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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica

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Volume 47, Issue 7


Pregnancy outcomes after thyroid cancer

Efrat Spiegel / Andrea R. Spence
  • Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Nicholas Czuzoj-Shulman
  • Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Haim Arie Abenhaim
  • Corresponding author
  • Jewish General Hospital, McGill University, Obstetrics and Gynecology, Montreal, Canada
  • Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2019-07-19 | DOI: https://doi.org/10.1515/jpm-2019-0039



Thyroid cancer is one of the most common cancers in women of reproductive age. Our purpose was to evaluate the association between thyroid cancer and maternal and neonatal outcomes of pregnancy.


We conducted a retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) database from the US. A cohort consisting of women who delivered between 1999 and 2014 was created. Multivariate logistic regression, controlling for baseline maternal characteristics, was used to compare pregnancy complications and neonatal outcomes of pregnant women with thyroid cancer [International Classification of Diseases, ninth edition (ICD-9) code 193] diagnosed before or during pregnancy with those of the obstetric population without thyroid cancer.


The study included 14,513,587 pregnant women, of which 581 women had a diagnosis of thyroid cancer (4/100,000). During the observation period, there was an upward trend in the prevalence of thyroid cancer among pregnant women, though not statistically significant (P = 0.147). Women with thyroid cancer were more likely to be Caucasian, belong to a higher income quartile, have private insurance, to be discharged from an urban teaching hospital and to have pre-gestational hypertension. Women with thyroid cancer had a greater chance of delivering vaginally, requiring transfusion of blood and developing venous thromboembolism (VTE). Neonates of mothers with thyroid cancer were not found to be at increased risk for the adverse neonatal outcomes examined, specifically, congenital malformations, intrauterine growth restriction, fetal death and preterm labor.


Pregnancies complicated by thyroid cancer have higher incidences of VTE and need for transfusions, with comparable overall newborn outcomes.

Keywords: neonatal outcomes; pregnancy; pregnancy outcomes; thyroid cancer


  • 1.

    Smith LH, Danielsen B, Allen ME, Cress R. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol 2003;189:1128–35.PubMedCrossrefGoogle Scholar

  • 2.

    Khaled H, Al Lahloubi N, Rashad N. A review on thyroid cancer during pregnancy: multitasking is required. J Adv Res 2016;7:565–70.CrossrefWeb of SciencePubMedGoogle Scholar

  • 3.

    Modesti C, Aceto P, Masini L, Lombardi CP, Bellantone R, Sollazzi L. Approach to thyroid carcinoma in pregnancy. Updates Surg 2017;69:261–5.Web of ScienceCrossrefPubMedGoogle Scholar

  • 4.

    Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg 2014;140:317–22.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 5.

    Topstad D, Dickinson JA. Thyroid cancer incidence in Canada: a national cancer registry analysis. CMAJ Open 2017;5:E612–6.CrossrefGoogle Scholar

  • 6.

    Gibelli B, Zamperini P, Proh M, Giugliano G. Management and follow-up of thyroid cancer in pregnant women. Acta Otorhinolaryngol Ital 2011;31:358–65.PubMedGoogle Scholar

  • 7.

    Mazzaferri EL. Approach to the pregnant patient with thyroid cancer. J Clin Endocrinol Metab 2011;96:265–72.Web of SciencePubMedCrossrefGoogle Scholar

  • 8.

    Moosa M, Mazzaferri EL. Outcome of differentiated thyroid cancer diagnosed in pregnant women. J Clin Endocrinol Metab 1997;82:2862–6.CrossrefPubMedGoogle Scholar

  • 9.

    Zhou YQ, Zhou Z, Qian MF, Gong T, Wang JD. Association of thyroid carcinoma with pregnancy: a meta-analysis. Mol Clin Oncol 2015;3:341–6.Web of ScienceCrossrefPubMedGoogle Scholar

  • 10.

    Lee JC, Zhao JT, Clifton-Bligh RJ, Gill AJ, Gundara JS, Ip J, et al. Papillary thyroid carcinoma in pregnancy: a variant of the disease? Ann Surg Oncol 2012;19:4210–6.Web of ScienceCrossrefPubMedGoogle Scholar

  • 11.

