Endocrine Abstracts

Objectives: Thyroid cancer is the common occurring cancer in women of reproductive age. The impact of thyroidectomy on childbearing plans remains unknown. The aim of this study is to longitudinally compare the reproductive concern and intention between young female patients with differentiated thyroid cancer (DTC) and those with thyroid benign disease after thyroidectomy.

Methods: This prospective cohort study enrolled female patients with DTC or thyroid benign disease undergoing thyroidectomy between 18 and 40 years old from Oct, 2019 to Oct, 2021 (registration number: ChiCTR1900027205). Reproductive Concerns After Cancer scale (RCAC) and Fertility Intention Scale (FIS) were evaluated preoperatively and postoperatively at 1, 3, 6, 12, 18, and 24 months, respectively. Pregnancy outcomes after thyroidectomy were also collected.

Results: Of the 482 eligible patients, 402 were diagnosed with DTC (157 underwent total thyroidectomy [TT] and 245 underwent thyroid lobectomy [TL]), and 80 were diagnosed with thyroid benign disease. Compared with the benign group, DTC group had significantly higher RCAC scores from 3 to 24 months postoperatively (60.1±6.5 vs. 58.1±4.7, 65.4±5.3 vs. 61.4±8.6, 66.5±6.4 vs. 57.4±6.3, 52.6±8.9 vs. 50.1±6.0, and 53.0±7.5 vs. 50.8±4.5, respectively). DTC group had lower FIS scores than those with thyroid benign disease at 3, 6, and 12 months postoperatively (46.9±8.9 vs. 49.3±7.0, 44.1±9.2 vs. 49.0±6.9, and 40.8±6.1 vs. 50.7±5.3, respectively). However, there was no significant difference of FIS scores at 18 and 24 months postoperatively. Among the DTC patients, TT subgroup experienced more reproductive concern and lower fertility intention than LT subgroup from 1 to 18 months postoperatively. However, at 24 months postoperatively, TT subgroup still had significantly higher RCAC scores than LT subgroup, but there was no difference in FIS scores. During follow-up, 79 women became pregnant (59 in DTC group [14.7%] and 20 in thyroid benign disease [25.0%]). The median time from surgery to pregnancy was 12.0 months for DTC and 13.5 months for thyroid benign disease. Seven women (3 in DTC group [5.1%] and 4 in thyroid benign disease [20.0%]) suffered miscarriage in the first trimester, and all of them conceived between 2 and 9 months after thyroidectomy.

Conclusions: It is necessary to take into account the reproductive concern and intention of female patients under child-bearing period after thyroidectomy, especially for those had DTC and underwent TT. Fertility counseling guidance should be provided for all patients after thyroidectomy with fertility intention, regardless of with DTC or thyroid benign disease.