n association between postpartum thyroiditis and postpartum depression has been proposed but remains unresolved. Lucas and coworkers (2001) found a 1.7-percent incidence of postpartum depression at 6 months in women with thyroiditis as well as in controls. Pederson and colleagues (2007) found a signiicant correlation between abnormal scores on the Edinburgh Postnatal Depression Scale and total thyroxine values in the low normal range during pregnancy in 31 women. Similarly unsettled is the link between depression and thyroid antibodies. Kuijpens and associates (2001) reported that TPO antibodies were a marker for postpartum depression in euthyroid women. In a randomized trial, however, Harris and coworkers (2002) reported no diference in postpartum depression in 342 women with TPO antibodies who were given either levothyroxine or placebo.
hyroid nodules can be found in 1 to 2 percent of reproductive-aged women (Fitzpatrick, 2010). Management of a palpable thyroid nodule during pregnancy depends on gestational age and mass size. Small nodules detected by sensitive sonographic methods are more common during pregnancy in some populations. Kung and associates (2002) used high-resolution sonography and found that 15 percent of Chinese women had nodules larger than 2 mm in diameter. Almost half were multiple, and the nodules usually enlarged modestly across preg nancy and did not regress postpartum. Biopsy of thoser> 5 mmrthat persisted at 3 months usually showed nodular hyperplasia, and none were malignant. In most studies, 90 to 95 percent of solitary nodules are benign (Burch, 2016).
Evaluation of thyroid nodules during pregnancy should be similar to that for nonpregnant patients. As discussed in Chapter 46 (p. 908), radioiodine scanning in pregnancy is usually not recommended (American College of Obstetricians and Gynecologists, 2017). Sonographic examination reliably detects nodules > 5 mm, and their solid or cystic structure also is determined. According to the American Association of Clinical Endocrinologists, sonographic characteristics associated with malignancy include hypoechogenic pattern, irregular margins, and microcalcifications (Gharib, 2005). Fine-needle aspiration (FNA) is an excellent assessment method, and histological tumor markers and immunostaining are reliable to evaluate for malignancy (Hegedus, 2004). If the FNA biopsy shows a follicular lesion, surgery may be deferred until after delivery.
Evaluation of thyroid cancer involves a multidisciplinary approach (Fagin, 2016). Most thyroid carcinomas are well differentiated and pursue an indolent course. Messuti and coworkers (2014) provided evidence that persistence or recurrence of these tumors may be more common in pregnant women. When thyroid malignancy is diagnosed during the first or second trimester, thyroidectomy may be performed before the third trimester (Chap. 63, p. 1201). In women without evidence of an aggressive thyroid cancer or in those diagnosed in the third trimester, surgical treatment can be deferred to the immediate puerperium (Gharib, 2010).