Papillary thyroid cancer in pregnancy – How can you proceed?

Introduction:

Malignant diseases in pregnancy present all involved with a great ethical and medical challenge. This current case example should clarify these decision conflicts by reference to metastasis papillary thyroid cancer.

Case example:

A 31-year-old woman came to representation, who was 8 weeks pregnant with her second child. The first pregnancy occurred without any problems. She reported two tumours that were lying on her neck, which had also already existed in the first pregnancy, but had now increased in size. An already prior MRT had given no path leading the way to a discovery. After performing a sonography re-examination, who are more likely to think of a neck cyst, a FNAC took place. Here thyroid cells were found and a prompt histological clarification was recommended. As the patient wished to proceed with the pregnancy, there was no further medical imaging possible. After consultation with the gynaecologists followed the decision to have an operative exploration in the 14th week of pregnancy. Histology revealed metastases of a papillary thyroid carcinoma. After reconsideration, more detailed discussion and the continued wish to proceed with the pregnancy followed the decision for a complete thyroidectomy with neck dissection on the right side. Histologically the previously diagnosed thyroid cancer was confirmed.

Conclusion:

Besides the restrictions of the imaging in the earlier phases of the pregnancy represent an anaesthesiological burden and especially emotional strain of the mothers are the decision factors in malignant tumours in the pregnancy. To discuss all of the connected questions as widely as possible – amongst including an ethicist – it helps to think through the decision process objectively and to decide rationally.

Publication History

Publication Date:
18 April 2018 (online)