Clinical features and prognosis in pregnant women with thyroid cancer / 대한산부인과학회지

ABSTRACT

OBJECTIVE: The aim of the present study is to evaluate pregnancy outcomes and whether to change disease progress of thyroid cancer during peripartum period in pregnant women diagnosed as thyroid cancer. to examine the effect of pregnancy on the prognosis of concomitant thyroid cancer. METHODS: The retrospective study was made by the review of medical records of 37 pregnancies of pregnant women with thyroid cancer, who had delivered in our hospital between Jan. 1990 and Jun. 2004. Pregnancy outcomes and treatment process were described. RESULTS: There were 37 deliveries of 34 women diagnosed as thyroid cancer among 23,303 deliveries of women who had delivered at our hospital during the study period. The mean age at operation for thyroid cancer and delivery was 26.7 +/- 3.6 years old and 30.1 +/- 3.8 years old, respectively. Regarding to the mode of delivery, there were 26 cases of vaginal delivery, 10 cases of cesarean section including emergency and one termination in 26-week gestational age because of severe fetal anomaly. Another women got a therapeutic abortion in 18-week gestational age because of subsequent unexpected pregnancy during postoperative radioiodine therapy. All of them undertook thyroid operation; thyroidecomy (9 cases of total thyroidectomy, 9 cases of subtotal thyroidectomy and 19 cases of lobectomy) and then got synthyroid and postoperative radioiodine therapy, if necessary. There were 11 women with relapse evidence of thyroid cancer during follow-up periods. And there was no difference of recurrence rate and clinical outcomes (e.g, lymph node metastasis or tumor size) between the group diagnosed as thyroid cancer during pregnancy and those with thyroid cancer who were not pregnant at the time of diagnosis. CONCLUSION: There was no difference in the relapse of thyroid cancer during the peripartum period. It is attributed that thyroid cancer has an excellent long-term prognosis and initial aggressive surgery and postoperative adjuvant management has developed. The women with thyroid cancer could be pregnant and deliver without a fear of relapse unless she is under radioiodine therapy or in aggravated disease state. We observed no increased risk in obstetric outcomes such as preterm delivery or small for gestational age.