Pregnancy and surgical thyroid disease

Twenty patients, aged 18 to 34 years, with thyroid nodular disease detected during pregnancy from 1981 to 1984 were referred for surgical management. An additional five patients are now in the process of investigation and preparation for surgical treatment. Of the 20 patients, four were hyperthyroid and operation was indicated for medical intractability. In the remaining 16 patients there were seven cancers, for a 43% rate, and three instances of metastatic nodal disease. Needle aspiration biopsy represented the most important maneuver in clinical diagnosis but if strictly interpreted could give rise to errors in management. Two of 20 patients underwent midtrimester surgery will no ill effect on pregnancy. Operations varied in extent, tailored to the presenting problem, and produced no major complication. One stillbirth occurred in a patient with cancer who did not undergo surgery who was managed throughout her pregnancy by thyroid feeding. Hyperthyroidism in pregnancy bears a significant risk to the fetus and with medical failure surgery can be both effective and safe. The occurrence of cancer in a goiter of pregnancy should be appreciated. The principles of management should be conservative, consisting of needle biopsy, thyroid feeding and follow-up, and surgery, if indicated, preferably reserved for the midtrimester or puerperium.