Thyroidectomy during the second trimester does therefore involve the lowest risk for the mother and fetus. Specific considerations are required in the management of women with a history of differentiated thyroid cancer who want to become pregnant again. Table 5 summarizes these considerations.. Considerations regarding pregnancy and lactation in women with a history of differentiated thyroid cancer..
What information should be given to women with a history of differentiated thyroid cancer who desire pregnancy? Women should be informed that pregnancy should be avoided in the 6—12 months following the administration of the therapeutic dose of radioactive iodine in order to achieve the stabilization of the levothyroxine dose and to verify disease remission. What are the potential risks in women previously receiving radioiodine therapy?
6: Thyroid nodules and thyroid cancer
Studies conducted on women previously given radioiodine for the treatment of differentiated thyroid cancer have not reported an increased risk of complications such as infertility, miscarriage, newborn mortality, congenital malformation, premature delivery, low birthweight, death in the first year of life, or cancer development. Can a new pregnancy increase the risk of recurrence in women with a history of thyroid cancer? Often, the patient is mainly interested in knowing whether cancer recurrence may or may not occur as a consequence of a new pregnancy..
From the pathophysiological viewpoint, it should be noted that both HCG and estrogens induce changes in serum TSH, FT4, and thyroglobulin levels during pregnancy. This occurs without stimulating proto-oncogene c-Myc and without promoting rapid cell proliferation. Several studies, three of them published in the past five years, have assessed the impact of pregnancy in women with a history of differentiated thyroid cancer. Three of these women had active disease, and five had no evidence of disease.
However, no recurrence was found in the early postpartum period in women with negative neck ultrasound whose serum thyroglobulin levels were less than 3. Data from these studies suggest that pregnancy involves no risk of recurrence in women with no evidence of biochemical or structural disease before pregnancy. However, as previously noted question 11 , it has not been completely ruled out that pregnancy may represent a stimulus in patients with active disease. In any woman with hypothyroidism, it is crucial to maintain thyroid hormone levels within the specific reference intervals throughout pregnancy.
Various studies have shown that even mild hypothyroidism is associated with adverse effects for the mother and fetus. How should the levothyroxine dose be adjusted? Thyroid hormone levels should always be measured when pregnancy is documented. Thyroid function tests should initially be repeated every four weeks until week 16—20, and then once between weeks 26 and If an adjustment of the levothyroxine dose is required, thyroid hormones should be assessed again four weeks later.
Should TSH suppression be maintained during pregnancy? Goal TSH levels during pregnancy do not change as compared to before pregnancy. In patients with no evident biochemical or structural disease but with risk factors at diagnosis T3-T4, N1, M1, or with an aggressive histology , the goal is to maintain circulating TSH levels ranging from 0. It should be noted, however, that if the risk of disease before pregnancy makes the maintenance of suppressed circulating TSH levels advisable, the same caution should be exercised during pregnancy, the levothyroxine dose being adjusted as appropriate.
Low TSH levels did not correlate to adverse effects in any of the women.
Should iodine supplements be used? How should monitoring be performed? Most pregnant women with low-risk differentiated thyroid cancer only require monitoring of circulating TSH levels and adjustments of treatment, when needed, as well as an examination every three months. However, women with high thyroglobulin levels before pregnancy or with morphological evidence of disease should be monitored with thyroglobulin tests and neck ultrasound in every trimester of pregnancy.
What considerations should be taken into account during breast-feeding?
Breast-feeding may be safe in women with a history of differentiated thyroid cancer. Treatment should be delayed if a higher than normal radioactivity level is found.. Involution of the lactating breast is variable, and there is evidence that bromocriptine is able to accelerate it. The authors state that they have no conflicts of interest..
6: Thyroid nodules and thyroid cancer | The Medical Journal of Australia
ISSN: Previous article Next article. Issue 3. Pages March Clinical guidelines for management of thyroid nodule and cancer during pregnancy. Download PDF. Corresponding author. This item has received. Article information. Table 1. Table 2. Table 3. Table 4. Table 5. Show more Show less. Pregnancy is an absolute contraindication for radioactive iodine administration. Palabras clave:. If a more in depth discussion of any concept is required, or the strength of or evidence for any particular recommendation needs to be known, the abovementioned guidelines may be consulted.
In order to allow for rapid consultation, the recommendations are presented in a clear, practical, and manageable question and answer format.
Interpretation of thyroid function and goiter during pregnancy Changes occurring in the thyroid gland during pregnancy have been thoroughly studied in recent years and may be both morphological and functional. The special characteristics of pregnancy are associated with changes in nodule prevalence, size, and growth, and to indications for treatment, particularly surgery. Ultrasound features of thyroid nodules suggesting malignancy.
Action protocol in the first visit of a pregnant patient with thyroid nodules. Indications for surgery of a thyroid nodule in the second trimester of pregnancy. Ca: carcinoma; US: thyroid ultrasound examination; mts: metastases; TG: thyroglobulin. Figure 1. Considerations regarding pregnancy and lactation in women with a history of differentiated thyroid cancer.
Stagnaro-Green, M. Abalovich, E. Alexander, F. Azizi, J. Mestman, R. Negro, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum.
follow url Thyroid, , pp. De Groot, M.
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