Thyroid cancer in pregnancy: case reports

Czech version

Authors: Jan Jiskra; Jan Krátký; Zdeňka Límanová
Authors‘ workplace: III. interní klinika 1. LF UK a VFN, Praha, prof. MUDr. Štěpán Svačina, DrSc., MBA
Published in: Prakt Gyn 2014; 18(1): 47-53
Category: Oncogynecology: Case report

Overview

Thyroid cancer in pregnancy requires multidisciplinary cooperation and every case has to be considered individually, if there is some optimal treatment strategy, or if it is possible to proceed in various ways. The article describes two case reports, the first surgery was postponed after birth and the second was performed in the 2nd trimester of pregnancy. It is impossible to favor any of these procedures based on current knowledge except locally advanced disease and thus, final decision is always individual. Actually, the vast majority of cases have a good prognosis. Improvement in the field of ultrasound equipment quality and newly emerged ultrasound modalities (elastography, 3D-view, etc.) and the genetic mutation analysis of samples obtained by fine needle biopsy of thyroid can bring useful information about the potentially aggressive nature of the tumor.

Key words:
pregnancy – thyroid cancer – ultrasound of the thyroid

Sources

1. Stagnaro-Green A, Abalovich M, Alexander E et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011; 21(10): 1081–1125.

2. Struve CW, Haupt S, Ohlen S. Influence in frequency of previous pregnancies on the prevalence of thyroid nodules in women without clinical evidence of thyroid disease. Thyroid 1993; 3(1): 7–9.

3. Kung AW, Chau MT, Lao TT et al. The effect of pregnancy on thyroid nodule formation. J Clin Endocrinol Metab 2002; 87(3): 1010–1014.

4. Tan GH, Gharib H, Goellner JR et al. Management of thyroid nodules in pregnancy. Arch Intern Med 1996; 156(20): 2317–2320.

5. Marley F, Oertel YC. Fine needle aspiration of thyroid lesions in 57 pregnant and postpartum women. Diagn Cytopathol 1997; 16(2): 122–125.

6. Mazzaferri EL. Approach to the pregnant patient with thyroid cancer. J Clin Endocrinol Metab 2011; 96(2): 265–272.

7. Smith LH, Danielsen B, Allen ME et al. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet and Gynecol 2003; 189(4): 1128–1135.

8. Rosen IB, Walfish PG. Pregnancy as a predisposing factor in thyroid neoplasia. Arch Surg 1986; 121(11): 1287–1290.

9. Cooper DS, Doherty GM, Haugen BR et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19(11): 1167–1214.

10. McTiernan AM, Weiss NS, Daling JR. Incidence of thyroid cancer in women in relation to reproductive and hormonal factors. Am J Epidemiol 1984; 120(3): 423–435.

11. Rago, Fiore E, Scutari M et al. Male sex, single nodularity, and young age are associated with the risk of finding a papillary thyroid cancer on fine-needle aspiration cytology in a large series of patients with nodular thyroid disease. Eur J Endocrinol 2010; 162(4): 763–770.

12. Yoshimura M, Hershman JM. Thyrotropic action of human chorionic gonadotropin. Thyroid 1995; 5(5): 425–434.

13. Gibelli B, Zamperini P, Tradati N. Pregnancy and thyroid cancer. Recent Results Cancer Res 2008; 178: 123–135.

14. Hirsch D, Levy S, Tsvetov G et al. Impact of pregnancy on outcome and prognosis of survivors of papillary thyroid cancer. Thyroid 2010; 20(10): 1179–1185.

15. Rajoria S, Nicolini A, Hanly E et al. Interlinking of Hypoxia and Estrogen in Thyroid Cancer Progression. Curr Med Chem 2014; 21(11): 1351–1360.

16. Mack WJ, Preston-Martin S, Bernstein L et al. Reproductive and hormonal risk factors for thyroid cancer in Los Angeles County females. Cancer Epidemiol Biomarkers Prev 1999; 8(11): 991–997.

17. Vannucchi G, Perrino M, Rossi S et al. Clinical and molecular features of differentiated thyroid cancer diagnosed during pregnancy. Eur J Endocrinol 2010; 162(1): 145–151.

18. Moosa M, Mazzaferri EL. Outcome of differentiated thyroid cancer diagnosed in pregnant women. J Clin Endocrinol Metab 1997; 82(9): 2862–2866.

19. Kuy S, Roman SA, Desai R et al. Outcomes following thyroid and parathyroid surgery in pregnant women. Arch Surg 2009; 144(5): 399–406.

20. Límanová Z, Jiskra J, Springer D et al. Doporučení pro diagnostiku a léčbu onemocnění štítné žlázy v těhotenství a pro ženy s poruchou fertility. Prakt Gyn 2013; 17(2): 173–199.

21. Abalovich M, Amino N, Barbour LA et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2007; 92(8, Suppl): 1–47.

22. De Groot L, Abalovich M, Alexander EK et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97(8): 2543–2565.

23. Loh JA, Wartofsky L, Jonklaas J et al. The magnitude of increased levothyroxine requirements in hypothyroid pregnant women depends upon the etiology of the hypothyroidism. Thyroid 2009; 19(3): 269–275.