Cáncer diferenciado de tiroides y gestación

Manuel DELGADO-GÓMEZ, Maria Sonsoles HOZ-GUERRA, Alexis Rodrigo ALAN-PEINADO, Álvaro VALVERDE-MÁRQUEZ, Ximena Carolina VIVAS-VACA

Resumen


Introducción y objetivo: el presente trabajo de revisión pretende valorar la influencia mutua que puedan tener la gestación sobre la progresión del carcinoma diferenciado de tiroides, así como la influencia que el carcinoma diferenciado de tiroides pueda tener sobre la gestación. Síntesis: El cáncer de tiroides aparece con frecuencia en mujeres en edad reproductiva y durante el embarazo. Dado que la presentación más común es en forma de nódulo tiroideo, el manejo adecuado de esta patología constituye una prioridad durante la gestación. La ecografía tiroidea y la PAAF guiada por ecografía son herramientas fundamentales tanto para el correcto diagnóstico como para el seguimiento de los nódulos tiroideos. Además, el carcinoma diferenciado de tiroides puede presentarse durante el embarazo en al menos tres escenarios diferentes (recién diagnosticado, microcarcinoma papilar de tiroides bajo vigilancia activa y carcinoma diferenciado de tiroides tratado previamente antes del embarazo) que deben abordarse de distintas maneras. Por lo general, el embarazo no presenta ningún riesgo adicional para el pronóstico de los carcinomas diferenciados de tiroides. Además, el carcinoma diferenciado de tiroides no parece tener una influencia negativa en la progresión del embarazo ni para la madre ni para el feto. El tratamiento de elección de los carcinomas de nueva aparición es la cirugía, que debe posponerse hasta después del parto siempre que sea posible o realizarse en el segundo trimestre en los casos más agresivos. Los microcarcinomas papilares no parecen estar significativamente influenciados por el embarazo y no requieren un seguimiento especial durante la gestación. Para los carcinomas tratados previamente, el embarazo tampoco empeora el pronóstico en la mayoría de los casos. Solo aquellos clasificados como de respuesta estructural incompleta requieren especial atención en su seguimiento. El tratamiento con las dosis correctas de levotiroxina para conseguir los niveles de TSH más adecuados a la situación de riesgo, constituye otro de los pilares fundamentales en el manejo del carcinoma diferenciado de tiroides. Finalmente, el tratamiento con I-131, si fuera necesario, está formalmente contraindicado durante el embarazo y la lactancia.

Palabras clave


Carcinoma diferenciado de tiroides; gestación; nódulo tiroideo; microcarcinoma papilar de tiroides; cirugía tiroidea;

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DOI: http://dx.doi.org/10.14201/orl.23818

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