52
(
4
):
287
96
.
[PubMed]
0009-9228
46.
Abuid
J
,
Stinson
DA
,
Larsen
PR
.
Serum triiodothyronine and thyroxine in the neonate and the acute increases in these hormones following delivery
.
J Clin Invest
.
1973
May
;
52
(
5
):
1195
9
.
[PubMed]
0021-9738
47.
Erenberg
A
,
Phelps
DL
,
Lam
R
,
Fisher
DA
.
Total and free thyroid hormone concentrations in the neonatal period
.
Pediatrics
.
1974
Feb
;
53
(
2
):
211
6
.
[PubMed]
0031-4005
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