Pregnancy as a Predisposing Factor in Thyroid Neoplasia

Abstract

• 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. (Arch Surg1986;121:1287-1290)