Do thyroid nodules affect pregnancy?

Written by Hu Jian Zhuo
Nephrology and Endocrinology
Updated on September 21, 2024
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This decision should be based on the nature of the thyroid nodules. If the thyroid nodule is benign, pregnancy generally will not be affected, and it is possible to conceive. However, if the patient has malignant thyroid nodules, I would advise against rushing into pregnancy. Firstly, prioritize treating the malignant thyroid nodules promptly. If you become pregnant during this time, the risks associated with surgery and medications for both the pregnant mother and the fetus are very high. Nevertheless, after receiving timely and standardized treatment and once the patient's condition has stabilized, it is possible to conceive. However, it should be noted that surgery may lead to reduced thyroid function. In the first 12 weeks of pregnancy, the fetus relies on the mother for thyroid hormone supply. If the mother's thyroid hormone levels are too low, it can lead to delayed fetal development, and even abnormal brain development, resulting in a baby born with intellectual disabilities. Therefore, women with a history of thyroid disease should develop a treatment plan under the joint collaboration of an endocrinologist and an obstetrician-gynecologist.

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Written by Hu Jian Zhuo
Nephrology and Endocrinology
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Probability of thyroid nodules becoming cancerous

The malignant manifestation of thyroid nodules is thyroid cancer. Thus, thyroid nodules are divided into two major categories: benign and malignant. Benign nodules generally make up the vast majority, with malignancies accounting for less than 5%. Malignant thyroid nodules are cancerous. Some benign thyroid nodules may also become malignant over time. Generally, small nodules do not show obvious clinical symptoms during the cancerous transformation, but their nature changes. When a nodule compresses surrounding tissues and causes certain symptoms, such as hoarseness, tracheal compression, and difficulty swallowing, it often indicates that the tumor is in the middle or late stage. Overall, the chances of benign nodules becoming cancerous are very small. The malignancy rate of benign nodular goiter is about 5%, and the possibility of adenomas turning malignant is around 10%. As the diameter increases, the possibility of adenomas becoming malignant gradually increases. There are several high-risk factors for the malignant transformation of thyroid nodules: for instance, having a history of radiation exposure to the head and neck area during childhood or adolescence, patients who are younger than 14 or older than 70; the rate of malignant transformation of thyroid nodules significantly increases; and the rate of malignant transformation in male nodules is significantly higher than in females. Also, patients whose nodules significantly increase in size in a short period during regular check-ups are also considered high-risk for malignancy.

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Written by Hu Jian Zhuo
Nephrology and Endocrinology
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Do thyroid nodules require surgery?

Whether thyroid nodules require treatment generally depends on medical guidelines. Thyroid nodules larger than 1cm with malignant features typically require biopsy. The decision for a biopsy should be made by a professional ultrasonographer after examination. Therefore, upon detecting a nodule, it is crucial to visit a specialized hospital for further ultrasound examination. If the nodule is malignant, we recommend surgical removal. If it is benign, close observation is advisable. However, treatment is necessary under the following conditions: First, if the nodule is too large and compresses other organs, causing breathing difficulties, localized swelling, pain, or other discomforts. Second, if the nodule grows quickly, increasing in volume by more than 50% within six months, the possibility of malignancy should be considered and treatment is needed. Third, if the thyroid nodule is located behind the sternum, which is called an ectopic thyroid nodule, surgical treatment is necessary. If the thyroid nodule is large enough to affect the aesthetics of the neck, surgical treatment may also be considered.

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Written by Zhang Jun Jun
Endocrinology
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"Malignant thyroid nodules" means what?

Thyroid nodules are assessed under ultrasound with a grading system, and if rated at level three or higher, they tend to be more likely to be malignant. The most common malignancy in thyroid nodules is thyroid cancer. Among all types of tumors, thyroid cancer tends to grow slowly and is relatively less malignant. Therefore, if an ultrasound suggests a high likelihood of malignancy in a thyroid nodule, further examinations should be conducted. This can include a fine needle aspiration biopsy, thyroid contrast-enhanced ultrasound, or even direct surgical removal of the malignant nodule for further pathological examination to determine whether it is benign or malignant. Since the degree of malignancy of thyroid nodules is relatively low compared to other malignant tumors, a high grading score on a thyroid nodule should not be overly worrying. It is advisable to proceed with formal medical checks and regular follow-ups, as the five-year survival rate is quite high, exceeding 80%.

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Written by Chen Xie
Endocrinology
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The difference between thyroid enlargement and thyroid nodules

Thyroid enlargement generally refers to simple thyroid enlargement, which is typically diffuse thyroid enlargement, mainly caused by iodine deficiency, commonly seen in endemic goiter and physiological thyroid enlargement. Thyroid nodules, on the other hand, are nodular hyperplasia of the thyroid caused by certain physical and chemical factors. Thyroid nodules can manifest as benign hyperplasia or malignant hyperplasia. Therefore, the risks associated with thyroid nodules are relatively greater than those of thyroid enlargement. However, some patients with thyroid enlargement, as the disease progresses, can develop nodular hyperplasia of the thyroid. These are the differences between the two.

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Written by Hu Jian Zhuo
Nephrology and Endocrinology
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Should thyroid nodules be punctured?

Thyroid fine needle aspiration is a reliable and highly valuable diagnostic method we use to distinguish between benign and malignant thyroid nodules. Generally, thyroid nodules with a diameter >1 cm are considered for fine needle aspiration. Fine needle aspiration is not routinely considered in the following situations: (1) The nodule has already been evaluated with a nuclear scan indicating a hyperfunctioning adenoma due to hyperthyroidism; (2) The nodule is purely cystic; (3) The nodule is highly suspected to be highly malignant. In cases where the nodules grow rapidly and significantly enlarge, causing compression of the surrounding trachea and symptoms such as breathing difficulties and hoarseness, these thyroid nodules requiring surgery do not necessitate further fine needle aspiration treatment.