ATA Guidelines Tools

45 Recommendations Table 21. Differentiated Thyroid Cancer Preconception Strength * Level # Patient-tailored preconception counseling about the effects of DTC treatment options on fertility and future pregnancy should be provided, including the potential risks of preconception I-131 administration on ovarian function. Good Practice Statement In women who desire a future pregnancy, any required initial treatments of DTC should be completed preconception, while maintaining contraception. Good Practice Statement e decision to administer postoperative I-131 treatment of DTC during preconception or to postpone until aer pregnancy should be guided by DTC risk. a Good Practice Statement Pregnancy should be avoided for at least 6 months following RAI treatment of DTC. In women who conceive within 6 months of receiving I-131, fetal monitoring for malformations should be considered. Good Practice Statement e same DTC risk-based TSH suppression goals should be used for women planning pregnancy as for the general population, though not exceeding 2.5 mU/L. Good Practice Statement Pregnancy Strength * Level # Pregnant women with biopsy-suspicious thyroid nodules or biopsy-proven DTC, who do not have a high risk of thyroid cancer progression or impending tumor-related complications based on the anatomic location of the tumor, may be counseled to delay thyroid surgery until the postpartum period. Conditional Very Low For DTC in pregnancy with a high risk of progression or immediate complications, the decision to undergo surgery may be based on oncologic indications, similar to if the patient was not pregnant. Conditional Very Low Pregnant women with DTC may have the same TSH goal as was determined preconception, with TSH monitoring approximately every 4 weeks during the first half of pregnancy, at least once in the third trimester, and every 4–6 weeks aer any dose adjustment. Conditional Low Pregnant women with DTC may be followed using the same measures and frequency of cancer surveillance as was followed during preconception, with the exception of radioisotope imaging that is contraindicated. Conditional Very Low a For intermediate-risk DTCs, it may be reasonable to delay postoperative I-131 treatment if imminent pregnancy is desired in a woman near the end of her reproductive span or with suboptimal fertility, which should be discussed in shared decision-making with the patient. For high-risk DTCs, the decision to administer I-131 therapy in the short-term or delay until aer pregnancy is complete is best determined in multidisciplinary discussion. I-131 treatment cannot be administered during pregnancy or lactation. * Strength of Recommendation; # Level of Evidence; Good Practice Statement.

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