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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Thyroid Disorders in Pregnancy
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8. Thyroid Nodules
Young women represent a significant proportion of the patients diagnosed with thyroid cancer. Their principal interface with the health care system may be during pregnancy, and a careful general physical examination, including the thyroid, is always appropriate at this time. Solitary thyroid nodules
found in pregnancy may be malignant in up to 40% of cases, but the pregnancy itself does not seem to affect the outcome of thyroid cancer.
The differential diagnosis of thyroid nodules includes benign colloid nodules, follicular adenomas, and thyroid cysts, in addition to papillary or follicular carcinomas. Ultrasonography can characterize nodules as solid, cystic, or mixed, but cannot differentiate between benign and malignant nodules. Ultrasonographically guided fine needle aspiration should be arranged and, if cytologic results are positive or indeterminate, the patient should undergo an excisional biopsy.
Thyroidectomy for malignancy may safely be performed in pregnancy, preferably in the second trimester. Radiotherapy should be deferred until the postpartum period. If the fine needle aspirate cytology of the nodule returns with negative cytology, follow-up postpartum nevertheless remains important. (see Postpartum Management) While formerly recommended, the best current evidence does not demonstrate that thyroxine suppressive therapy of benign nodules or cysts is effective.
