# Thyroid cancer surgical indication during pregnancy: Systematic literature review and series of illustrative cases

## TL;DR

This paper reviews when to perform thyroid cancer surgery during pregnancy, suggesting second-trimester surgery for severe cases and post-delivery for less severe ones.

## Contribution

The study provides clinical guidance on thyroidectomy timing during pregnancy based on tumor severity and patient safety.

## Key findings

- Surgery during the second trimester is suitable for aggressive thyroid cancers with lymph node metastasis.
- Postpartum surgery is safer for less severe cases to reduce risks to the fetus and mother.
- Recent studies support flexibility in performing thyroidectomy during the second trimester.

## Abstract

•There is no literature consensus about the better time to perform thyroidectomy in pregnant patients with thyroid cancer.•Surgery in the second trimester should be considered for the most severe cases, such as those that present lymph node metastasis or effective nodule growth within the first weeks of pregnancy.•In less severe cases, it is safer to perform thyroidectomy after delivery, decreasing the risks related to surgery to the patient and the fetus.

There is no literature consensus about the better time to perform thyroidectomy in pregnant patients with thyroid cancer.

Surgery in the second trimester should be considered for the most severe cases, such as those that present lymph node metastasis or effective nodule growth within the first weeks of pregnancy.

In less severe cases, it is safer to perform thyroidectomy after delivery, decreasing the risks related to surgery to the patient and the fetus.

To evaluate and discuss timing possibilities for surgical treatment in thyroid cancer in pregnant women.

Systematic literature review based on online search at the Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and National Center for Biotechnology Information (NCBI) databases. Retrospective analysis of thyroidectomies performed in the second trimester of pregnancy by the authors between 1999 and 2019.

The systematic review included nine articles. Their conclusions diverge with respect to the optimal timing of thyroid surgery. The medical literature considers thyroidectomy after safe delivery. The most recent studies are more flexible regarding carrying out this surgery during the second trimester of pregnancy. In the authors’ experience (n = 5), surgical treatment during the second trimester of pregnancy is a good option for more aggressive tumors.

More aggressive cases of thyroid papillary carcinoma can be treated with surgery during the second trimester of pregnancy. Performing the surgery after delivery is safer in the case of less aggressive cancer cases. The decision should consider hospital costs, surgery risks, and patient anxiety in relation to cancer.

Level II.