European Thyroid Journal (Jan 2023)
Thyroid nodules and thyroid cancer in women with positive thyroid screening in pregnancy: a double-centric, retrospective, cohort study
Abstract
Objective: Thyroid nodules are a common finding in the general population. The primary aim of the study was to determine the prevalence of thyroid nodules and cancer found by ultrasound (US) in women who underwent screening for thyroid dysfunction during pregnancy. Design: A double-centric, retrospective, cohort study. Patients and methods: We searched through medical records, including thyroid ultrasonography, of pregnant women who were positively screened for thyroid disorders (using thyroid-stimulating hormone and thyroid antibodies) from an unselected population (‘universal screening group’, n = 690) and of women who underwent the testing based on the presence of clinical risk factors defined b y American Thyroid Association (’case-finding group’, n = 249). Results: Prevalence of benign and malignant thyroid nodules was lower in the ‘universal screening group’ than in the ‘case-finding group’ (9.9% vs 17.7% , P = 0.002, and 0.9% vs 7.2%, P < 0.001, respectively). Consistently, the thyroid cancer rate w as lower among the nodules in the ‘universal screening group’ than in the ‘cas e-finding group’ (8.1% vs 29.0%, P = 0.003). Ultrasound EU-TIRADS (European Thyroid Imaging and Reporting Data System) category ≥4 had a 95.8% sensitivity for thyroid cancer. In palpable nodul es, the prevalence of cancer was significantly higher than in the non-pa lpable ones (44.0% vs 2.2%, P < 0.001). In a multivariate regression analysis, thyroid nodul es were associated with a history of infertility and parity. Conclusions: Compared to the data from cancer registries, universal screening allowed detecting thyroid cancer in pregnancy three to five times more f requently, but the cancer rate among nodules (8.1%) did not differ from the common populat ion. US had very good sensitivity for thyroid cancer in pregnancy.
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