Progress of Diagnosis and Treatment for Differentiated Thyroid Carcinoma in Pregnancy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Xiaohu ,  DAI Wenjie

Department of Thyroid and Breast Surgery，The First Affiliated Hospital of Harbin Medical University，Harbin 150001，Heilongjiang Province，China;

Corresponding author：

DAI Wenjie, Email: wenjdai@yahoo.com.cn

Keywords：

Pregnancy; Differentiated thyroid carcinoma; Thyroid hormone; Treatment

Video：

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Objective 　To explore the progress of diagnosis and treatment for differentiated thyroid carcinoma （DTC） in pregnancy.
Methods 　The literatures on studying the diagnosis and treatment of DTC in pregnancy were reviewed and analyzed retrospectively.
Results 　Radionuclide scanning and radioiodine （131I） administration during pregnancy were contraindicated. Surgery during the second trimester was considered safe. Monitoring of pregnancy must be strict during each trimester if surgery was delayed until after delivery.
Conclusions 　Pregnancy makes the diagnosis and treatment of DTC become more complicated，the diagnosis and treatment of DTC during pregnancy present a challenging situation for the endocrinologists，surgeon，and obstetrician.

Citation： WU Xiaohu,DAI Wenjie,.. Progress of Diagnosis and Treatment for Differentiated Thyroid Carcinoma in Pregnancy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(9): 1001-1005. doi: Copy

