Thyroid Nodules and Thyroid Cancer
48
Recommendations Table 22. Thyroid Cancer in Lactation
Strength
*
Level
#
If thyroid cancer surgery is indicated during lactation, a patient-
centered anesthesia plan as well as the risks and benefits of
continued breastfeeding versus delaying surgery until lactation
is completed should be discussed in a multidisciplinary fashion.
Good Practice Statement
If postoperative I-131 ablation is indicated during lactation,
a patient-centered plan considering the risks and benefits of
delaying I-131 treatment in order to continue breastfeeding
should be discussed in a multidisciplinary fashion.
Good Practice Statement
e same DTC risk-based TSH suppression goals should be
used for breastfeeding women as for the general population.
Good Practice Statement
Lactating women who are recommended to receive targeted
systemic DTC therapies should be counseled about the need
to discontinue breastfeeding.
a
Good Practice Statement
a
If breastfeeding should be stopped, consider dopamine agonist therapy to reduce symptomatolog y
related to abrupt breastfeeding cessation.
* Strength of Recommendation;
#
Level of Evidence; Good Practice Statement.
Recommendations Table 23. Medullary and Advanced
Thyroid Cancers
Medullary thyroid cancer and pregnancy Strength
*
Level
#
Women diagnosed with MTC should undergo initial
management (including thyroid surgery) prior to pregnancy
and maintain contraception until this is complete.
Good Practice Statement
Women diagnosed with MTC should undergo genetic
testing prior to pregnancy.
Good Practice Statement
Routine surveillance of postoperative MTC in pregnancy
is similar to the non-pregnant patient. However, due to
a possible pregnancy and lactation-related increase of
serum calcitonin concentrations, monitoring may also
include serum CEA concentrations during pregnancy and
postpartum until breastfeeding is complete.
Conditional Very Low
Advanced thyroid cancers in pregnancy Strength
*
Level
#
e same urgency should be applied to pursuing thyroid
surgery, EBRT, and/or systemic therapy for poorly
differentiated and anaplastic thyroid cancers in pregnant women
as in non-pregnant individuals, with case-by-case considerations
in a multidisciplinary discussion weighing the expected risks of
delaying treatment versus the fetal/maternal risks.
Good Practice Statement
* Strength of Recommendation;
#
Level of Evidence; Good Practice Statement.
