• 哈爾濱醫(yī)科大學(xué)附屬第一醫(yī)院甲狀腺乳腺外科（黑龍江哈爾濱 150001）;

目的 　探討妊娠期分化型甲狀腺癌的診治進(jìn)展。
方法 　復(fù)習(xí)妊娠期分化型甲狀腺癌診治的相關(guān)文獻(xiàn)，進(jìn)行回顧性分析和總結(jié)。
結(jié)果 　妊娠期分化型甲狀腺癌禁忌行核素掃描和放射性碘治療，在妊娠中期行使手術(shù)相對安全，推遲到分娩后手術(shù)并不影響產(chǎn)婦的預(yù)后，但需在妊娠全程嚴(yán)密監(jiān)測腫瘤的生長速度。
結(jié)論 　妊娠期分化型甲狀腺癌的診治變得更復(fù)雜，其是內(nèi)分泌科、外科及婦產(chǎn)科醫(yī)生共同面臨的挑戰(zhàn)。

引用本文： 吳小虎,代文杰. 妊娠期分化型甲狀腺癌的診治進(jìn)展. 中國普外基礎(chǔ)與臨床雜志, 2013, 20(9): 1001-1005. doi: 復(fù)制

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2. Lee ML， Chen GG， Vlantis AC， et al. Induction of thyroid papillary carcinoma cell proliferation by estrogen is associated with an altered expression of Bcl-xL[J]. Cancer J， 2005， 11(2)：113-121.
3. Antico-Arciuch VG， Dima M， Liao XH， et al. Cross-talk betweenPI3K and estrogen in the mouse thyroid predisposes to the develo-pment of follicular carcinomas with a higher incidence in females[J]. Oncogene， 2010， 29(42)：5678-5686.
4. Zeng Q， Chen G， Vlantis A， et al. The contributions of oestrogenreceptor isoforms to the development of papillary and anaplastic thyroid carcinomas[J]. J Pathol， 2008， 214(4)：425-433.
5. Chen GG， Vlantis AC， Zeng Q， et al. Regulation of cell growth by estrogen signaling and potential targets in thyroid cancer[J]. Curr Cancer Drug Targets， 2008， 8(5)：367-377.
6. Vivacqua A， Bonofiglio D， Albanito L， et al. 17beta-estradiol， genistein， and 4-hydroxytamoxifen induce the proliferation of thyroid cancer cells through the g protein-coupled receptor GPR30[J]. Mol Pharmacol， 2006， 70(4)：1414-1423.
7. McTiernan AM， Weiss NS， Daling JR. Incidence of thyroid cancer in women in relation to reproductive and hormonal factors[J]. Am J Epidemiol， 1984， 120(3)：423-435.
8. Mack WJ， Preston-Martin S， Bernstein L， et al. Reproductiveand hormonal risk factors for thyroid cancer in Los Angeles Countyfemales[J]. Cancer Epidemiol Biomarkers Prev， 1999， 8(11)：991-997.
9. Pham TM， Fujino Y， Mikami H， et al. Reproductive and mens-trual factors and thyroid cancer among Japanese women：the Japa-nese Collaborative Cohort Study[J]. J Womens Health (Larchmt)，.
10. Yasmeen S， Cress R， Romano PS， et al. Thyroid cancer in pregnancy[J]. Int J Gynaecol Obstet， 2005， 91(1)：15-20.
11. Vannucchi G， Perrino M， Rossi S， et al. Clinical and molecular features of differentiated thyroid cancer diagnosed during pregnancy[J]. Eur J Endocrinol， 2010， 162(1)：145-151.
12. Pacini F， Pinchera A， Giani C， et al. Serum thyroglobulin in thyroid carcinoma and other thyroid disorders[J]. J Endocrinol Invest， 1980， 3(3)：283-292.
13. Lee RH， Spencer CA， Mestman JH， et al. Free T4 immunoassaysare ?awed during pregnancy[J]. Am J Obstet Gynecol， 2009， 200(3)：e1-e6.
14. Fiore E， Vitti P. Serum TSH and risk of papillary thyroid cancer in nodular thyroid disease[J]. J Clin Endocrinol Metab， 2012， 97(4)：1134-1145.
