For women between 30-50 years old, thyroid cancer is a relatively common tumor.In the United States, the incidence of thyroid cancer during pregnancy is 14.4/100 000, including 3.3/100,000 diagnosis before childbirth, 0.3/100,000 during childbirth, and 10.8/100 000 within one year after birth.At present, the incidence of thyroid cancer during pregnancy in China is not clear.According to data reported by the National Cancer Center, the incidence of thyroid cancer in China in 2015 was 22.56/100,000.Considering that with age, the incidence of thyroid cancer also increases, especially women over 40 years old.
In addition, a large study of samples shows that the risk factors of women in women who are not parathylene cancer are non -thyroid cancer.Therefore, it can be speculated that the possibility of thyroid cancer during pregnancy is no different from the risk of cancer with women of the same age, that is, pregnancy does not increase the risk of thyroid cancer.
Among them, the most common thyroid cancer is also differentiated with thyroid cancer such as thyroid papillary cancer and thyroid filtration bubble cancer. Pitheromy -like cancer and unlimary cancer and low -differentiated cancer are also rare.
Some information shows that thyroid nodules and tumors may grow during pregnancy.Because theoretically, during pregnancy, many hormones in women, such as human puffed gonad hormone and estrogen, may be related to thyroid nodules and tumor growth.However, some of the more samples have shown that the progress of hypothyroidism during pregnancy is not obvious, and its postoperative recurrence rate has not increased significantly.At the same time, women under 45 years of age have better prognosis when suffering from methyl -shaped glandular cancer.Therefore, it can be considered that pregnancy has little effect on the prognosis of most patients with thyroid cancer.
During pregnancy, if you want to clarify the nature of the foundation, the thyroid ultrasound is generally preferred to evaluate the nature of the thyroid nodule based on the sound characteristics of the nodule.If you combine the condition, you need to consider further clarification of its nature, or you can choose a thyroid fine needle puncture cytology.
Stranging is a safer examination method that can be implemented at all stages of pregnancy.Do you need to do a puncture test, depending on the vicious risk of ultrasonic assessment and the level of tshopinexin (TSH).
If the ultrasonic assessment of non -high -risk nodules, the patient’s TSH level is reduced and continued until 16 weeks of pregnancy.If TSH is still very low after childbirth, it can be scanned by feasible radioactive nuclein to evaluate the thyroid nodule function.
If the ultrasonic assessment is a high -risk nodule, it should be determined whether the ultrasonic results of the thyroid nodule should be determined whether the thyroid puncture is performed.If there are ultrasonic malignant characteristics, you can consider the puncture inspection of thin needles at this time.
Most surgery is generally the first -line choice after the diagnosis of thyroid cancer.However, thyroid surgery during pregnancy may cause hypothyroidism and thyroid adrenal injuries in pregnant women. The latter is not good for fetal development, and surgery may also increase the risk of premature birth and abortion.
If the non -invasive differential segmented thyroid cancer is found during pregnancy, you can choose to delay after giving birth, and then perform thyroid cancer surgery.At this time, hypersonic monitoring of thyroid cancer should be performed, and patients with high TSH are given thyroid hormone inhibitory therapy.If the tumor increases significantly or has the metastasis of the cervical lymph nodes at the first 24 weeks of pregnancy, surgical treatment should be performed immediately.However, if the tumor is still stable until the middle of the pregnancy, or the tumor is diagnosed in the middle and late pregnancy, the surgery should be implemented after childbirth.
During pregnancy, if the foundation of thyroid cancer is discovered in advanced thyroid carcinoma (such as obvious violations or distant metastasis), or cytology indicates myeline -like cancer or unlimized cancer, surgical treatment can be selected in the middle of pregnancy.
For women who have found thyroid cancer and are preparing for pregnancy, they usually choose to undergo thyroid cancer surgery before pregnancy, adjust the thyroid function, and then prepare for pregnancy.For patients with small thyroid nipple cancer, active follow -up observations are performed if surgical treatment is not received. Once pregnancy, the tumor has no clear conclusion.At this time, the management method is the same as the non -invasive division of thyroid cancer discovered during pregnancy.
Fifth, after thyroid cancer surgery, is it necessary to treat endocrine if you are pregnant?
Endocrine therapy is generally taken after thyroid cancer, that is, thyroid hormone therapy (please refer to the role of endocrine therapy in thyroid cancer).If the thyroid function is normal, we call it alternative.If it is to suppress the level of TSH and reduce the risk of recurrence of thyroid cancer, we call it inhibitory treatment.
Women who have been treated with differentiated thyroid cancer surgery are best to suppress TSH levels to stabilize for more than 3 months before considering pregnancy.Once you prepare for pregnancy, you should continue to be treated with thyroid hormone and check the level of TSH to adjust the dose of the drug.There is no significant difference in the TSH inhibitory targets before and during pregnancy after the patients with differentiated thyroid cancer. The level of inhibitory inhibitory should depend on the risk of thyroid residues or recurrence of A cancer before pregnancy.Patients with high risk of recurrence of thyroid cancer should be controlled even lower.If the patient meets the risk of low recurrence or a good treatment response, the TSH target value can be relaxed appropriately.
For other rare thyroid cancers, including thyroid myeline -like cancer and unlimized cancer. Because the growth of cancer cells is not regulated by TSH, there is no need to suppress TSH to low levels.At this time, the purpose of thyroid hormone therapy is to replace the treatment to maintain normal thyroid function.At this time, TSH should be controlled within the target range of the corresponding pregnancy stage.
Many patients worry about whether thyroid hormones have adverse effects on mothers and fetuses.In fact, in addition to a very few patients allergic to thyroid hormones, as long as the drug dosage is appropriate, the thyroid function control meets the expected goal, and the treatment of thyroid hormones is generally safe.Moreover, if there is no treatment during pregnancy or insufficient dosage of drugs, mild hypothyroidism will affect the intellectual and skeletal development of the fetus, and the mild hyperthyroidism caused by TSH inhibitory therapy during pregnancy has a small impact on the fetus.
6. Does iodine -131 have an impact on pregnancy?
For patients with non-pregnancy, patients with thyroid cancer, according to the high and low risk of postoperative recurrence, decide whether to do postoperative iodine-131 treatment.But during pregnancy, iodine-131 treatment is used taboo.Because iodine-131 treatment may cause risks such as delayed delivery, reduction rate, and teratogenic.
For women who need to be treated with iodine -131 treatment after thyroid cancer, at least 6 months after treatment and the needle control can be appropriately controlled, pregnancy can be considered.
For women who are older and eager to be pregnant, considering that thyroid cancer risk is limited in pregnancy, you can first consider pregnancy under the guidance of a professional team, and then iodine-131 treatment after giving birth.
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Author: Deputy Chief Physician Xu Shuhang, Ph.D. in Medicine, Humboldt University, Germany
Hosted or participated in a number of National Natural Science Foundations and provincial scientific research topics.Member and secretary of the Orthopedic Professional Committee of the China Non -Public Hospital Association, and deputy leader of the thyroid gland science group of the Jiangsu Medical Association of the Jiangsu Medical Association.
Review expert: Professor Guan Haixia, Li Xiaoyi
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