A suspicious thyroid lesion in pregnancy
Tanday R, Machenahalli P, McHardy Young S, Darko D
We present a case of our management at Central Middlesex of a young woman with a suspicious thyroid lesion in pregnancy.
Our patient is a 25 year old with no past medical history. She takes no medications and came to the UK from India 5 years ago. There is no family history known as she is adopted. She presented to her GP in December 2011 with a 6 month history of a left neck swelling. A thyroid USS was performed showing a left sided nodule and she was referred to our endocrine department.
She was seen in January 2012 when a soft ‘cystic’ nodule was palpable in the left lobe. She was clinically euthyroid. Serum analysis showed a TSH 1.29mIU/L and a TPO antibody <1kU/L. A detailed USS showed a left large partly cystic and solid nodule (3.1x2.1x2.9cm) with atypical blood flow suspicious of neoplasia. A FNA showed abundant colloid and dispersed follicular cells, some with Hurthle cell change – classified as Thy2. She was reassured with a plan for repeat of these investigations in 6 months.
In the intervening period she fell pregnant. 6 months later USS demonstrated the nodule was less cystic, predominantly solid, hyperechoic but unchanged in size. Central vascularity again was noted. A repeat FNA showed colloid and follicular cells now almost all showing Hurthle cell change – classified as Thy3f.
She was discussed in our thyroid MDT and it was felt that a hemithyroidectomy would be needed after she had delivered. She was recently seen in our antenatal-endocrine clinic where the diagnosis and plan was explained.
We shall explore the following issues:
Has the pathology changed?
Can pregnancy alter the behaviour of thyroid nodules?
Does she really need surgery?
Is hemithyroidectomy too little or too much?
Can we safely wait until delivery?
What if her cytology was Thy4/Thy5?