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Table 8. Guidance for the Management of DTC in Pregnancy
Therapy Guidance
Thyroid surgery • For most patients with DTC diagnosed during pregnancy,
delaying treatment until postpartum does not impact thyroid
cancer outcomes.
• If thyroid surgery is recommended in pregnancy, a patient-
centered plan that incorporates case timing and fetal safety
should be discussed in a multidisciplinary setting.
Postoperative
RAI treatment
• Radiopharmaceutical use in pregnancy is absolutely
contraindicated.
TSH suppression • Postoperative TSH suppression requires a balance of maternal
DTC treatment goals and risk of excessive levothyroxine
exposure to the fetus.
• Levothyroxine overtreatment in pregnancy increases the risk of
pregnancy-induced hypertension, preeclampsia, preterm delivery,
and fetal complications (e.g., low birth weight and adverse
neurodevelopmental measures).
• There is limited evidence regarding the optimal strategies for
maintaining LT4 suppression therapy during pregnancy in
women with DTC.
DTC monitoring • DTC monitoring in pregnant women should generally follow
the same measures as in non-pregnant patients.
Ablative
techniques
• There are insufficient data to determine if RFA and other
thermal ablation techniques for thyroid cancer therapy may
affect pregnancy outcomes.
Treatment of
advanced DTC
• Most targeted therapies are contraindicated for use in
pregnancy. Risks and benefits of treatment of advanced DTC
during pregnancy should be discussed in a multidisciplinary
environment weighing the risks of disease treatment with the
safety of the mother and fetus.
