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Radioiodine Treatment of Hyperthyroidism in a Pregnant Woman

Thyroid Unit, Departments of Oncology, Medicine, Radiation Physics, Nuclear Medicine, Clinical Chemistry and Gynecology, Sahlgrenska University Hospital, Gothenburg; Department of Pediatrics, East Hospital, University of Göteborg, Gothenburg; Department of Radiation Physics, Malmö University Hospital, University of Lund, Malmoö, Sweden

Correspondence: For correspondence or reprints contact: Gertrud E. B. Berg, MD, Thyroid Unit, Department of Oncology, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden.

ABSTRACT

We describe the effects of radioiodine treatment of a pregnant thyrotoxic woman. Methods: The woman received 500 MBq of ¹³¹I in her 20th gestational week. The pregnancy was discovered 10 days after radioiodine administration. A gamma camera examination of the abdomen at that time showed a distinct focus of activity, which was interpreted as the fetal thyroid. Gamma camera examinations of the mother and fetus were performed at 10, 11, 12, 13 and 18 days after administration of the therapeutic activity and were the basis of dose calculations. The child was examined by hormone tests and mental performance tests, up to 8 yr after birth. Results: The uptake at 24 hr postadministration was calculated to be 10 MBq (2%) in the fetal thyroid gland. The effective half-life was 2.5 days, giving a calculated absorbed dose to the fetal thyroid gland of 600 Gy, which is considered to be an ablative dose. The calculated absorbed dose to the fetal body, including brain, was about 100 mGy, and 40 mGy to the fetal gonads. Doses were estimated taking contributions from radioiodine in the mother, the fetal body and the fetal thyroid into consideration. The woman was encouraged to continue her pregnancy and received levothyroxine in a dose to render her slightly thyrotoxic. At full term, an apparently healthy boy, having markedly raised cord blood serum thyroid-stimulating hormone concentration and subnormal thyroxine (T4) and low-normal triiodothyronine (T3) concentrations, was born. Treatment with thyroxine was initiated from the age of 14 days, when the somatosensoric evoked potential latency time increased to a pathological value and hormonal laboratory tests repeatedly confirmed the hypothyroid state. At 8 yr of age, the child attends regular school. A neuropsychological pediatric examination showed that the mental performance was within normal limits, but with an uneven profile. He has a low attention score and displays evidently subnormal capacity regarding figurative memory. Conclusion: Radioiodine treatment in pregnancy in the 20th gestational week does not give a total absorbed dose to the fetal body that justifies termination of pregnancy. A high absorbed dose to the fetal thyroid, however, should be the basis of the management of the pregnancy and offspring.

Key Words: radioiodine • pregnancy • fetal thyroid • hyperthyroidism

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