Timing of Surgical Management of Papillary Thyroid Cancer Diagnosed during Pregnancy

Yoonseok Kim; Changhoon Lee; Eunae Jae; Youngjin Lee; Jueun Jung; Susun Kim; Mihyang Kim; Eunsuk Lee; Chunsuk Park; Jaemook Park; Hyunwoo Jung; Musil Park; Jaejun Lee; Junmo Ahn; Soo Lee

doi:10.11106/ijt.2016.9.2.168

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Kim, Lee, Jae, Lee, Jung, Kim, Kim, Lee, Park, Park, Jung, Park, Lee, Ahn, and Lee: Timing of Surgical Management of Papillary Thyroid Cancer Diagnosed during Pregnancy

Original Article

Int J Thyroidol 2016;9(2):168-173.

Published online: 20 November 2016

DOI: https://doi.org/10.11106/ijt.2016.9.2.168

Timing of Surgical Management of Papillary Thyroid Cancer Diagnosed during Pregnancy

Yoonseok Kim¹, Changhoon Lee^1,, Eunae Jae², Youngjin Lee², Jueun Jung², Susun Kim², Mihyang Kim², Eunsuk Lee², Chunsuk Park², Jaemook Park², Hyunwoo Jung², Musil Park², Jaejun Lee², Junmo Ahn², Soo Lee²

¹Department of Surgery, Mirae Woman's Hospital, Busan, Korea

²Department Obstetrics & Gynecology, Mirae Woman's Hospital, Busan, Korea

Correspondence: Changhoon Lee, MD, PhD, Department of Surgery, Mirae Woman' s Hospital, 459 Gaya-daero, Busanjin-gu, Busan 47268, Korea Tel: 82-51-890-9955, Fax: 82-51-890-9987, E-mail: gschlee@naver.com

Received 31 October 2015 Revised 12 May 2016 Accepted 26 May 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives

Although the thyroid cancer occurs in every one of 1000 pregnant women, the optimal timing of surgery is still uncertain. The aim of this study is to propose the timing of surgical management of papillary thyroid cancer in pregnant woman.

Materials and Methods

The authors reviewed the medical records of papillary thyroid cancer patients diagnosed during pregnancy in our hospital from May 1st, 2013 to April 30th, 2015. We analyzed the changes of radiologic and pathologic findings during prenatal and postpartum period.

Results

17 of 4978 patients were diagnosed with papillary thyroid cancer. 10 of 17 patients enrolled in this study. Each size of thyroid cancer in 1st trimester, in 2nd trimester, in 3rd trimester, and after delivery was 11.30±6.01 mm, 12.74±7.79 mm, 13.82±9.93 mm, and 13.82±8.19 mm, respectively. No patient showed the recurrence or death after surgery.

Conclusion

There was no statistical significance on the prognosis of papillary thyroid cancer during prenatal and postpartum period. The authors propose that the surgical treatment of papillary thyroid cancer diagnosed during pregnancy could be delayed after delivery.

Keywords: Pregnancy, Thyroid neoplasms, Timing of surgery

References

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Fig. 1.

TIRADS 4a mass which sized less than 0.5 centimeters. (A) Transverse view, (B) Longitudinal view. TIRADS: Thyroid Image Reporting and Data System.

Fig. 2.

Ultrasonographic findings which shows an increase in the size of tumor. (A) 1st trimester, (B) 2nd trimester and (C) 3rd trimester.

Table 1.

Characteristics of patients (n=17)

	No. of patients (%)
Time of ultrasonographic diagnosis
1st trimester	16 (94.1%)
3rd trimester	1 (5.9%)
Time of FNA∗ diagnosis
1st trimester	5 (29.4%)
2nd trimester	3 (17.6%)
After delivery	9 (52.9%)
Ultrasonographic findings
Location
Right	4 (23.5%)
Left	5 (29.4%)
Isthmus	2 (11.8%)
Both	6 (35.3%)
Size
＜1 cm	8 (47.1%)
≥1 cm	9 (52.9%)
Central neck node metastasis
Yes	4 (23.5%)
No	13 (76.5%)
Lateral neck node metastasis
Yes	2 (11.1%)
No	15 (88.9%)

^∗ FNA: fine needle aspiration

Table 2.

Characteristics of patients who received thyroid surgery (n=10)

	No. of patients (%)
Timing of surgery
2nd trimester	1 (10.0%)
After delivery	9 (90.0%)
Surgical procedure
TT c CCND^∗	8 (80.0%)
TT c mRND^†	2 (20.0%)
RAI^‡
Yes	4 (40.0%)
No	6 (60.0%)

^∗ Bilateral total thyroidectomy with central compartment neck dissection;

^† Bilateral total thyroidectomy with modified radical neck dissection;

^‡ Radioactive iodine

Table 3.

Data of patients who enrolled in this study (n=10)

No.	Age (yr)	Location	Size∗ (mm)	Node metastasis status^†	Time of surgery	Surgical procedure	RAI^‡
1	32	Right	28.0	Negative	S^§	TT c CCND^∥	No
2	39	Both	26.0	Negative	P^¶	TT c CCND	Yes
3	35	Both	11.9	Central Lateral	P	TT c mRND^∗∗	Yes
4	32	Left	10.7	Negative	P	TT c CCND	No
5	39	Left	10.0	Negative	P	TT c CCND	No
6	34	Left	3.0	Central	P	TT c CCND	No
7	34	Both	10.0	Negative	P	TT c CCND	No
8	36	Right	9.0	Negative	P	TT c CCND	No
9	37	Both	16.0	Negative	P	TT c CCND	Yes
10	30	Both	35.0	Central Lateral	P	TT c mRND	Yes

^∗ Largest mass size at ultrasonographic diagnosis,

^† Pathologic finding,

^‡ Radioactive iodine,

^§ Second trimester,

^∥ Bilateral total thyroidectomy with central compartment neck dissection,

^¶ Postpartum period

^∗∗ Bilateral total thyroidectomy with modified radical neck dissection

Table 4.

Change in tumor size during prenatal and postpartum period (n=9)

	1st trimester	2nd trimester	3rd trimester	Final pathology
Size^∗ (mm)	11.30±6.01	12.74±7.79	13.82±9.93	13.84±8.19
p value^†	Reference standard	0.12	0.13	0.08

^∗ Mean±standard deviation,

^† Statistical value compared with 1st trimester

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