Impact of pregnancy on papillary thyroid carcinoma prognosis

Abstract

Introduction: thyroid carcinoma is more frequent in women of reproductive age. It can affect both fertility and the course of pregnancy. The aim of the study was to investigate the influence of pregnancy as a factor of recurrence or progression, on the prognosis of thyroid carcinoma.

Methods: we conducted a retrospective cohort study of 117 young female patients followed up for papillary thyroid carcinoma (PTC) at the Department of Endocrinology, Diabetology and Metabolic Diseases of Ibn Rochd University Hospital of Casablanca, from January 2010 to December 2018, divided into 2 groups: group 1 composed of pregnant patients (n=42) and group 2 being the control group (n=75). Statistical analysis was made using SPSS software version 22.0.0.

Results: average age of pregnant patients was 35 ± 6.5 years old. Mean duration between first pregnancy and treatment completion was 4.4 ± 3.1 years. Over an average treatment duration of 14.4 months in postpartum, 30 patients were in remission (thyroglobulin (Tg) <1μg/l, negative thyroglobulin antibody and no morphological abnormality), while 12 had persistent symptoms (detectable Tg/thyroglobulin antibody and/or morphological abnormality). Thyroid stimulating hormone (TSH) during pregnancy was on average 0.83 mIU/l. Cancer progression was correlated with persistence of thyroid cancer to treatment before pregnancy (p = 0.01), pre-existing distant or locoregional metastases (p = 0.02) and delayed administration of radio-iodine therapy (p = 0.01). Interval between diagnosis and pregnancy, TSH level during pregnancy or the pre-conception thyroglobulin level did not have a statistically significant impact. Pregnancy was not associated with progression or recurrence of thyroid cancer (adjusted risk ratio 1.04, 95% confidence interval 0.91-1.32).

Conclusion: this study shows that pregnancy has no impact on recurrence or progression of thyroid cancer in patients declared in remission prior to conception.