Int J Thyroidol.  2024 May;17(1):188-192. 10.11106/ijt.2024.17.1.188.

Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part IV. Thyroid Cancer during Pregnancy 2024

• Ahn HY
• Kang HC
• Kim M
• Kim BH
• Kim SW
• Kim WG
• Kim HK
• Na DG
• Park YJ
• Song YS
• Shin DY
• Yoon JH
• Lim DJ
• Chung YJ
• Jo K
• Cho YY
• Hong AR
• Lee EK
• Korean Thyroid Association Guideline Committee on the Managements of Thyroid Nodule and Cancer

• KMID: 2556515
• DOI: http://doi.org/10.11106/ijt.2024.17.1.188

Abstract

The prevalence of thyroid cancer in pregnant women is unknown; however, given that thyroid cancer commonly develops in women, especially young women of childbearing age, new cases are often diagnosed during pregnancy. This recommendation summarizes the follow-up and treatment when thyroid cancer is diagnosed during pregnancy and when a woman with thyroid cancer becomes pregnant. If diagnosed in the first trimester, surgery should be postponed until after delivery, and the patient should be monitored with ultrasound. If follow-up before 24–26 weeks of gestation shows that thyroid cancer has progressed, surgery should be considered. If it has not progressed at 24–26 weeks of gestation or if papillary thyroid cancer is diagnosed after 20 weeks of pregnancy, surgery should be considered after delivery.

Keyword

Thyroid cancer; Pregnancy; Guideline; Korean Thyroid Association

Reference

References

1. Moosa M, Mazzaferri EL. 1997; Outcome of differentiated thyroid cancer diagnosed in pregnant women. J Clin Endocrinol Metab. 82(9):2862–6. DOI: 10.1210/jcem.82.9.4247. PMID: 9284711.

2. Uruno T, Shibuya H, Kitagawa W, Nagahama M, Sugino K, Ito K. 2014; Optimal timing of surgery for differentiated thyroid cancer in pregnant women. World J Surg. 38(3):704–8. DOI: 10.1007/s00268-013-2334-9. PMID: 24248429.

3. Oh HS, Kim WG, Park S, Kim M, Kwon H, Jeon MJ, et al. 2017; Serial neck ultrasonographic evaluation of changes in papillary thyroid carcinoma during pregnancy. Thyroid. 27(6):773–7. DOI: 10.1089/thy.2016.0618. PMID: 28446078.

4. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2016; 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 26(1):1–133. DOI: 10.1089/thy.2015.0020. PMID: 26462967. PMCID: PMC4739132.

5. Derakhshan A, Peeters RP, Taylor PN, Bliddal S, Carty DM, Meems M, et al. 2020; Association of maternal thyroid function with birthweight: a systematic review and individual-participant data meta-analysis. Lancet Diabetes Endocrinol. 8(6):501–10. DOI: 10.1016/S2213-8587(20)30061-9. PMID: 32445737.

6. Korevaar TIM, Derakhshan A, Taylor PN, Meima M, Chen L, et al. Consortium on Thyroid and Pregnancy-Study Group on Preterm Birth. 2019; Association of thyroid function test abnormalities and thyroid autoimmunity with preterm birth: a systematic review and meta-analysis. JAMA. 322(7):632–41. DOI: 10.1001/jama.2019.10931. PMID: 31429897. PMCID: PMC6704759.

7. Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W, et al. 2006; European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 154(6):787–803. DOI: 10.1530/eje.1.02158. PMID: 16728537.

8. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017; 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 27(3):315–89. DOI: 10.1089/thy.2016.0457. PMID: 28056690.

9. Leboeuf R, Emerick LE, Martorella AJ, Tuttle RM. 2007; Impact of pregnancy on serum thyroglobulin and detection of recurrent disease shortly after delivery in thyroid cancer survivors. Thyroid. 17(6):543–7. DOI: 10.1089/thy.2007.0020. PMID: 17614775.

10. Rakhlin L, Fish S, Tuttle RM. 2017; Response to therapy status is an excellent predictor of pregnancy-associated structural disease progression in patients previously treated for differentiated thyroid cancer. Thyroid. 27(3):396–401. DOI: 10.1089/thy.2016.0501. PMID: 27835925. PMCID: PMC5912718.

11. Hirsch D, Levy S, Tsvetov G, Weinstein R, Lifshitz A, Singer J, et al. 2010; Impact of pregnancy on outcome and prognosis of survivors of papillary thyroid cancer. Thyroid. 20(10):1179–85. DOI: 10.1089/thy.2010.0081. PMID: 20860423.

12. Khan AA, Clarke B, Rejnmark L, Brandi ML. 2019; Management of endocrine disease: hypoparathyroidism in pregnancy: review and evidence-based recommendations for management. Eur J Endocrinol. 180(2):R37–R44. DOI: 10.1530/EJE-18-0541. PMID: 30444723.

13. Vidailhet M, Monin P, Andre M, Suty Y, Marchal C, Vert P. 1980; Neonatal hyperparathyroidism secondary to maternal hypoparathyroidism (author's transl). Arch Fr Pediatr. 37(5):305–12.

14. Mestman JH. 1998; Parathyroid disorders of pregnancy. Semin Perinatol. 22(6):485–96. DOI: 10.1016/S0146-0005(98)80028-1. PMID: 9880118.

15. Wright AD, Joplin GF, Dixon HG. 1969; Post-partum hypercalcaemia in treated hypoparathyroidism. Br Med J. 1(5635):23–5. DOI: 10.1136/bmj.1.5635.23. PMID: 5761890. PMCID: PMC1981853.

16. Bollerslev J, Rejnmark L, Zahn A, Heck A, Appelman- Dijkstra NM, Cardoso L, et al. 2022; European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE educational program of parathyroid disorders. Eur J Endocrinol. 186(2):R33–R63. DOI: 10.1530/EJE-21-1044. PMID: 34863037. PMCID: PMC8789028.