1.	Mazzaferri EL. Approach to the pregnant patient with thyroid cancer[J]. J Clin Endocrinol Metab， 2011， 96(2)：265-272.
2.	Lee ML， Chen GG， Vlantis AC， et al. Induction of thyroid papillary carcinoma cell proliferation by estrogen is associated with an altered expression of Bcl-xL[J]. Cancer J， 2005， 11(2)：113-121.
3.	Antico-Arciuch VG， Dima M， Liao XH， et al. Cross-talk betweenPI3K and estrogen in the mouse thyroid predisposes to the develo-pment of follicular carcinomas with a higher incidence in females[J]. Oncogene， 2010， 29(42)：5678-5686.
4.	Zeng Q， Chen G， Vlantis A， et al. The contributions of oestrogenreceptor isoforms to the development of papillary and anaplastic thyroid carcinomas[J]. J Pathol， 2008， 214(4)：425-433.
5.	Chen GG， Vlantis AC， Zeng Q， et al. Regulation of cell growth by estrogen signaling and potential targets in thyroid cancer[J]. Curr Cancer Drug Targets， 2008， 8(5)：367-377.
6.	Vivacqua A， Bonofiglio D， Albanito L， et al. 17beta-estradiol， genistein， and 4-hydroxytamoxifen induce the proliferation of thyroid cancer cells through the g protein-coupled receptor GPR30[J]. Mol Pharmacol， 2006， 70(4)：1414-1423.
7.	McTiernan AM， Weiss NS， Daling JR. Incidence of thyroid cancer in women in relation to reproductive and hormonal factors[J]. Am J Epidemiol， 1984， 120(3)：423-435.
8.	Mack WJ， Preston-Martin S， Bernstein L， et al. Reproductiveand hormonal risk factors for thyroid cancer in Los Angeles Countyfemales[J]. Cancer Epidemiol Biomarkers Prev， 1999， 8(11)：991-997.
9.	Pham TM， Fujino Y， Mikami H， et al. Reproductive and mens-trual factors and thyroid cancer among Japanese women：the Japa-nese Collaborative Cohort Study[J]. J Womens Health (Larchmt)，.
10.	Yasmeen S， Cress R， Romano PS， et al. Thyroid cancer in pregnancy[J]. Int J Gynaecol Obstet， 2005， 91(1)：15-20.
11.	Vannucchi G， Perrino M， Rossi S， et al. Clinical and molecular features of differentiated thyroid cancer diagnosed during pregnancy[J]. Eur J Endocrinol， 2010， 162(1)：145-151.
12.	Pacini F， Pinchera A， Giani C， et al. Serum thyroglobulin in thyroid carcinoma and other thyroid disorders[J]. J Endocrinol Invest， 1980， 3(3)：283-292.
13.	Lee RH， Spencer CA， Mestman JH， et al. Free T4 immunoassaysare ﬂawed during pregnancy[J]. Am J Obstet Gynecol， 2009， 200(3)：e1-e6.
14.	Fiore E， Vitti P. Serum TSH and risk of papillary thyroid cancer in nodular thyroid disease[J]. J Clin Endocrinol Metab， 2012， 97(4)：1134-1145.
15.	Moon WJ， Jung SL， Lee JH， et al. Benign and malignant thyroid nodules：US differentiation—multicenter retrospective study[J]. Radiology， 2008， 247(3)：762-770.
16.	Carmeci C， Jeffrey RB， McDougall IR， et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid masses[J]. Thyroid， 1998， 8(4)：283-289.
17.	Can AS， Peker K. Comparison of palpation versus ultrasound-guided fine-needle aspiration biopsies in the evaluation of thyroid nodules[J]. BMC Res Notes， 2008， 1：12.
18.	中华医学会内分泌学分会，中华医学会外科学分会，中国抗癌协会头颈肿瘤专业委员会，等. 甲状腺结节和分化型甲状腺癌诊治指南[J]. 中国肿瘤临床， 2012， 39(17)：1249-1272.
19.	Nikiforov YE， Steward DL， Robinson-Smith TM， et al. Moleculartesting for mutations in improving the fine-needle aspiration diag-nosis of thyroid nodules[J]. J Clin Endocrinol Metab， 2009， 94 (6)：2092-2098.
20.	Lee ST， Kim SW， Ki CS， et al. Clinical implication of highly sensitive detection of the BRAF V600E mutation in fine-needle aspirations of thyroid nodules：a comparative analysis of three molecular assays in 4 585 consecutive cases in a BRAF V600E mutation-prevalent area[J]. J Clin Endocrinol Metab， 2012， 97(7)：2299-2306.
21.	Kuy S， Roman SA， Desai R， et al. Outcomes following thyroid and parathyroid surgery in pregnant women[J]. Arch Surg， 2009， 144(5)：399-406.
22.	Nam KH， Yoon JH， Chang HS， et al. Optimal timing of surgery in well-differentiated thyroid carcinoma detected during pregnancy[J]. J Surg Oncol， 2005， 91(3)：199-203.
23.	Chong KM， Tsai YL， Chuang J， et al. Thyroid cancer in pregnancy：a report of 3 cases[J]. J Reprod Med， 2007， 52(5)：416-418.
24.	Driggers RW， Kopelman IN， Satin AJ. Delaying surgery for thyroid cancer in pregnancy. A case report[J]. J Reprod Med， 1998， 43(10)：909-912.
25.	中华医学会内分泌分会，中华医学会围产医学分会. 妊娠和产后甲状腺疾病诊治指南[J]. 中华内分泌代谢杂志， 2012， 28(5)：354-371.
26.	Stagnaro-Green A， Abalovich M， Alexander E， et al. Guidlines of the American Thyroid Association for the diagnosis and manag-ement of thyroid disease during pregnancy and postpartum[J]. Thyroid， 2011， 21(10)：1081-1125.
27.	Haddow JE， Palomaki GE， Allan WC， et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychologicaldevelopment of the child[J]. N Engl J Med， 1999， 341(8)：549-555.
28.	Benhadi N， Wiersinga WM， Reitsma JB， et al. Higher maternalTSH levels in pregnancy are associated with increased risk for miscarriage， fetal or neonatal death[J]. Eur J Endocrinol， 2009， 160(6)：985-991.
29.	Sawka AM， Lakra DC， Lea J， et al. A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors[J]. Clin Endocrinol (Oxf)， 2008， 69(3)：479-490.
30.	Schlumberger M， De Vathaire F， Ceccarelli C， et al. Exposure to radioactive iodine-131 for scintigraphy or therapy does not preclude pregnancy in thyroid cancer patients[J]. J Nucl Med， 1996， 37(4)：606-612.
31.	American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer；Cooper DS，Doherty GM， et al. Revised American Thyroid Association mana-gement guidelines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid， 2009， 19(11)：1167-1214.
32.	Silberstein EB， Alavi A， Balon HR， et al. The SNMMI practice guideline for therapy of thyroid disease with 131I 3.0[J]. J Nucl Med， 2012， 53(10)：1633-1651.
33.	De Groot L， Abalovich M， Alexander EK， et al. Management of thyroid dysfunction during pregnancy and postpartum：an Endo-crine Society clinical practice guideline[J]. J Clin Endocrinol Metab， 2012， 97(8)：2543-2565.
34.	National Institute of Clinical Excellence. Improving outcomes in head and neck cancer[EB/OL]. 2004. http：//www. nice. org. uk.
35.	Imran SA， Rajaraman M. Management of differentiated thyroid cancer in pregnancy[J]. J Thyroid Res， 2011， 2011：549609.
36.	， 18(3)：331-335.

