Impact of Pregnancy on Outcome and Prognosis of Survivors of Papillary Thyroid Cancer

Abstract

Pregnancy does not cause thyroid cancer recurrence in PTC survivors who have no structural or biochemical evidence of disease persistence at the time of conception. However, in the presence of such evidence, disease progression may occur during pregnancy, yet not necessarily as a consequence of pregnancy. The finding that a nonsuppressed TSH level during pregnancy does not stimulate disease progression suggests that it may be an acceptable therapeutic goal in this setting.

Response to Therapy Status Is an Excellent Predictor of Pregnancy-Associated Structural Disease Progression in Patients Previously Treated for Differentiated Thyroid Cancer

“…Previous studies have shown that pregnancy has little impact on the risk of recurrence in women with no biochemical or structural evidence of disease prior to pregnancy. However, minor progression of disease has been noted with pregnancy in women with evidence of a biochemical or structural incomplete response (10)(11)(12). While not formally evaluated previously, these findings do suggest that the response to therapy status prior to pregnancy may be an important predictor of the risk of pregnancy-associated disease progression.…”

Lack of Influence of Pregnancy on the Prognosis of Survivors of Thyroid Cancer

“…In the current study which has the mean follow-up duration in the pregnant and non-pregnant group was 6.05±2.5 and 5.2±0.5 respectively, we did not find a difference between groups in terms of relapse metastasis before and after pregnancy. Hirsch et al (2010) evaluated 63 consecutive women who were followed 1992-2009 and had given birth at least once after receiving treatment and reviewed for clinical, biochemical, and imaging data. They compared thyroglobulin levels and neck ultrasound findings before and after pregnancy.…”

Guidelines for the management of thyroid cancer

“…Serum TSH should be checked 4 weeks after each levothyroxine dose change ( 3, D) . Key recommendation US and thyroglobulin (Tg) monitoring should be performed each trimester during pregnancy in patients with previously treated thyroid cancer who are known, or suspected of having, recurrent disease. This is not required in low risk patients in whom evidence of persistent disease is absent ( 3, D ). The management of pregnant women with persistent or recurrent thyroid cancer should be discussed by the MDT and treatment should be undertaken in a specialist centre ( 4, D ). Breastfeeding must be discontinued at least 8 weeks before radioiodine remnant ablation (RRA) or 131 I therapy to avoid breast irradiation and should not be resumed, until after a future pregnancy (Chapter 9.2) (4, D) . Key recommendation …”