15. Moon WJ， Jung SL， Lee JH， et al. Benign and malignant thyroid nodules：US differentiation—multicenter retrospective study[J]. Radiology， 2008， 247(3)：762-770.
16. Carmeci C， Jeffrey RB， McDougall IR， et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid masses[J]. Thyroid， 1998， 8(4)：283-289.
17. Can AS， Peker K. Comparison of palpation versus ultrasound-guided fine-needle aspiration biopsies in the evaluation of thyroid nodules[J]. BMC Res Notes， 2008， 1：12.
18. 中華醫(yī)學(xué)會內(nèi)分泌學(xué)分會， 中華醫(yī)學(xué)會外科學(xué)分會， 中國抗癌協(xié)會頭頸腫瘤專業(yè)委員會， 等. 甲狀腺結(jié)節(jié)和分化型甲狀腺癌診治指南[J]. 中國腫瘤臨床， 2012， 39(17)：1249-1272.
19. Nikiforov YE， Steward DL， Robinson-Smith TM， et al. Moleculartesting for mutations in improving the fine-needle aspiration diag-nosis of thyroid nodules[J]. J Clin Endocrinol Metab， 2009， 94 (6)：2092-2098.
20. Lee ST， Kim SW， Ki CS， et al. Clinical implication of highly sensitive detection of the BRAF V600E mutation in fine-needle aspirations of thyroid nodules：a comparative analysis of three molecular assays in 4 585 consecutive cases in a BRAF V600E mutation-prevalent area[J]. J Clin Endocrinol Metab， 2012， 97(7)：2299-2306.
21. Kuy S， Roman SA， Desai R， et al. Outcomes following thyroid and parathyroid surgery in pregnant women[J]. Arch Surg， 2009， 144(5)：399-406.
22. Nam KH， Yoon JH， Chang HS， et al. Optimal timing of surgery in well-differentiated thyroid carcinoma detected during pregnancy[J]. J Surg Oncol， 2005， 91(3)：199-203.
23. Chong KM， Tsai YL， Chuang J， et al. Thyroid cancer in pregnancy：a report of 3 cases[J]. J Reprod Med， 2007， 52(5)：416-418.
24. Driggers RW， Kopelman IN， Satin AJ. Delaying surgery for thyroid cancer in pregnancy. A case report[J]. J Reprod Med， 1998， 43(10)：909-912.
25. 中華醫(yī)學(xué)會內(nèi)分泌分會， 中華醫(yī)學(xué)會圍產(chǎn)醫(yī)學(xué)分會. 妊娠和產(chǎn)后甲狀腺疾病診治指南[J]. 中華內(nèi)分泌代謝雜志， 2012， 28(5)：354-371.
26. Stagnaro-Green A， Abalovich M， Alexander E， et al. Guidlines of the American Thyroid Association for the diagnosis and manag-ement of thyroid disease during pregnancy and postpartum[J]. Thyroid， 2011， 21(10)：1081-1125.
27. Haddow JE， Palomaki GE， Allan WC， et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychologicaldevelopment of the child[J]. N Engl J Med， 1999， 341(8)：549-555.
28. Benhadi N， Wiersinga WM， Reitsma JB， et al. Higher maternalTSH levels in pregnancy are associated with increased risk for miscarriage， fetal or neonatal death[J]. Eur J Endocrinol， 2009， 160(6)：985-991.
29. Sawka AM， Lakra DC， Lea J， et al. A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors[J]. Clin Endocrinol (Oxf)， 2008， 69(3)：479-490.
30. Schlumberger M， De Vathaire F， Ceccarelli C， et al. Exposure to radioactive iodine-131 for scintigraphy or therapy does not preclude pregnancy in thyroid cancer patients[J]. J Nucl Med， 1996， 37(4)：606-612.
31. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer；Cooper DS，Doherty GM， et al. Revised American Thyroid Association mana-gement guidelines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid， 2009， 19(11)：1167-1214.
32. Silberstein EB， Alavi A， Balon HR， et al. The SNMMI practice guideline for therapy of thyroid disease with 131I 3.0[J]. J Nucl Med， 2012， 53(10)：1633-1651.
33. De Groot L， Abalovich M， Alexander EK， et al. Management of thyroid dysfunction during pregnancy and postpartum：an Endo-crine Society clinical practice guideline[J]. J Clin Endocrinol Metab， 2012， 97(8)：2543-2565.