    Vannucchi G, Perrino M, Rossi S, Colombo C, Vicentini L, Dazzi D, et al. Clinical and molecular features of differentiated thyroid cancer diagnosed during pregnancy. Eur J Endocrinol 2010;162:145–51.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 12.

    Messuti I, Corvisieri S, Bardesono F, Rapa I, Giorcelli J, Pellerito R, et al. Impact of pregnancy on prognosis of differentiated thyroid cancer: clinical and molecular features. Eur J Endocrinol 2014;170:659–66.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 13.

    Chen AC, Livhits MJ, Du L, Wu JX, Kuo EJ, Yeh MW, et al. Recent pregnancy is not associated with high-risk pathological features of well-differentiated thyroid cancer. Thyroid 2018;28:68–71.Web of ScienceCrossrefPubMedGoogle Scholar

  • 14.

    Alves GV, Santin AP, Furlanetto TW. Prognosis of thyroid cancer related to pregnancy: a systematic review. J Thyroid Res 2011;2011:691719.PubMedGoogle Scholar

  • 15.

    Yasmeen S, Cress R, Romano PS, Xing G, Berger-Chen S, Danielsen B, et al. Thyroid cancer in pregnancy. Int J Gynaecol Obstet 2005;91:15–20.PubMedCrossrefGoogle Scholar

  • 16.

    Herzon FS, Morris DM, Segal MN, Rauch G, Parnell T. Coexistent thyroid cancer and pregnancy. Arch Otolaryngol Head Neck Surg 1994;120:1191–3.PubMedCrossrefGoogle Scholar

  • 17.

    Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 Guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017;27:315–89.CrossrefWeb of SciencePubMedGoogle Scholar

  • 18.

    Boucek J, de Haan J, Halaska MJ, Plzak J, Van Calsteren K, de Groot CJM, et al. Maternal and obstetrical outcome in 35 cases of well-differentiated thyroid carcinoma during pregnancy. Laryngoscope 2018;128:1493–1500.Web of SciencePubMedCrossrefGoogle Scholar

  • 19.

    Shim MH, Mok CW, Chang KH, Sung JH, Choi SJ, Oh SY, et al. Clinical characteristics and outcome of cancer diagnosed during pregnancy. Obstet Gynecol Sci 2016;59:1–8.PubMedCrossrefGoogle Scholar

  • 20.

    Steiner C, Elixhauser A, Schnaier J. The healthcare cost and utilization project: an overview. Eff Clin Pract 2002;5:143–51.PubMedGoogle Scholar

  • 21.

    Overview of the HCUP-NIS https://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed on January 17, 2019.

  • 22.

    Weeks KS, Kahl AR, Lynch CF, Charlton ME. Racial/ethnic differences in thyroid cancer incidence in the United States, 2007–2014. Cancer 2018;124:1483–91.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 23.

    La Vecchia C, Malvezzi M, Bosetti C, Garavello W, Bertuccio P, Levi F, et al. Thyroid cancer mortality and incidence: a global overview. Int J Cancer 2015;136:2187–95.Web of SciencePubMedCrossrefGoogle Scholar

  • 24.

    Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L. Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med 2016;375:614–7.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 25.

    Aschebrook-Kilfoy B, Ward MH, Sabra MM, Devesa SS. Thyroid cancer incidence patterns in the United States by histologic type, 1992–2006. Thyroid 2011;21:125–34.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 26.

    Blackburn BE, Ganz PA, Rowe K, Snyder J, Wan Y, Deshmukh V, et al. Aging-related disease risks among young thyroid cancer survivors. Cancer Epidemiol Biomarkers Prev 2017;26:1695–704.CrossrefWeb of SciencePubMedGoogle Scholar

  • 27.

    Schlumberger M, Tahara M, Wirth LJ, Robinson B, Brose MS, Elisei R, et al. Lenvatinib versus placebo in radioiodine-refractory thyroid cancer. N Engl J Med 2015;372:621–30.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 28.

    Ancker OV, Wehland M, Bauer J, Infanger M, Grimm D. The adverse effect of hypertension in the treatment of thyroid cancer with multi-kinase inhibitors. Int J Mol Sci 2017;18:piii: E625.CrossrefWeb of ScienceGoogle Scholar

  • 29.

