Palpable thyroid nodules are detected in 4 to 7 percent of the population, and approximately 10 percent are malignant (Burman, 2015). Clinical nodules are typically evaluated with sonography and measurement of serum thyroid-stimulating hormone (TSH) and free thyroxine levels. Fine-needle aspiration is indicated for a suspicious nodule (lexander, 2017; Gharib, 2016).
With a diagnosis of thyroid malignancy, pregnancy termination is not necessary. Primary therapy is thyroidectomy performed ideally during the second trimester. Postoperatively, replacement thyroxine is given. Most thyroid cancers are well diferentiated and follow an indolent course. Thus, delayed surgical treatment does not usually alter outcome (Yazbeck, 2012; Yu, 2016).
In some types of thyroid cancer, radioiodine is used for primary or postoperative treatment. This is contraindicated in both pregnancy and lactation for several reasons. First, transplacental 1311 is avidly trapped by the fetal thyroid gland to cause hypothyroidism. Second, during lactation, the breast also concentrates a substantial amount of iodide. This may pose neonatal risk due to radioiodine-contaminated milk ingestion and maternal risk from significant breast irradiation. To limit maternal exposure, a delay of 3 months between lactation and thyroid ablation will more reliably ensure complete breast involution (Sisson, 2011). In women with thyroid cancer who ultimately receive 131 I doses, pregnancy should be avoided for 6 months to 1 year. This time ensures thyroid function stability and permits confirmation of cancer remission (Abalovich, 2007).
This lymphoma is probably B-cell derived and is cytologically distinguished from other lymphomas by Reed-Sternberg cells. Of cancers in pregnancy, lymphomas are common, and gestational rates are rising because of delayed childbearing (Horowitz, 2016). In pregnant women, Hodgkin lymphomas are more frequent than non-Hodgkin lymphomas. In one populationbased review of 7.9 million births from the Nationwide Inpatient Sample, El-Messidi and colleagues (2015) reported its incidence to be 1 in 12,400.
In more than 70 percent of Hodgkin disease cases, lymph nodes painlessly enlarge at sites above the diaphragm, that is, in the axillary, cervical, or submandibular chains. Approximately one third of patients have symptoms such as fever, night sweats, malaise, weight loss, and pruritus. Diagnosis is by histological examination of involved nodes (Longo, 2015).
The Ann Arbor staging system, shown in Table 63-2, is applied to Hodgkin and other lymphomas. For staging, pregnancy limits the use of some radiographic studies, but at minimum, chest radiography, abdominal imaging with sonography or MR imaging, and bone marrow biopsy are completed (Williams, 2001). MR imaging is excellent for evaluating thoracic and abdominal paraaortic lymph nodes (Brenner, 2012). Staging laparotomy is seldom done today (Longo, 2015).
The current trend for nonpregnant individuals is to administer chemotherapy for all stages of Hodgkin disease. In pregnancy, for early-stage disease in the first trimester, options include observation until after 12 weeks' gestation, single-agent vinblastine until the second trimester, pregnancy termination followed by multiagent chemotherapy, or radiotherapy alone for isolated neck or axillary sites (EI-Hemaidi, 2012; Eyre, 2015).