34. National Institute of Clinical Excellence. Improving outcomes in head and neck cancer[EB/OL]. 2004. http：//www. nice. org. uk.
35. Imran SA， Rajaraman M. Management of differentiated thyroid cancer in pregnancy[J]. J Thyroid Res， 2011， 2011：549609.
36. ， 18(3)：331-335.
  1. 1. Mazzaferri EL. Approach to the pregnant patient with thyroid cancer[J]. J Clin Endocrinol Metab， 2011， 96(2)：265-272.
  2. 2. Lee ML， Chen GG， Vlantis AC， et al. Induction of thyroid papillary carcinoma cell proliferation by estrogen is associated with an altered expression of Bcl-xL[J]. Cancer J， 2005， 11(2)：113-121.
  3. 3. Antico-Arciuch VG， Dima M， Liao XH， et al. Cross-talk betweenPI3K and estrogen in the mouse thyroid predisposes to the develo-pment of follicular carcinomas with a higher incidence in females[J]. Oncogene， 2010， 29(42)：5678-5686.
  4. 4. Zeng Q， Chen G， Vlantis A， et al. The contributions of oestrogenreceptor isoforms to the development of papillary and anaplastic thyroid carcinomas[J]. J Pathol， 2008， 214(4)：425-433.
  5. 5. Chen GG， Vlantis AC， Zeng Q， et al. Regulation of cell growth by estrogen signaling and potential targets in thyroid cancer[J]. Curr Cancer Drug Targets， 2008， 8(5)：367-377.
  6. 6. Vivacqua A， Bonofiglio D， Albanito L， et al. 17beta-estradiol， genistein， and 4-hydroxytamoxifen induce the proliferation of thyroid cancer cells through the g protein-coupled receptor GPR30[J]. Mol Pharmacol， 2006， 70(4)：1414-1423.
  7. 7. McTiernan AM， Weiss NS， Daling JR. Incidence of thyroid cancer in women in relation to reproductive and hormonal factors[J]. Am J Epidemiol， 1984， 120(3)：423-435.
  8. 8. Mack WJ， Preston-Martin S， Bernstein L， et al. Reproductiveand hormonal risk factors for thyroid cancer in Los Angeles Countyfemales[J]. Cancer Epidemiol Biomarkers Prev， 1999， 8(11)：991-997.
  9. 9. Pham TM， Fujino Y， Mikami H， et al. Reproductive and mens-trual factors and thyroid cancer among Japanese women：the Japa-nese Collaborative Cohort Study[J]. J Womens Health (Larchmt)，.
  10. 10. Yasmeen S， Cress R， Romano PS， et al. Thyroid cancer in pregnancy[J]. Int J Gynaecol Obstet， 2005， 91(1)：15-20.
  11. 11. Vannucchi G， Perrino M， Rossi S， et al. Clinical and molecular features of differentiated thyroid cancer diagnosed during pregnancy[J]. Eur J Endocrinol， 2010， 162(1)：145-151.
  12. 12. Pacini F， Pinchera A， Giani C， et al. Serum thyroglobulin in thyroid carcinoma and other thyroid disorders[J]. J Endocrinol Invest， 1980， 3(3)：283-292.
  13. 13. Lee RH， Spencer CA， Mestman JH， et al. Free T4 immunoassaysare ?awed during pregnancy[J]. Am J Obstet Gynecol， 2009， 200(3)：e1-e6.
  14. 14. Fiore E， Vitti P. Serum TSH and risk of papillary thyroid cancer in nodular thyroid disease[J]. J Clin Endocrinol Metab， 2012， 97(4)：1134-1145.
  15. 15. Moon WJ， Jung SL， Lee JH， et al. Benign and malignant thyroid nodules：US differentiation—multicenter retrospective study[J]. Radiology， 2008， 247(3)：762-770.
  16. 16. Carmeci C， Jeffrey RB， McDougall IR， et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid masses[J]. Thyroid， 1998， 8(4)：283-289.
  17. 17. Can AS， Peker K. Comparison of palpation versus ultrasound-guided fine-needle aspiration biopsies in the evaluation of thyroid nodules[J]. BMC Res Notes， 2008， 1：12.