1. Mazzaferri EL. Approach to the pregnant patient with thyroid cancer[J]. J Clin Endocrinol Metab， 2011， 96(2)：265-272.
2. Lee ML， Chen GG， Vlantis AC， et al. Induction of thyroid papillary carcinoma cell proliferation by estrogen is associated with an altered expression of Bcl-xL[J]. Cancer J， 2005， 11(2)：113-121.
3. Antico-Arciuch VG， Dima M， Liao XH， et al. Cross-talk betweenPI3K and estrogen in the mouse thyroid predisposes to the develo-pment of follicular carcinomas with a higher incidence in females[J]. Oncogene， 2010， 29(42)：5678-5686.
4. Zeng Q， Chen G， Vlantis A， et al. The contributions of oestrogenreceptor isoforms to the development of papillary and anaplastic thyroid carcinomas[J]. J Pathol， 2008， 214(4)：425-433.
5. Chen GG， Vlantis AC， Zeng Q， et al. Regulation of cell growth by estrogen signaling and potential targets in thyroid cancer[J]. Curr Cancer Drug Targets， 2008， 8(5)：367-377.
6. Vivacqua A， Bonofiglio D， Albanito L， et al. 17beta-estradiol， genistein， and 4-hydroxytamoxifen induce the proliferation of thyroid cancer cells through the g protein-coupled receptor GPR30[J]. Mol Pharmacol， 2006， 70(4)：1414-1423.
7. McTiernan AM， Weiss NS， Daling JR. Incidence of thyroid cancer in women in relation to reproductive and hormonal factors[J]. Am J Epidemiol， 1984， 120(3)：423-435.
8. Mack WJ， Preston-Martin S， Bernstein L， et al. Reproductiveand hormonal risk factors for thyroid cancer in Los Angeles Countyfemales[J]. Cancer Epidemiol Biomarkers Prev， 1999， 8(11)：991-997.
9. Pham TM， Fujino Y， Mikami H， et al. Reproductive and mens-trual factors and thyroid cancer among Japanese women：the Japa-nese Collaborative Cohort Study[J]. J Womens Health (Larchmt)，.
10. Yasmeen S， Cress R， Romano PS， et al. Thyroid cancer in pregnancy[J]. Int J Gynaecol Obstet， 2005， 91(1)：15-20.
11. Vannucchi G， Perrino M， Rossi S， et al. Clinical and molecular features of differentiated thyroid cancer diagnosed during pregnancy[J]. Eur J Endocrinol， 2010， 162(1)：145-151.
12. Pacini F， Pinchera A， Giani C， et al. Serum thyroglobulin in thyroid carcinoma and other thyroid disorders[J]. J Endocrinol Invest， 1980， 3(3)：283-292.
13. Lee RH， Spencer CA， Mestman JH， et al. Free T4 immunoassaysare ﬂawed during pregnancy[J]. Am J Obstet Gynecol， 2009， 200(3)：e1-e6.
14. Fiore E， Vitti P. Serum TSH and risk of papillary thyroid cancer in nodular thyroid disease[J]. J Clin Endocrinol Metab， 2012， 97(4)：1134-1145.
15. Moon WJ， Jung SL， Lee JH， et al. Benign and malignant thyroid nodules：US differentiation—multicenter retrospective study[J]. Radiology， 2008， 247(3)：762-770.
16. Carmeci C， Jeffrey RB， McDougall IR， et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid masses[J]. Thyroid， 1998， 8(4)：283-289.
17. Can AS， Peker K. Comparison of palpation versus ultrasound-guided fine-needle aspiration biopsies in the evaluation of thyroid nodules[J]. BMC Res Notes， 2008， 1：12.
18. 中华医学会内分泌学分会，中华医学会外科学分会，中国抗癌协会头颈肿瘤专业委员会，等. 甲状腺结节和分化型甲状腺癌诊治指南[J]. 中国肿瘤临床， 2012， 39(17)：1249-1272.
19. Nikiforov YE， Steward DL， Robinson-Smith TM， et al. Moleculartesting for mutations in improving the fine-needle aspiration diag-nosis of thyroid nodules[J]. J Clin Endocrinol Metab， 2009， 94 (6)：2092-2098.
