Vini L, Hyer S, Pratt B, Harmer C
Thyroid Unit, Royal Marsden NHS Trust, Downs Road, Sutton, Surrey SM2 5PT, UK.
Eur J Endocrinol. 1999 May;140(5):404-6. doi: 10.1530/eje.0.1400404.
To assess the outcome of thyroid cancer diagnosed during pregnancy.
Retrospective analysis of patients diagnosed between 1949 and 1997 with thyroid cancer presenting during pregnancy.
Nine women with a median age of 28 years were identified. A thyroid nodule was discovered by the clinician during routine antenatal examination in four cases, the remainder had noted a lump in the neck. In all patients, the nodule was reported to almost double in size during the pregnancy. One patient underwent subtotal thyroidectomy during the second trimester; eight were operated on within 3 to 10 months from delivery. Total thyroidectomy was performed in five and subtotal thyroidectomy in four. All tumours were well differentiated and ranged in size from 1 to 6 cm.
The median follow-up was 14 years (5-31 years). One patient relapsed locally requiring further surgery. One patient developed bone metastases dying 7 years after presentation; her planned treatment had been delayed because of an intervening pregnancy. Eight of the original cohort of patients are currently disease free.
Differentiated thyroid cancer presenting in pregnancy generally has an excellent prognosis. When the disease is discovered early in pregnancy, surgery should be considered in the second trimester but radioiodine scans and treatment can be safely delayed until after delivery. In all cases, treatment should not be delayed for more than a year.
评估孕期诊断出的甲状腺癌的预后情况。
对1949年至1997年间孕期诊断出甲状腺癌的患者进行回顾性分析。
确定了9名女性，中位年龄为28岁。4例患者的甲状腺结节是临床医生在常规产前检查时发现的，其余患者是自己注意到颈部有肿块。据报告，所有患者的结节在孕期几乎增大了一倍。1例患者在孕中期接受了甲状腺次全切除术；8例在分娩后3至10个月内接受了手术。5例行甲状腺全切除术，4例行甲状腺次全切除术。所有肿瘤均为高分化，大小从1厘米至6厘米不等。
中位随访时间为14年（5至31年）。1例患者局部复发，需要进一步手术。1例患者发生骨转移，在确诊后7年死亡；由于其间有一次妊娠，她的计划治疗被推迟。最初的一组患者中有8例目前无疾病。
孕期出现的分化型甲状腺癌通常预后良好。如果在孕早期发现该病，应考虑在孕中期进行手术，但放射性碘扫描和治疗可安全推迟至分娩后。在所有情况下，治疗不应推迟超过一年。