  18. 18. 中華醫(yī)學(xué)會內(nèi)分泌學(xué)分會， 中華醫(yī)學(xué)會外科學(xué)分會， 中國抗癌協(xié)會頭頸腫瘤專業(yè)委員會， 等. 甲狀腺結(jié)節(jié)和分化型甲狀腺癌診治指南[J]. 中國腫瘤臨床， 2012， 39(17)：1249-1272.
  19. 19. Nikiforov YE， Steward DL， Robinson-Smith TM， et al. Moleculartesting for mutations in improving the fine-needle aspiration diag-nosis of thyroid nodules[J]. J Clin Endocrinol Metab， 2009， 94 (6)：2092-2098.
  20. 20. Lee ST， Kim SW， Ki CS， et al. Clinical implication of highly sensitive detection of the BRAF V600E mutation in fine-needle aspirations of thyroid nodules：a comparative analysis of three molecular assays in 4 585 consecutive cases in a BRAF V600E mutation-prevalent area[J]. J Clin Endocrinol Metab， 2012， 97(7)：2299-2306.
  21. 21. Kuy S， Roman SA， Desai R， et al. Outcomes following thyroid and parathyroid surgery in pregnant women[J]. Arch Surg， 2009， 144(5)：399-406.
  22. 22. Nam KH， Yoon JH， Chang HS， et al. Optimal timing of surgery in well-differentiated thyroid carcinoma detected during pregnancy[J]. J Surg Oncol， 2005， 91(3)：199-203.
  23. 23. Chong KM， Tsai YL， Chuang J， et al. Thyroid cancer in pregnancy：a report of 3 cases[J]. J Reprod Med， 2007， 52(5)：416-418.
  24. 24. Driggers RW， Kopelman IN， Satin AJ. Delaying surgery for thyroid cancer in pregnancy. A case report[J]. J Reprod Med， 1998， 43(10)：909-912.
  25. 25. 中華醫(yī)學(xué)會內(nèi)分泌分會， 中華醫(yī)學(xué)會圍產(chǎn)醫(yī)學(xué)分會. 妊娠和產(chǎn)后甲狀腺疾病診治指南[J]. 中華內(nèi)分泌代謝雜志， 2012， 28(5)：354-371.
  26. 26. Stagnaro-Green A， Abalovich M， Alexander E， et al. Guidlines of the American Thyroid Association for the diagnosis and manag-ement of thyroid disease during pregnancy and postpartum[J]. Thyroid， 2011， 21(10)：1081-1125.
  27. 27. Haddow JE， Palomaki GE， Allan WC， et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychologicaldevelopment of the child[J]. N Engl J Med， 1999， 341(8)：549-555.
  28. 28. Benhadi N， Wiersinga WM， Reitsma JB， et al. Higher maternalTSH levels in pregnancy are associated with increased risk for miscarriage， fetal or neonatal death[J]. Eur J Endocrinol， 2009， 160(6)：985-991.
  29. 29. Sawka AM， Lakra DC， Lea J， et al. A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors[J]. Clin Endocrinol (Oxf)， 2008， 69(3)：479-490.
  30. 30. Schlumberger M， De Vathaire F， Ceccarelli C， et al. Exposure to radioactive iodine-131 for scintigraphy or therapy does not preclude pregnancy in thyroid cancer patients[J]. J Nucl Med， 1996， 37(4)：606-612.
  31. 31. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer；Cooper DS，Doherty GM， et al. Revised American Thyroid Association mana-gement guidelines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid， 2009， 19(11)：1167-1214.
  32. 32. Silberstein EB， Alavi A， Balon HR， et al. The SNMMI practice guideline for therapy of thyroid disease with 131I 3.0[J]. J Nucl Med， 2012， 53(10)：1633-1651.
  33. 33. De Groot L， Abalovich M， Alexander EK， et al. Management of thyroid dysfunction during pregnancy and postpartum：an Endo-crine Society clinical practice guideline[J]. J Clin Endocrinol Metab， 2012， 97(8)：2543-2565.
  34. 34. National Institute of Clinical Excellence. Improving outcomes in head and neck cancer[EB/OL]. 2004. http：//www. nice. org. uk.
  35. 35. Imran SA， Rajaraman M. Management of differentiated thyroid cancer in pregnancy[J]. J Thyroid Res， 2011， 2011：549609.
  36. 36. ， 18(3)：331-335.

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