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Structural disease before pregnancy affects later DTC progression
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Pregnancy does not seem to cause substantial disease progression in women with differentiated thyroid cancer, but disease progression may be affected if women had structural disease before pregnancy.
R. Michael Tuttle, MD, of the endocrinology service, department of medicine, Memorial Sloan Kettering Cancer Center in New York, and colleagues evaluated 235 women with a term pregnancy after initial treatment for differentiated thyroid cancer (DTC) between 1997 and 2015. The researchers sought to determine the risk for recurrence and progression of DTC after applying response-to-therapy assessments to prepregnancy status.
Median age at delivery was 34 years, and delivery occurred a median of 3 years after initial treatment for DTC. Total thyroidectomy was performed in 89% of participants with 61% receiving radioactive iodine ablation.
Before pregnancy, 63% of participants had an excellent response to therapy, 16% had a structural incomplete response, 12% had an indeterminate response and 9% had a biochemical incomplete response.
After pregnancy, 5% of participants experienced structural disease recurrence or progression. Among participants with a structural incomplete response to therapy before pregnancy, 29% had structural disease progression, and 8% of them required additional therapy in the years after delivery. Structural disease progression during pregnancy required additional therapy in 1.3% of the entire cohort.
“This is the first study that formally applies response-to-therapy assessment to thyroid cancer patients who had at least one full-term pregnancy,” the researchers wrote. “Our analyses show that none of the patients with an excellent, indeterminate or biochemical incomplete response to therapy prior to pregnancy developed structurally identifiable disease after a full-term delivery. Furthermore, [less than] 10% of patients with a structural incomplete response to therapy required additional treatment during the first postpartum years. These data confirm that response-to-therapy status prior to pregnancy is an excellent predictor of pregnancy-associated disease recurrence/progression in women who were previously treated for DTC.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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