Thyroid Nodules and Thyroid Cancer
46
Table 7. Guidance for the Management of DTC Preconception
Therapy Guidance
Thyroid surgery • Thyroid surgery for suspicious thyroid nodules and/or thyroid
cancer should ideally be completed by a high-volume surgeon
before conception. A patient-centered, multidisciplinary
discussion can help determine optimal DTC management in
the context of pregnancy planning.
Postoperative RAI
treatment
• Women should be advised to wait at least 6 months after
I-131 treatment of DTC before conceiving, to avoid the
potential adverse effects of radiopharmaceutical use on future
pregnancy.
TSH suppression • Preconception serum TSH should be targeted to that
recommended for the risk stratification of DTC though not
exceeding 2.5 mU/L, as would be advised to patients not
considering pregnancy.
DTC monitoring • Women with a non-operated DTC should be counseled that
the tumor size may increase slightly (though usually not in
a clinically significant manner) during gestation. Patients
with persistent or metastatic DTC desiring pregnancy
should be managed in the context of a patient-centered,
multidisciplinary approach and a desired pregnancy planned
once disease is relatively stable.
• Women who have received a total thyroidectomy for
the treatment of DTC should be counseled that serum
thyroglobulin concentrations may increase slightly during
pregnancy, but are likely to return to their previous
concentrations after delivery.
Treatment of
advanced DTC
• Data regarding fertility risks of targeted systemic therapies are
extremely limited.
