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Summary
Thyroid nodular disease in pregnancy requires careful management. Surgery for hyperthyroidism or cancer can be safe, especially in the midtrimester, but conservative approaches are often preferred.
Area of Science:
- Endocrinology
- Obstetrics
- Surgical Oncology
Background:
- Thyroid nodular disease is a common finding during pregnancy.
- Hyperthyroidism and thyroid cancer in pregnancy present unique diagnostic and management challenges.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical management for thyroid nodular disease in pregnant patients.
- To assess the incidence of malignancy in pregnant patients with thyroid nodules.
Main Methods:
- Retrospective review of 20 pregnant patients with thyroid nodular disease managed surgically between 1981 and 1984.
- Analysis of diagnostic methods, including needle aspiration biopsy, and surgical outcomes.
- Correlation of maternal and fetal outcomes with treatment strategies.
Main Results:
- Seven of 16 patients (43%) with non-hyperthyroid nodular disease had thyroid cancer, with three cases of metastatic nodal disease.
- Two patients underwent midtrimester surgery without adverse effects on pregnancy.
- One stillbirth occurred in a patient with untreated thyroid cancer managed with thyroid feeding.
Conclusions:
- Hyperthyroidism in pregnancy poses risks to the fetus; surgery can be safe and effective when medical management fails.
- Thyroid cancer incidence in pregnancy goiter is significant and requires appreciation.
- Conservative management, including needle biopsy and selective surgery in the midtrimester or puerperium, is recommended.