Teng Chung-Jen, Yeh Chiu-Mei, Liu Chia-Jen, Chen Tzeng-Ji, Huang Nicole, Chou Yiing-Jenq
Division of Oncology and Hematology, Department of Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Road, Banqiao District, New Taipei City 22060, Taiwan.
Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Yang Ming Campus, No. 155, Sec. 2, Linong Street, Beitou District, Taipei 11217, Taiwan.
Postgrad Med J. 2025 Jun 22;101(1197):636-643. doi: 10.1093/postmj/qgae197.
Thyroid cancer primarily affects young women and raises concerns about future fertility due to treatments of thyroidectomy and radioactive iodine (RAI) therapy. This study investigated the effects of these treatments on pregnancy probability in young female patients post-diagnosis.
A nationwide, population-based study using data from Taiwan's National Health Insurance Research Database (2000-2017) examined pregnancy likelihood in women ≤45 years with thyroid cancer. The effects of thyroidectomy and RAI therapy on pregnancy were analyzed using logistic regression and Cox proportional-hazards models.
In a cohort of 10 937 patients with thyroid cancer, 7022 (64.2%) underwent total thyroidectomy, with 718 receiving RAI treatment. The type of thyroidectomy and RAI treatment, even at doses exceeding 120 millicuries, did not reduce the likelihood of pregnancy. Age was identified as the most critical factor influencing pregnancy; women aged >30 years had a significantly lower likelihood of becoming pregnant than younger women did. Other factors associated with a reduced likelihood of pregnancy included comorbidity with diabetes (HR = 0.65, P = .002) and higher socioeconomic status (HR = 0.69, P = .085).
Thyroidectomy and RAI therapy do not diminish pregnancy probability in young women with thyroid cancer. Age remains a crucial factor, with younger women more likely to conceive. These findings are critical for fertility counseling and treatment planning. Key message What is already known on this subjec? Thyroid cancer primarily affects young women, and its standard treatments, including thyroidectomy and radioactive iodine (RAI) therapy, have raised concerns about their potential impact on fertility. Previous studies have shown that RAI treatment may temporarily affect ovarian function but typically does not have a significant long-term effect on fertility. What this study adds? This nationwide population-based study found that neither total nor partial thyroidectomy, nor RAI treatment, adversely affects the likelihood of pregnancy in young women with thyroid cancer. Age was identified as the most significant factor influencing pregnancy, with younger women having a higher probability of becoming pregnant after treatment. How this study might affect research, practice, or policy? Clinicians should recognize that age, rather than the type of thyroidectomy or RAI treatment, is the most critical factor influencing fertility in young women with thyroid cancer. This insight can guide personalized fertility counseling and treatment planning to optimize outcomes.
甲状腺癌主要影响年轻女性，由于甲状腺切除术和放射性碘（RAI）治疗，引发了对未来生育能力的担忧。本研究调查了这些治疗对年轻女性患者确诊后怀孕可能性的影响。
一项基于全国人群的研究，使用台湾国民健康保险研究数据库（2000 - 2017年）的数据，调查了年龄≤45岁的甲状腺癌女性的怀孕可能性。使用逻辑回归和Cox比例风险模型分析甲状腺切除术和RAI治疗对怀孕的影响。
在10937例甲状腺癌患者队列中，7022例（64.2%）接受了全甲状腺切除术，其中718例接受了RAI治疗。甲状腺切除术和RAI治疗的类型，即使剂量超过120毫居里，也不会降低怀孕的可能性。年龄被确定为影响怀孕的最关键因素；年龄>30岁的女性怀孕的可能性明显低于年轻女性。与怀孕可能性降低相关的其他因素包括合并糖尿病（HR = 0.65，P = 0.002）和较高的社会经济地位（HR = 0.69，P = 0.085）。
甲状腺切除术和RAI治疗不会降低年轻甲状腺癌女性的怀孕概率。年龄仍然是一个关键因素，年轻女性更有可能怀孕。这些发现对于生育咨询和治疗计划至关重要。关键信息 关于这个主题已经知道了什么？甲状腺癌主要影响年轻女性，其标准治疗方法，包括甲状腺切除术和放射性碘（RAI）治疗，引发了对其对生育能力潜在影响的担忧。先前的研究表明，RAI治疗可能会暂时影响卵巢功能，但通常对生育能力没有显著的长期影响。这项研究增加了什么？这项基于全国人群的研究发现，全甲状腺切除术或部分甲状腺切除术以及RAI治疗均不会对年轻甲状腺癌女性的怀孕可能性产生不利影响。年龄被确定为影响怀孕的最重要因素，年轻女性在治疗后怀孕的概率更高。这项研究可能如何影响研究、实践或政策？临床医生应该认识到，年龄而非甲状腺切除术或RAI治疗的类型，是影响年轻甲状腺癌女性生育能力的最关键因素。这一见解可以指导个性化的生育咨询和治疗计划，以优化结果。
