Clinical guidelines for management of thyroid nodule and cancer during pregnancy

A review on thyroid cancer during pregnancy: Multitasking is required

“…As both TSH and HCG are glycoprotein hormones with similar structure and encoded by the same gene [13] , HCG stimulates TSH receptors and leads to increase in the activity of thyroid gland. TSH level subsequently decreases mainly during the first 12 weeks of gestation then back to normal [3] , [12] , [14] . HCG stimulating effect on thyroid gland can be noted in diseases causing very high levels of HCG as gestational trophoblastic diseases [15] , with less than 10% of these patients presenting with manifest hyperthyroidism and thyrotoxicosis in rare cases [16] .…”

“…For monitoring of thyroid function during pregnancy, special reference ranges in relation to gestational age are used to avoid misinterpretation of thyroid function tests. This is of paramount importance in monitoring patients known to have thyroid cancer as TSH level guides suppressive treatment dose adjustment with levo-thyroxin [2] , [3] , [12] .…”

“…Pregnancy is an absolute contraindication for radioactive iodine administration. The timing of surgery, the impact of pregnancy on prognosis of thyroid cancer and monitoring of pregnant women with thyroid cancer are important points to be discussed while treating a case presented with thyroid cancer related to pregnancy [3] .…”

Clinical therapy and management of differentiated thyroid cancer in pregnant women

“…After reviewing the clinical management of DTC during pregnancy in previous studies, the therapy is usually intermittent, not integrated and not consistent among studies although multi-disciplinary proposals and therapies have been proposed by some experts [28]. In recent years, some physicians attempt to comprehensively and multi-disciplinarily treat DTC during pregnancy with the help of surgeons, radiologists, pathologists, experts in the obstetrics and gynecology, endocrinologist and nurse specialist, assuring that patients receive more rational strategies for the management and therapy of DTC and achieve better therapeutic efficacy [29]. This practice should be promoted and generalized [29].…”

“…In recent years, some physicians attempt to comprehensively and multi-disciplinarily treat DTC during pregnancy with the help of surgeons, radiologists, pathologists, experts in the obstetrics and gynecology, endocrinologist and nurse specialist, assuring that patients receive more rational strategies for the management and therapy of DTC and achieve better therapeutic efficacy [29]. This practice should be promoted and generalized [29].…”