Institute of Endocrinology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
Thyroid. 2010 Oct;20(10):1179-85. doi: 10.1089/thy.2010.0081.
Papillary thyroid cancer (PTC) commonly affects women of child-bearing age. During normal pregnancy, several factors may have a stimulatory effect on normal and nodular thyroid growth. The aim of the study was to determine whether pregnancy in thyroid-cancer survivors poses a risk of progression or recurrence of the disease.
The files of 63 consecutive women who were followed at the Endocrine Institute for PTC in 1992-2009 and had given birth at least once after receiving treatment were reviewed for clinical, biochemical, and imaging data. Thyroglobulin levels and neck ultrasound findings were compared before and after pregnancy. Demographic and disease-related characteristics and levels of thyroid-stimulating hormone (TSH) during pregnancy were correlated with disease persistence before conception and disease progression during pregnancy using Pearson's analysis.
Mean time to the first delivery after completion of thyroid-cancer treatment was 5.08 ± 4.39 years; mean duration of follow up after the first delivery was 4.84 ± 3.80 years. Twenty-three women had more than one pregnancy, for a total of 90 births. Six women had evidence of thyroid cancer progression during the first pregnancy; one of them also showed disease progression during a second pregnancy. Another two patients had evidence of disease progression only during their second pregnancy. Mean TSH level during pregnancy was 2.65 ± 4.14 mIU/L. There was no correlation of disease progression during pregnancy with pathological staging, interval from diagnosis to pregnancy, TSH level during pregnancy, or thyroglobulin level before conception. There was a positive correlation of cancer progression with persistence of thyroid cancer before pregnancy and before total I-131 dose was administered.
Pregnancy does not cause thyroid cancer recurrence in PTC survivors who have no structural or biochemical evidence of disease persistence at the time of conception. However, in the presence of such evidence, disease progression may occur during pregnancy, yet not necessarily as a consequence of pregnancy. The finding that a nonsuppressed TSH level during pregnancy does not stimulate disease progression suggests that it may be an acceptable therapeutic goal in this setting.
甲状腺乳头状癌（PTC）常见于育龄女性。在正常妊娠期间，多种因素可能对正常和结节性甲状腺的生长产生刺激作用。本研究旨在确定甲状腺癌幸存者在妊娠期间是否会增加疾病进展或复发的风险。
回顾性分析 1992 年至 2009 年在内分泌研究所因 PTC 接受治疗且至少在治疗后分娩过一次的 63 例连续女性患者的病历，评估其临床、生化和影像学数据。比较妊娠前后的甲状腺球蛋白水平和颈部超声检查结果。采用 Pearson 分析，将妊娠前疾病持续存在和妊娠期间疾病进展与人口统计学和疾病相关特征以及妊娠期间甲状腺刺激激素（TSH）水平相关联。
完成甲状腺癌治疗后首次分娩的平均时间为 5.08±4.39 年；首次分娩后平均随访时间为 4.84±3.80 年。23 例患者有不止一次妊娠，共 90 例分娩。6 例患者在首次妊娠期间出现甲状腺癌进展证据；其中 1 例在第二次妊娠期间也出现疾病进展。另外 2 例患者仅在第二次妊娠期间出现疾病进展。妊娠期间 TSH 平均水平为 2.65±4.14 mIU/L。妊娠期间疾病进展与病理分期、从诊断到妊娠的时间间隔、妊娠期间 TSH 水平或怀孕前甲状腺球蛋白水平无相关性。疾病进展与妊娠前及甲状腺碘 131 治疗前总剂量时疾病持续存在呈正相关。
在妊娠时无结构或生化疾病持续存在的 PTC 幸存者中，妊娠不会导致甲状腺癌复发。然而，在存在上述证据的情况下，疾病可能在妊娠期间进展，但不一定是妊娠的结果。妊娠期间未抑制的 TSH 水平不会刺激疾病进展的发现表明，在这种情况下，它可能是一个可接受的治疗目标。