20. Lee ST， Kim SW， Ki CS， et al. Clinical implication of highly sensitive detection of the BRAF V600E mutation in fine-needle aspirations of thyroid nodules：a comparative analysis of three molecular assays in 4 585 consecutive cases in a BRAF V600E mutation-prevalent area[J]. J Clin Endocrinol Metab， 2012， 97(7)：2299-2306.
21. Kuy S， Roman SA， Desai R， et al. Outcomes following thyroid and parathyroid surgery in pregnant women[J]. Arch Surg， 2009， 144(5)：399-406.
22. Nam KH， Yoon JH， Chang HS， et al. Optimal timing of surgery in well-differentiated thyroid carcinoma detected during pregnancy[J]. J Surg Oncol， 2005， 91(3)：199-203.
23. Chong KM， Tsai YL， Chuang J， et al. Thyroid cancer in pregnancy：a report of 3 cases[J]. J Reprod Med， 2007， 52(5)：416-418.
24. Driggers RW， Kopelman IN， Satin AJ. Delaying surgery for thyroid cancer in pregnancy. A case report[J]. J Reprod Med， 1998， 43(10)：909-912.
25. 中华医学会内分泌分会，中华医学会围产医学分会. 妊娠和产后甲状腺疾病诊治指南[J]. 中华内分泌代谢杂志， 2012， 28(5)：354-371.
26. Stagnaro-Green A， Abalovich M， Alexander E， et al. Guidlines of the American Thyroid Association for the diagnosis and manag-ement of thyroid disease during pregnancy and postpartum[J]. Thyroid， 2011， 21(10)：1081-1125.
27. Haddow JE， Palomaki GE， Allan WC， et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychologicaldevelopment of the child[J]. N Engl J Med， 1999， 341(8)：549-555.
28. Benhadi N， Wiersinga WM， Reitsma JB， et al. Higher maternalTSH levels in pregnancy are associated with increased risk for miscarriage， fetal or neonatal death[J]. Eur J Endocrinol， 2009， 160(6)：985-991.
29. Sawka AM， Lakra DC， Lea J， et al. A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors[J]. Clin Endocrinol (Oxf)， 2008， 69(3)：479-490.
30. Schlumberger M， De Vathaire F， Ceccarelli C， et al. Exposure to radioactive iodine-131 for scintigraphy or therapy does not preclude pregnancy in thyroid cancer patients[J]. J Nucl Med， 1996， 37(4)：606-612.
31. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer；Cooper DS，Doherty GM， et al. Revised American Thyroid Association mana-gement guidelines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid， 2009， 19(11)：1167-1214.
32. Silberstein EB， Alavi A， Balon HR， et al. The SNMMI practice guideline for therapy of thyroid disease with 131I 3.0[J]. J Nucl Med， 2012， 53(10)：1633-1651.
33. De Groot L， Abalovich M， Alexander EK， et al. Management of thyroid dysfunction during pregnancy and postpartum：an Endo-crine Society clinical practice guideline[J]. J Clin Endocrinol Metab， 2012， 97(8)：2543-2565.
34. National Institute of Clinical Excellence. Improving outcomes in head and neck cancer[EB/OL]. 2004. http：//www. nice. org. uk.
35. Imran SA， Rajaraman M. Management of differentiated thyroid cancer in pregnancy[J]. J Thyroid Res， 2011， 2011：549609.
36. ， 18(3)：331-335.

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Progress of Diagnosis and Treatment for Differentiated Thyroid Carcinoma in Pregnancy

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