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Clinical and molecular features of differentiated thyroid cancer diagnosed during pregnancy

Endocrine Unit, Department of Medical Sciences, University of Milan, Fondazione Policlinico IRCCS, Pad Granelli, Via F Sforza, 35, 20122 Milan, Italy
¹ Pathology Unit, Department of Medicine, Surgery and Dentistry, University of Milan, Ospedale S Paolo and Fondazione Policlinico IRCCS, 20122 Milan, Italy
² Endocrine Surgery Unit, Fondazione Policlinico IRCCS, Milan, Italy
³ Division of Internal Medicine, Ospedale di Fidenza, 43036 Fidenza, Italy

(Correspondence should be addressed to L Fugazzola; Email: l.fugazzola{at}policlinico.mi.it)

(G Vannucchi and M Perrino contributed equally to this work)

Objective: Pregnancy represents a favorable condition for the development of thyroid nodules, likely due to the secretion of hormones with stimulatory activity. In particular, differentiated thyroid cancer (DTC) represents the second most frequent tumor among those diagnosed during pregnancy. However, few and discordant data are available about the impact of pregnancy on tumor outcome.

Methods: A total of 123 women with DTC were divided into three groups according to the timing of tumor diagnosis (group 1, at least 1 year after the delivery; group 2, during pregnancy or in the first year after delivery; and group 3, before pregnancy or nulliparity) and evaluated according to the international guidelines. Furthermore, immunohistochemical studies of estrogen receptor (ER) were performed in 38 papillary thyroid cancer tissues from the three groups.

Results: Thyroid cancer diagnosed during pregnancy was associated with a poorer prognosis compared to tumors developed in nongravidic periods (P<0.0001). Accordingly, at the stepwise logistic regression analysis, the diagnosis of DTC during pregnancy or in the first year post partum was the most significant indicator of persistent disease (P=0.001). Interestingly, ER expression significantly differed among tumors of the three groups, being detected in 31% of group 1, in 87.5% of group 2, and in 0% of group 3 (P=0.01).

Conclusions: Present data indicate that pregnancy has a negative impact on the outcome of thyroid cancer. The presence of ER in the majority of tumors diagnosed during pregnancy indicates that the poorer outcome of these cases could be related to the estrogen-mediated growth stimulus.