    Smith LH, Dalrymple JL, Leiserowitz GS, Danielsen B, Gilbert WM. Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol 2001;184:1504–12; discussion 12-3.CrossrefPubMedGoogle Scholar

  • 30.

    Timur H, Tokmak A, Iskender C, Yildiz ES, Inal HA, Uygur D, et al. Obstetric outcomes in non-gynecologic cancer patients in remission. Eurasian J Med 2016;48:130–4.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 31.

    M’Rabet-Bensalah K, Aubert CE, Coslovsky M, Collet TH, Baumgartner C, den Elzen WP, et al. Thyroid dysfunction and anaemia in a large population-based study. Clin Endocrinol (Oxf) 2016;84:627–31.CrossrefGoogle Scholar

  • 32.

    Padovani RP, Tuttle RM, Grewal R, Larson SM, Boucai L. Complete blood counts are frequently abnormal 1 year after dosimetry-guided radioactive iodine therapy for metastatic thyroid cancer. Endocr Pract 2014;20:213–20.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 33.

    Deng A, Galanis T, Graham MG. Venous thromboembolism in cancer patients. Hosp Pract (1995) 2014;42:24–33.CrossrefPubMedGoogle Scholar

  • 34.

    Lyman GH. Venous thromboembolism in the patient with cancer: focus on burden of disease and benefits of thromboprophylaxis. Cancer 2011;117:1334–49.CrossrefWeb of SciencePubMedGoogle Scholar

  • 35.

    Bleau N, Patenaude V, Abenhaim HA. Risk of venous thrombo-embolic events in pregnant patients with cancer. J Matern Fetal Neonatal Med 2016;29:380–4.Web of SciencePubMedGoogle Scholar

  • 36.

    Walker AJ, Card TR, West J, Crooks C, Grainge MJ. Incidence of venous thromboembolism in patients with cancer – a cohort study using linked United Kingdom databases. Eur J Cancer 2013;49:1404–13.CrossrefWeb of ScienceGoogle Scholar

  • 37.

    van der Boom T, Klein Hesselink EN, Kooistra HA, Meijer K, van der Horst-Schrivers AN, Lefrandt JD, et al. Risk factors for venous thromboembolism in patients treated for differentiated thyroid carcinoma. Endocr Relat Cancer 2017;24:267–73.CrossrefWeb of SciencePubMedGoogle Scholar

  • 38.

    Ko KY, Yen RF, Lin CL, Cheng MF, Huang WS, Kao CH. Pregnancy outcome after I-131 therapy for patients with thyroid cancer: a nationwide population-based cohort study. Medicine (Baltimore) 2016;95:e2685.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 39.

    Chow SM, Yau S, Lee SH, Leung WM, Law SC. Pregnancy outcome after diagnosis of differentiated thyroid carcinoma: no deleterious effect after radioactive iodine treatment. Int J Radiat Oncol Biol Phys 2004;59:992–1000.PubMedCrossrefGoogle Scholar

  • 40.

    Yu SS, Bischoff LA. Thyroid cancer in pregnancy. Semin Reprod Med 2016;34:351–5.Web of ScienceCrossrefPubMedGoogle Scholar

  • 41.

    Uruno T, Shibuya H, Kitagawa W, Nagahama M, Sugino K, Ito K. Optimal timing of surgery for differentiated thyroid cancer in pregnant women. World J Surg 2014;38:704–8.Web of ScienceCrossrefPubMedGoogle Scholar

  • 42.

    Hartnett KP, Ward KC, Kramer MR, Lash TL, Mertens AC, Spencer JB, et al. The risk of preterm birth and growth restriction in pregnancy after cancer. Int J Cancer 2017;141:2187–96.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 43.

    de Haan J, Verheecke M, Van Calsteren K, Van Calster B, Shmakov RG, Mhallem Gziri M, et al. Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients. Lancet Oncol 2018;19:337–46.Web of ScienceCrossrefPubMedGoogle Scholar

About the article

Received: 2018-10-16

Accepted: 2019-06-21

Published Online: 2019-07-19

Published in Print: 2019-09-25

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Journal of Perinatal Medicine, Volume 47, Issue 7, Pages 710–716, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2019-0039.

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