CCoPE
Date: 2009-11-03

Question:
My wife is 16 weeks pregnant and has just been diagnosed with Thyroid Cancer (Papillary Carcinoma, which is, we've been told, the "good" one to get). The doctor has said that we have found it very early (it is only .8 cm). The doctor has said that we don't need to operate till after the baby (which could be as far away as 8 months from now by the time she is ready), and has left us with two choices: 1-We wait. Our concern: It's a cancer and we're worried about it possibly growing or spreading. Since we've found it early, why not get rid of it early and reduce any further risk? 2-We operate now. A Thyroidectomy. Our concern: Risk to the baby during the operation. We have found very little information about this and we are running out of time and may not be able to speak to a specialist by the time the 2nd trimester ends. Any thoughts on our choices? We are looking for all the opinions we can get. Thank you.

Answer:
Continue to consult your physician. The following information should not replace the assessment and advice you have been receiving from your physician (cancer specialist, obstetrician, or other healthcare provider). It is offered for informational and educational purposes only. The risk associated with certain surgical procedures in the first trimester of pregnancy is negligible and in this case may outweigh the risk for late treatment of the cancer. The general anesthesia used during some surgical procedures has not been associated with increasing the baseline risk of 1-3% for malformations in pregnancy. The baseline risk is the risk that every pregnant woman has for giving birth to a child with a major malformation and occurs by chance alone; certain exposures can increase this baseline risk, but general anesthesia has not been associated with increasing the baseline risk for major malformations, low birth weight or spontaneous abortions. The process of thyroidectomy however will mean that mother's thyroxin levels will not be adequate, and must be stringently monitored and controlled by medication; there is an association between low thyroid levels in pregnancy and developmental delays in the child. The synthetic thyroxin used to treat hypothyroidism in pregnant women is considered safe for use even in first trimester. They are generally well absorbed and do not pose teratogenic risks to the baby.