DTC in pregnancy refers to differentiated thyroid cancer diagnosed in a pregnant woman or around the time of pregnancy. Differentiated thyroid cancer is the second most common cancer diagnosed around the time of pregnancy, with a prevalence of approximately 14 per 100,000 pregnancies.
Understanding Differentiated Thyroid Cancer (DTC)
Differentiated thyroid cancer encompasses papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC), which originate from follicular cells in the thyroid gland. These types of thyroid cancer are generally slow-growing and highly treatable, with excellent long-term survival rates.
DTC and Pregnancy: Key Considerations
When DTC is diagnosed during pregnancy, several factors need consideration for both the mother and the developing fetus:
- Diagnosis: Detecting DTC during pregnancy typically involves a physical exam, ultrasound, and fine-needle aspiration biopsy (FNAB) of any suspicious thyroid nodules.
- Management: The management of DTC during pregnancy is often conservative. Treatment decisions depend on the stage of the cancer, gestational age, and patient preferences. Active surveillance may be an option for small, low-risk tumors. Surgery, if needed, is usually performed in the second trimester to minimize risks to the fetus. Radioactive iodine (RAI) therapy is typically postponed until after delivery.
- Impact on Pregnancy: DTC itself does not generally pose a significant risk to the pregnancy. However, thyroid hormone levels need to be carefully monitored and managed throughout pregnancy to ensure optimal fetal development.
- Postpartum Management: After delivery, further evaluation and treatment, such as RAI therapy, can be considered as needed.
Prevalence
The rising incidence of DTC, especially in younger women, has led to it being a relatively common cancer diagnosis in women around the time of pregnancy. As noted, studies show a prevalence of around 14 per 100,000 pregnancies.
Conclusion
Differentiated thyroid cancer (DTC) diagnosed in pregnancy requires careful management to balance the mother's health and the fetus's well-being. Treatment strategies are typically conservative during pregnancy, with more definitive therapies often deferred until after delivery. Management involves a multidisciplinary approach, including endocrinologists, surgeons, and obstetricians.
