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Thyroid cancer in pregnancy: diagnosis, management, and treatment

  • Special Section: Cancer in Pregnancy
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Abstract

The evaluation and management of cancer during pregnancy requires special care to assure the health and safety of both the mother and fetus. The diagnosis and treatment of thyroid cancer in the non-pregnant patient often involves radioactive iodine exposure. However, radioactive iodine is contraindicated in pregnancy and surgical interventions pose risks to both the mother and fetus. Thus, the management of thyroid cancer during pregnancy is a unique clinical challenge. In this review, we discuss the imaging of thyroid nodules during pregnancy, including the role of CT, MRI, and nuclear Imaging, as well as that of Ultrasound and FNA. The staging and prognosis are discussed along with the management, treatment, and surveillance of thyroid cancer in pregnancy. Finally, the risks to the fetus through treatment are examined. Case examples are provided with an emphasis on the appropriate direction of care from a radiologist’s perspective.

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Fig. 1

Adapted from ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper [24]

Fig. 2
Case 1
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Author information

Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA

    Jonathan Langdon, Ferenc Czeyda-Pommersheim & Margarita Revzin

  2. Department of Radiology and Imaging Science, University of Rochester, Rochester, NY, USA

    Akshya Gupta

  3. Department of Radiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Kedar Sharbidre

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  1. Jonathan Langdon
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Correspondence to Jonathan Langdon.

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Appendix

Appendix

See Figs. 3, 4, and 5.

Fig. 3
figure 3

Comparison of ATA “High Suspicion” nodules with TI-RADS Nomenclature. In the center of the figure, the equivalent descriptors used for ATA “High Suspicion” nodules are provided for each TI-RADS category. The minimum and maximum TI-RADS score that may be derived from these descriptors is shown on the right. Note the ATA “High Suspicion” nodules are necessarily “Hypoechoic.” Thus, the isoechoic and hyperechoic nodules would never be considered “High Suspicion” using ATA Guidelines. Lesions in this category may map to either TR4 or TR5 depending on the specific descriptors

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Fig. 4
figure 4

Comparison of ATA “Intermediate Suspicion” nodules with TI-RADS Nomenclature. In the center of the figure, the equivalent descriptors used for ATA “Intermediate Suspicion” nodules are provided for each TI-RADS category. The minimum and maximum TI-RADS score that may be derived from these descriptors is shown on the right. Note the ATA “Intermediate Suspicion” nodules like the “High Suspicion” nodules must be “Hypoechoic.” Importantly, these nodules cannot be “Taller-than-Wide,” “Irregular,” demonstrate “Extra Thyroid Extension” or contain “microcalcifications.” Lesions in this category may map to either TR4 or TR5 depending on the specific descriptors

Full size image
Fig. 5
figure 5

Comparison of ATA “Low Suspicion” nodules with TI-RADS Nomenclature. In the center of the figure, the equivalent descriptors used for ATA “Low Suspicion” nodules are provided for each TI-RADS category. The minimum and maximum TI-RADS score that may be derived from these descriptors is shown on the right. Note the ATA “Low Suspicion” contain the hyerechoic and isoechoic nodules. These nodules must also have “smooth” or “ill-defined” margins and be “Wider-than-Tall” amongst other requirements as shown in the figure. As a result, the mapping from TI-RADS to ATA is incomplete with combinations such as “Taller-than-Wide” and “Isoechoic” left without an ATA assessment category. These “Low Suspicion” lesions may map to as low as TR2 or as high as TR5 based on the equivalent TI-RADS descriptors

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Langdon, J., Gupta, A., Sharbidre, K. et al. Thyroid cancer in pregnancy: diagnosis, management, and treatment. Abdom Radiol 48, 1724–1739 (2023). https://doi.org/10.1007/s00261-023-03808-1

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  • DOI: https://doi.org/10.1007/s00261-023-03808-1

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