Non-Gynecologic Tumors and Fertility Thyroid

Thyroid disease is common and affects 1% to 2% of pregnant women. Pregnancy outcomes can depend on optimal management of thyroid disease, and the course of thyroid disease may be modified by pregnancy. During pregnancy, the evaluation of a thyroid nodule includes a serum TSH and a US assessment of the neck and thyroid gland. Fine needle aspiration (FNA) cytology should be performed for predominantly solid thyroid nodules >1cm discovered in pregnancy. The incidence of thyroid carcinoma is about threefold higher in women than in men, particularly during women’s reproductive years; however, results from case-control and prospective studies showed weak and inconsistent results on the associations between pregnancy, parity, menstrual cycle regularity, exogenous hormone use and menopausal status and thyroid carcinoma risk. Two guidelines on thyroid and pregnancy were developed in October 2011 and August 2012 by American Thyroid Association and Endocrine Society, respectively. A recent case report underlines the importance of the trimester of pregnancy: if well-differentiated thyroid cancer is diagnosed prior to the mid-trimester, it is possible to carry out the surgical intervention in the mid-trimester. During late pregnancy, resection after delivery is the option of choice. There is no indication for termination of pregnancy. Radioiodine or 131I (RAI) is an effective treatment of differentiated thyroid carcinoma (DTC) in both preventing relapses and treating metastases. The possibility of genetic or physical damage to the offspring in terms of congenital malformation and childhood malignancies is a real concern, but several studies did not find a statistically significant association between previous RAI exposure and unfavourable pregnancy outcome. There is a general agreement to defer the thyroid surgery to the second trimester and avoid conception within one year after RAI, allowing RAI clearance and hormonal stabilization.

Keywords: Chemotherapy, Offspring, Pregnancy, Radioiodine, Relapse, Stage, Surgery, Survival, Thyroid neoplasia.