MANAGEMENT OF THYROID-NODULES IN PREGNANCY

Background: Disorders of the thyroid are common in pregnancy. In parti cular, a thyroid nodule is frequently discovered before or during preg nancy. Objective: To develop guidelines for the management of thyroid nodules during pregnancy. Methods: We reviewed the cases of 40 pregnan t patients with thyroid nodules evaluated during a 10-year period. Cyt ological findings were compared with available histological findings, and concordance rates were determined. The rank sum test was used for statistical analysis. Results: Fine-needle aspirations of thyroid nodu les in 62% of patients were benign cytologically (25 patients). Of 8 p atients with negative cytological results who had thyroidectomy, all h ad benign disease histologically (100% concordance rate). Cytological findings of papillary cancer (3 patients) strongly correlated with fin al histological diagnosis (100% concordance rate), whereas papillary c ancer was confirmed histologically in only 2 of 4 patients with cytolo gical findings suspicious for this disease (50% concordance rate). All 3 nodules with cytological findings suspicious for follicular neoplas m were benign adenomas histologically. Of 2 nodules suspicious for Hur thle cell neoplasm, 1 was Hurthle cell adenoma and the other was Hurth le cell carcinoma (100% concordance rate). Thyroidectomy during the se cond trimester of pregnancy or the early postpartum period was success ful. Conclusions: The approach to thyroid nodules in pregnancy should be similar to that for nonpregnant patients. Thyroidectomy should be p erformed (1) during the second trimester for malignant lesions and cyt ological findings suspicious for papillary cancer and (2) in the postp artum period for cytological findings suspicious for follicular neopla sm.