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Thyroid5 min read

A thyroid nodule during pregnancy: what can be checked now and what waits until after delivery.

Finding a thyroid nodule while pregnant brings together two concerns that are frightening on their own. What is reassuring is that the guidelines have a clear answer for almost every situation: what is done exactly as it would be outside pregnancy, what waits until after delivery and what should be avoided until then.

Dr. Joan JacoboSurgical oncologist, thyroid specialist
A pregnant woman seen from behind, sitting by a bright window with a plant on the sill, one hand resting near her neck.
In short
  • Ultrasound, blood tests and, if needed, a biopsy are performed just as they would be outside pregnancy, in any trimester.
  • The scintigraphy scan and any treatment with radioactive iodine wait until after delivery, and radiofrequency ablation waits too.
  • If a nodule turns out to be papillary cancer, surgery can almost always wait until after delivery, and if it must be done earlier, it is done in the second trimester.

A nodule found during pregnancy is usually found the same way as any other: as an incidental finding on an ultrasound ordered for another reason, or because the obstetrician felt a nodule during the examination. The question every patient asks, whether the pregnancy made it grow or will make it grow, matters less than you might think. What matters is what kind of nodule it is, and that can be found out without waiting.

What is done just as outside pregnancy

Evaluating a nodule in a pregnant woman follows the same path as in anyone else: history, examination, The pituitary hormone that tells the thyroid to produce. In pregnancy its normal values change by trimester. and ultrasound. And if the ultrasound shows that a biopsy is needed, the biopsy is performed: an ultrasound-guided fine-needle aspiration, with no radiation and no effect on the pregnancy. There is no need to wait for delivery to know what it is.

What waits until after delivery

  • The thyroid An image showing which parts of the thyroid take up iodine. It uses a radioactive tracer, which is why it is not done in pregnancy. scan, because it uses a radioactive tracer. If the TSH comes back low and a nodule producing hormone on its own is suspected, it is managed with blood tests and confirmed afterwards.
  • Treatment with radioactive iodine, in any dose and for any reason. It is contraindicated in pregnancy and while breastfeeding.
  • Radiofrequency ablation: the usual electrode is contraindicated in pregnancy, and a benign nodule can wait a few months without anything changing.

If it turns out to be cancer

It is the situation that frightens most and the one with the most reassuring answer. The most common type of thyroid cancer, slow-growing and with a very good prognosis in the vast majority of cases. thyroid cancer, by far the most common type, grows slowly, and in most cases the American guideline allows monitoring it with ultrasound during pregnancy and operating after delivery, without affecting the prognosis. Surgery comes earlier only if the nodule clearly grows in the first half of pregnancy or if cancer appears in the lymph nodes. And if surgery is needed, it is performed in the second trimester, which is the safest time for mother and baby.

  1. 01First trimesterThe nodule is evaluated with ultrasound, a TSH test and, if indicated, a biopsy. If it is benign, nothing else is needed during the pregnancy.
  2. 02Second trimesterIf the nodule is malignant and there is a reason not to wait, this is when surgery is performed. If not, a follow-up ultrasound is done.
  3. 03Third trimesterSurgery is avoided except in an emergency. Monitoring continues, and the plan for after delivery is prepared.
  4. 04After deliveryEverything that was postponed resumes: the scan if it was needed, surgery if it was indicated, or ablation of a benign nodule that causes symptoms.

If you already take levothyroxine

You keep taking it, and a higher dose is usually needed: pregnancy increases the need for thyroid hormone from the first weeks. It is one of the first things to review when the pregnancy is confirmed, with your endocrinologist or obstetrician, and it has nothing to do with the nodule. A nodule does not require taking hormone, and taking hormone does not treat the nodule.

Sources
  1. Alexander EK 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(3): 315-389.
  2. Haugen BR et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016, 26(1): 1-133.
  3. Kim JH et al. 2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology. Korean J Radiol. 2018, 19(4): 632-655.
Questions

What people usually ask about this.

  • No. It is a fine-needle biopsy of the neck, guided by ultrasound, with no radiation and no general anesthesia. It has no effect on the pregnancy.

  • Some nodules change size during pregnancy and others do not. What decides the next step is not that change but how the nodule looks on ultrasound and, if needed, the biopsy result. It is monitored, and measured again after delivery.

  • It is best to decide before trying to conceive, because during pregnancy both ablation and radioiodine have to wait. We review the nodule and your biopsy results and decide calmly whether to treat it now or later.

  • Yes. Surgery does not prevent breastfeeding. What cannot be done while breastfeeding is treatment with radioactive iodine, and that is planned for later.

More to read

Other articles that help you decide.

If you wish, we can go over your test results at your consultation.

You can be seen in person in Santiago, Santo Domingo or San Francisco de Macorís, or by video call from anywhere. If you have not had any tests yet, the consultation starts with them.

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