Approach to the Pregnant Patient with Thyroid Cancer

Abstract

Thyroid cancer, the most common endocrine malignancy, increased progressively from 1972 through 2002 largely as the result of an increasing incidence of small papillary thyroid cancers, the majority of which are less than 2 cm and which increased almost 3-fold during the 30-yr study. During this time, thyroid cancer was found to affect women more often than men by a ratio of almost 3 to 1. Moreover, papillary thyroid cancer was found to be the most common form of differentiated thyroid cancer among women of childbearing age, 10% of whom were either pregnant or in the early postpartum period when thyroid cancer was diagnosed. Although the prevalence of thyroid cancer in pregnant women remains high, most are first identified after delivery. Nonetheless, the management of thyroid cancer during pregnancy poses serious diagnostic and therapeutic challenges to both the patient and fetus. The thyroid gland may secrete more thyroid hormone than usual during early pregnancy, which may not only be the cause of this problem but also may be responsible for the higher rate of differentiated thyroid cancer during pregnancy. There is concern about therapy for thyroid cancer during this period, including the timing of surgery, the use of levothyroxine, and the assessment of follow-up during gestation.

Prognosis of Thyroid Cancer Related to Pregnancy: A Systematic Review

“…Most recurrences of DTC occur within the first five years after initial treatment, but recurrences may occur many years or even decades later, particularly in patients with papillary cancer [16, 17]. In addition to this, decisions about cancer treatment during pregnancy are associated with ethical conflicts between the best option for the mother and for the fetus [18, 19]. The management of pregnant women with cancer should consider the maternal-fetal risk related to treatment, as well as the possibility of tumor progression for postponing treatment or for the tumor being related to pregnancy.…”

Recent Pregnancy Is Not Associated with High-Risk Pathological Features of Well-Differentiated Thyroid Cancer

“…Previous studies have investigated the potential for progression of thyroid cancer during and after pregnancy, highlighting the thyroid-stimulating effects of human chorionic PREGNANCY AND THYROID CANCER 69 gonadotropin (hCG) and increased levels of estrogen during pregnancy as possible mechanisms (10). In a recent metaanalysis, Zhou et al reported that the odds ratio of developing thyroid carcinoma among women with a history of pregnancy was similar to non-pregnant controls.…”

Thyroid disorders in subfertility and early pregnancy

“… 86 Additional indications to consider surgery during pregnancy may include rapid growth rate, nodal metastasis or features such as extracapsular invasion. 87 …”