Fine-needle aspiration of thyroid lesions in 57 pregnant and postpartum women

Marley, Edith F.; Oertel, Yolanda C.

doi:10.1002/(sici)1097-0339(199702)16:2<122::aid-dc5>3.0.co;2-j

Cited by 45 publications

(27 citation statements)

References 21 publications

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“…In the cases in which surgery was performed, pathological examination of the specimens confirmed the diagnosis of all FNAs classified by cytology as either benign or malignant. Six of the 16 (37.5%) cases reported by cytology as suspicious for malignancy were found to be malignant at pathological examination (219,220). Pregnancy does not appear to increase the difficulty of making a cytological diagnosis of thyroid tissue obtained by FNA.…”

Section: Pregnancy and Postpartum Thyroid Management Guidelinesmentioning

confidence: 88%

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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

2,065

2,716

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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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Section: Pregnancy and Postpartum Thyroid Management Guidelinesmentioning

confidence: 88%

“…The research performed at the referral centers revealed a 15% (6/40, Mayo Clinic) (219), 12% (7/57, George Washington Hospital) (220), and 43% (7/16, Mount Sinai Hospital-Toronto) (221) rate of thyroid malignancy. All three studies are limited by two major methodological flaws.…”

Section: Question 58: What Is the Frequency Of Thyroid Nodules Duringmentioning

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

2,065

2,716

View full text Add to dashboard Cite

show abstract

“…Normal physiological changes in pregnancy include increase in maternal thyroid volume, including increased size of thyroid nodules (4). Various authors have reported higher frequency of benign and malignant neoplasms in thyroid nodules detected during pregnancy, with figures as high as 80% for all neoplasms, 37 to 63% for benign nodules, and 28.5 to 43% for differentiated thyroid cancer (DTC) (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Evolution of differentiated thyroid cancer during pregnancy in a community University Hospital in Buenos Aires, Argentina

Cabezón

Carrizo

Costanzo

2013

Arq Bras Endocrinol Metab

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Objective: To analyze the presentation, follow-up and evolution of differentiated thyroid cancer (DTC) detected during pregnancy. Subjects and methods: Twenty nine women with DTC detected during pregnancy were analyzed. Group I (n = 13) was seen during pregnancy and DTC was diagnosed during gestation; detection of the nodule occurred during pregnancy (first trimester). Group II (n = 16) was seen after delivery; detection of the nodule occurred during pregnancy (second or third trimester). Complete thyroidectomy, ablative dose of radioactive iodine, and treatment with levothyroxine were performed. Follow-up: neck ultrasound; TSH, free T4, thyroglobulin, and anti-thyroglobulin antibodies with and without treatment with levothyroxine; and 131 I whole body scans. Histological diagnosis, lymph node metastases, tumor size and stage, complications from pregnancy, and DTC evolution were evaluated. Results: 100% of the patients had papillary thyroid carcinoma. Lymph node metastases were detected in 13 (44.8%), and invasion of adjacent extrathyroid tissue in 2 patients. Tumor size was larger in Group II: 22.1 ± 10.9 versus 13.9 ± 3.5 mm; p = 0.03. No differences were found in the tumor stages between groups. All patients had full-term pregnancies and healthy newborns. Follow-up: 5.7 ± 4.3 years; one patient had persistent disease. Conclusions: DTC detected during pregnancy had a favorable evolution. Surgery may be postponed to the post-delivery period, unless there are risk factors that justify it during pregnancy. Arq Bras Endocrinol Metab. 2013;57(4):307-11

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“…L'existence d'une hyperplasie folliculaire ne semble pas poser de difficultés majeures pour la lecture cytologique, même si sur ce plan les évaluations sont rares et imparfaites. Le risque de carcinome folliculaire en cas de cytologie folliculaire apparaît grossièrement identique à celui de la population générale [155][156][157].…”

Section: Quelles Spécificités De Prise En Charge ?unclassified

Recommandations de la Société française d’endocrinologie pour la prise en charge des nodules thyroïdiens

2011

La Presse Médicale

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Fine-needle aspiration of thyroid lesions in 57 pregnant and postpartum women

Cited by 45 publications

References 21 publications

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

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

Evolution of differentiated thyroid cancer during pregnancy in a community University Hospital in Buenos Aires, Argentina

Recommandations de la Société française d’endocrinologie pour la prise en charge des nodules thyroïdiens

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