14
Maternal Disorders
Thyroid Nodules and Thyroid Cancer During Pregnancy
Î For women with suppressed serum TSH levels that persist beyond 16
weeks gestation, FNA of a clinically relevant thyroid nodule may be
deferred until after pregnancy. At that time, if serum TSH remains
suppressed, a radionuclide scan to evaluate nodule function can be
performed if not breastfeeding. (S-L)
Î The utility of measuring calcitonin in pregnant women with thyroid
nodules is unknown. The task force cannot recommend for or against
routine measurement of serum calcitonin in pregnant women with
thyroid nodules. (I)
Î Thyroid nodule FNA is generally recommended for newly detected
nodules in pregnant women with a non-suppressed TSH. Determination
of which nodules require FNA should be based upon the nodule's
sonographic pattern as outlined in Table 2. The timing of FNA, whether
during gestation or early postpartum, may be influenced by the clinical
assessment of cancer risk, or by patient preference. (S-M)
Î Radionuclide scintigraphy or radioiodine uptake determination should
NOT be performed during pregnancy. (S-H)
Î Pregnant women with cytologically benign thyroid nodules do not
require special surveillance strategies during pregnancy and should
be managed according to the 2015 ATA Management Guidelines for
Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739132/). (S-M)
Î Pregnant women with cytologically indeterminate (AUS/FLUS, SFN, or
SUSP) nodules, in the absence of cytologically malignant lymph nodes
or other signs of metastatic disease, do not routinely require surgery
while pregnant. (S-M)
Î During pregnancy, if there is clinical suspicion of an aggressive
behavior in cytologically indeterminate nodules, surgery may be
considered. (W-L)
Î Molecular testing is NOT recommended for evaluation of cytologically
indeterminate nodules during pregnancy. (S-L)
Î Papillary thyroid carcinoma (PTC) detected in early pregnancy
should be monitored sonographically. If it grows substantially before
24–26 weeks gestation, or if cytologically malignant cervical lymph
nodes are present, surgery should be considered during pregnancy.
However, if the disease remains stable by midgestation, or if it is
diagnosed in the second half of pregnancy, surgery may be deferred
until after delivery. (W-L)
