The Effect of Subsequent Pregnancy on Patients with Thyroid Carcinoma Apparently Free of the Disease

Rosário, Pedro Weslley; Barroso, Álvaro Luís; Purisch, Saulo

doi:10.1089/thy.2007.0242

Cited by 30 publications

(15 citation statements)

References 3 publications

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“…This is the first retrospective study to apply response-totherapy assessment as a predictor of postpartum clinical outcome. Consistent with these previous small studies (10)(11)(12), the present findings demonstrate that pregnancy is seldom associated with clinically significant disease progression, except in those patients with structural disease present prior to pregnancy. Even in patients with a structural incomplete response to therapy, the degree of disease progression is usually minor and generally does not require additional therapy in the first postpartum years.…”

Section: Discussionsupporting

confidence: 93%

“…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.…”

Section: Introductionmentioning

confidence: 85%

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

Rakhlin

Fish

Tuttle

2017

Thyroid

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None of the patients with an excellent, indeterminate, or biochemical incomplete response to therapy prior to pregnancy developed structurally identifiable disease after a full-term delivery. Even though structural disease progression was seen in almost a third of the patients with known structural disease prior to pregnancy, only a minority of these patients had changes sufficient to warrant additional therapy. These data confirm that pre-pregnancy response to therapy status is an excellent predictor of pregnancy-associated disease progression in women previously treated for DTC.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 85%

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

Rakhlin

Fish

Tuttle

2017

Thyroid

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“…Disease progression was documented by the enlargement of a previously stable cervical node in one patient and by a marked rise in serum Tg without evidence of structural disease progression in another patient with previously stable lung metastasis. Rosario et al (265) reported that pregnancy did not result in cancer recurrence in any of 64 women previously treated for DTC who were thyroid cancer free at the time of pregnancy (as determined by Tg levels, ultrasound, and physical examination). Hirsch and colleagues (266) evaluated 63 women who had given birth after receiving treatment for DTC.…”

Section: Level B-uspstfmentioning

confidence: 99%

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Alexander

Pearce

Brent

et al. 2017

Thyroid

1,878

2,502

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INTRODUCTION Pregnancy has a profound impact on the thyroid gland and thyroid function. The gland increases 10% in size during pregnancy in iodine-replete countries and by 20%-40% in areas of iodine deficiency. Production of thyroxine (T 4 ) and triiodothyronine (T 3 ) increases by 50%, along with a 50% increase in the daily iodine requirement. These physiological changes may result in hypothyroidism in the later stages of pregnancy in iodine-deficient women who were euthyroid in the first trimester. The range of thyrotropin (TSH), under the impact of placental human chorionic gonadotropin (hCG), is decreased throughout pregnancy with the lower normal TSH level in the first trimester being poorly defined and an upper limit of 2.5 mIU/L. Ten percent to 20% of all pregnant women in the first trimester of pregnancy are thyroid peroxidase (TPO) or thyroglobulin (Tg) antibody positive and euthyroid. Sixteen percent of the women who are euthyroid and positive for TPO or Tg antibody in the first trimester will develop a TSH that exceeds 4.0 mIU/L by the third trimester, and 33%-50% of women who are positive for TPO or Tg antibody in the first trimester will develop postpartum thyroiditis. In essence, pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency, and postpartum thyroiditis in women with underlying Hashimoto's disease who were euthyroid prior to conception.Knowledge regarding the interaction between the thyroid and pregnancy/the postpartum period is advancing at a rapid pace. Only recently has a TSH of 2.5 mIU/L been accepted as the upper limit of normal for TSH in the first trimester. This has important implications in regards to interpretation of the literature as well as a critical impact for the clinical diagnosis of hypothyroidism. Although it is well accepted that overt hypothyroidism and overt hyperthyroidism have a deleterious impact on pregnancy, studies are now focusing on the potential impact of subclinical hypothyroidism and subclinical hyperthyroidism on maternal and fetal health, the association between miscarriage and preterm delivery in euthyroid women positive for TPO and/or Tg antibody, and the prevalence and long-term impact of postpartum thyroiditis. Recently completed prospective randomized studies have begun to produce critically needed data on the impact of treating thyroid disease on the mother, fetus, and the future intellect of the unborn child.It is in this context that the American Thyroid Association (ATA) charged a task force with developing clinical guidelines on the diagnosis and treatment of thyroid disease during pregnancy and the postpartum. The task force consisted of international experts in the field of thyroid disease and pregnancy, and included representatives from the ATA, Asia and Oceania Thyroid Association, Latin American Thyroid Society, American College of Obstetricians and Gynecologists, and the Midwives Alliance of North America. Inclusion of thyroidologists, obstetricians, and midwives ...

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“…Studies comparing structural imaging and/or serum Tg levels before pregnancy and shortly after delivery in women previously treated for DTC overall indicate that pregnancy has no unfavorable impact in women free of disease prior to pregnancy (59–62) or in those with indeterminate or biochemical incomplete response (62). By contrast, some progression has been described in patients with structural evidence of disease prior to pregnancy (60–62).…”

Section: Resultsmentioning

confidence: 99%

Female Reproductive Factors and Differentiated Thyroid Cancer

et al. 2017

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Differentiated thyroid cancer (DTC) is markedly more common in women than men, the highest female-to-male ratio being recorded during the reproductive period. This evidence has led to the suggestion that female hormonal and reproductive factors may account for the observed DTC gender disparity. This review focuses on current evidence on the risk of DTC in conjunction with major female reproductive factors, including the impact of pregnancy on DTC occurrence and progression/recurrence. Overall, studies exploring the link between the risk of DTC and menstrual and menopausal factors, oral contraceptives and/or hormone replacement therapy, showed these associations, if any, to be generally weak. Nonetheless, there is some evidence that higher levels of exposure to estrogens during reproductive years may confer an increased risk of DTC. As far as pregnancy is concerned, it is unclear whether a potential association between parity and risk of DTC actually exists, and whether it is enhanced in the short-term following delivery. A possible role for pregnancy-related factors in DTC progression has been recently suggested by some reports, the results of which are consistent with a worse outcome in the short-term of women diagnosed with DTC during gestation compared to non-pregnant control patients. Also, some progression of disease has been described in women with structural evidence of disease prior to pregnancy. However, there seems to be no impact from pregnancy in DTC-related death or overall survival. Several in vitro and animal studies have evaluated the influence of estrogens (E) and estrogen receptors (ERs) on thyroid cell proliferation. Presently available data are indicative of a role of E and ERs in thyroid cancer growth, although considerable discrepancies in respect to ER expression patterns in thyroid cancer tissues actually exist. Further studies providing more direct evidence on the possible role of E and of placental hormones and growth factors on thyroid growth may expand our knowledge on the mechanisms beyond the gender disparity of proliferative thyroid diseases.

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The Effect of Subsequent Pregnancy on Patients with Thyroid Carcinoma Apparently Free of the Disease

Cited by 30 publications

References 3 publications

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

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

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Female Reproductive Factors and Differentiated Thyroid Cancer

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