The principles of differentiated thyroid cancer surgery and anesthesia in pregnancy: three case reports

Abstract

Development of thyroid nodule during pregnancy is rare, however the cancer rate of this nodule is high. Herein, we present medical outcomes of three pregnant women who were operated with the diagnosis of differentiated thyroid carcinoma in the light of literature. As sonographic findings of three cases showed malignant characteristics, fine needle aspiration biopsy FNAB was performed. Cytological examination result was reported as papillary thyroid carcinoma PTC . Surgery was performed in the second trimester in all cases. One case underwent total thyroidectomy with neck dissection at level III and VI and two cases underwent total thyroidectomy with neck dissection at level VI. Pathological examination result was also reported as PTC. Lymph node metastases in the dissected materials were detected. During the intraoperative and early postoperative period, no complications occurred and no findings of recurrence or residues were observed during one-year follow-up following surgery. In conclusion, as the first trimester has an increased risk of congenital malformations, elective surgery should be performed at the second trimester, if applicable. In pregnants with malignant sonographic features and PTC confirmed by FNAB, surgery can be applied safely by taking precautions during pre-/peri- and postoperative period. These patients should not be given premedication for anesthesia, should be properly positioned and teratogenic agents should be avoided. After surgery, mother and fetus should be monitored closely.

Keywords

• Differentiated thyroid cancer, pregnancy, thyroid surgery

Gebelikte diferansiye tiroid kanseri cerrahisi ve anestezi ilkeleri: Üç olgu sunumu

Abstract

Gebelikte tiroid nodülü gelişmesi nadirdir ancak bu nodülün kanser olma oranı yüksektir. Bu yazıda, diferansiye tiroid karsinomu tanısıyla ameliyat edilen üç gebe kadının tıbbi sonuçları literatür eşliğinde sunuldu. Üç olgunun ultrason bulguları malign özellikler içermesi nedeniyle, ince iğne aspirasyon biyopsisi İİAB yapıldı. Sitolojik inceleme sonucu papiller tiroid karsinom PTK olarak bildirildi. Tüm olgularda cerrahi ikinci trimesterde gerçekleştirildi. Bir olgumuza total tiroidektomi ile birlikte seviye III ve seviye VI boyun diseksiyonu ve iki olguya total tiroidektomi ile seviye VI boyun diseksiyonu uygulandı. Patolojik inceleme sonucu da, PTK olarak bildirildi. Diseksiyon materyallerinde lenf nodu metastazı saptandı. Ameliyat sırası ve ameliyat sonrası erken dönemde komplikasyon gelişmedi ve ameliyat sonrası bir yıllık takip sırasında nüks veya rezidü bulgusuna rastlanmadı. Sonuç olarak, ilk trimesterde doğuştan malformasyonların riski yüksek olduğu için, yapılacak ameliyat elektif ise, ikinci trimesterde gerçekleştirilmelidir. Sonografide malign özellikler içeren ve PTK’nin İİAB ile doğrulandığı gebelere ameliyat öncesi, sırası ve sonrasında gerekli önlemler alınarak güvenle cerrahi uygulanabilir. Bu hastaların anestezisinde premedikasyon yapılmamalı, hastalara uygun pozisyon verilmeli ve teratojenik ajanlar kullanılmamalıdır. Ameliyat sonrasında anne ve fetüs yakından takip edilmelidir

Keywords

• Diferansiye tiroid kanseri, gebelik, tiroid cerrahisi

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