Thyroid Cancer in Pregnancy

Owing to the young median age of diagnosis, thyroid cancer in women can coincide with pregnancy and affect its management. The evaluation of a thyroid nodule in pregnant women is similar to that in nonpregnant women, but special consideration must be taken for the impact of a cancer diagnosis and its sequelae in pregnancy. The initial comprehensive exam for pregnant and nonpregnant women includes evaluation of the biochemical function and structure of the thyroid gland, and then fine-needle aspiration biopsy of any suspicious nodule. Management diverges after biopsy and diagnosis, as pregnancy affects timing of thyroidectomy and radioiodine exposure. Owing to the indolent nature of differentiated thyroid cancers, surgery can often be delayed to the immediate postpartum period without change in recurrence or mortality rate. However, for more aggressive thyroid cancers or if the patient wishes to pursue surgery during pregnancy, a discussion about maternal health, fetal risk, and disease prognosis is needed between the physician and patient. This review serves to discuss the evaluation of the thyroid nodule and management of thyroid cancers in the pregnant population, as well as address thyroid cancer surveillance in pregnant women with a previous history of thyroid cancer.