Thyroid Cancer in Pregnant Women: Diagnostic and Therapeutic Management

Choe, Wonsick; McDougall, I. Ross

doi:10.1089/thy.1994.4.433

Cited by 50 publications

(18 citation statements)

References 11 publications

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“…Level I-USPSTF Fine-needle aspiration. FNA is a safe diagnostic tool in pregnancy and may be performed in any trimester (229,(234)(235)(236)(237)(238)(239)(240)(241)(242). Two retrospective case series of FNAs performed during pregnancy, involving a total of 94 patients, have been…”

Section: And Recommendation 46mentioning

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

2,059

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: And Recommendation 46mentioning

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

2,059

2,716

View full text Add to dashboard Cite

show abstract

“…Probably the report from 1976 by Asteris and DeGroot (29) is the only one to state that pregnancy should be avoided by women with known residual thyroid cancer, and that therapeutic abortion should be considered in such a circumstance. More recent studies have concluded that "differentiated thyroid cancer should not inhibit a patient from having a child, and in general it should not be a reason for recommending therapeutic abortion" (30).…”

Section: Discussionmentioning

confidence: 99%

“…The Stanford group (30) also feel that it is important to differentiate between the nodule found early in pregnancy and the one found later. They feel that "it would not be desirable to wait for [8][9][10][11][12] months with anxiety in the case of nodules found early in pregnancy, but it would be tolerable to wait for 2-4 months before work-up or surgery in cases of nodules found later in pregnancy" (30).…”

Section: Discussionmentioning

confidence: 99%

“…They feel that "it would not be desirable to wait for [8][9][10][11][12] months with anxiety in the case of nodules found early in pregnancy, but it would be tolerable to wait for 2-4 months before work-up or surgery in cases of nodules found later in pregnancy" (30). Of course, even when there is available a considerable body of evidence to justify an approach, such as that described in this review, patients who are pregnant with NTD may not be willing to accept the physician's advice.…”

Section: Discussionmentioning

confidence: 99%

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Nodular Thyroid Disease Diagnosed During Pregnancy: How and When to Treat

Hay¹

1999

Thyroid

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“…The optimal timing of treatment, however, is still controversial, with some authors advocating surgery during the midtrimester whilst others recommend waiting until after delivery (3)(4)(5). We reviewed the records of pregnant women with thyroid cancer treated in our unit with particular regard to timing of treatment and outcome.…”

Section: Introductionmentioning

confidence: 99%

Management of differentiated thyroid cancer diagnosed during pregnancy

Vini

Hyer

Pratt

et al. 1999

European Journal of Endocrinology

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Objective: To assess the outcome of thyroid cancer diagnosed during pregnancy. Design: Retrospective analysis of patients diagnosed between 1949 and 1997 with thyroid cancer presenting during pregnancy. Results: Nine women with a median age of 28 years were identified. A thyroid nodule was discovered by the clinician during routine antenatal examination in four cases, the remainder had noted a lump in the neck. In all patients, the nodule was reported to almost double in size during the pregnancy. One patient underwent subtotal thyroidectomy during the second trimester; eight were operated on within 3 to 10 months from delivery. Total thyroidectomy was performed in five and subtotal thyroidectomy in four. All tumours were well differentiated and ranged in size from 1 to 6 cm. Outcome: The median follow-up was 14 years (5-31 years). One patient relapsed locally requiring further surgery. One patient developed bone metastases dying 7 years after presentation; her planned treatment had been delayed because of an intervening pregnancy. Eight of the original cohort of patients are currently disease free. Conclusions: Differentiated thyroid cancer presenting in pregnancy generally has an excellent prognosis. When the disease is discovered early in pregnancy, surgery should be considered in the second trimester but radioiodine scans and treatment can be safely delayed until after delivery. In all cases, treatment should not be delayed for more than a year.

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Thyroid Cancer in Pregnant Women: Diagnostic and Therapeutic Management

Cited by 50 publications

References 11 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

Nodular Thyroid Disease Diagnosed During Pregnancy: How and When to Treat

Management of differentiated thyroid cancer diagnosed during pregnancy

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