Pregnancy as a predisposing factor in thyroid neoplasia
I. B. Rosen and P. G. Walfish
Thirty patients were assessed with thyroid neoplasia arising during
pregnancy, predominantly in the third trimester, and manifesting
preeminently with a solitary nodule. Despite appropriate thyroid treatment,
20% of the patients showed marked increase in nodular growth during
pregnancy. Needle aspiration biopsy specimens were obtained for most
patients but disclosed cancer in only 50% of relevant patients, although
cellularity was revealed in the remaining patients. Twenty-six operations
were performed, two in the second trimester and 24 post partum. There was a
43% incidence of cancer and a 37% incidence of adenoma, for a total
neoplasia rate of 80%. Surgery had no major morbidity or complications; one
woman who received thyroid feeding throughout her pregnancy delivered a
stillborn child. Thyroid neoplasia associated with pregnancy appears to
have a higher incidence of cancer, and its course may be aggravated by
pregnancy. Needle biopsy and clinical assessment permit the appropriate
selection of patients with thyroid cancer for surgery, which can be done
safely either during the second trimester of pregnancy or post partum.
