Reproductive Concern, Fertility Intention, and Pregnancy Outcomes in Young Women with Thyroid Cancer after Thyroid Surgery: A Prospective Cohort Study.

Abstract

Background: Factors contributing to the development of reproductive concern, fertility intention and pregnancy outcomes in young women following thyroidectomy are unclear. This study aimed to compare the reproductive concern, fertility intentions and pregnancy outcomes between young women who had either thyroid cancer (TC) or benign thyroid disease and were treated with total thyroidectomy (TT) or thyroid lobectomy (TL). Methods: This prospective cohort study enrolled women aged 20-40 and scheduled for thyroid surgery at a tertiary hospital in China from November 2019 to October 2021 (ChiCTR1900027205). Reproductive concern and intention were evaluated preoperatively and at 1, 3, 6, 12, 18, and 24 months postoperatively using Reproductive Concerns After Cancer (RCAC) and Fertility Intention Scale (FIS), respectively. Pregnancy outcomes were monitored. Results: Of the 482 eligible women, 402 women had TC (157 [39.1%] underwent TT), and 80 had benign thyroid disease (10 [12.5%] underwent TT). Compared with the benign group, the TC group had significantly higher RCAC scores from 3 months to 2 years postoperatively (all p < 0.05). The TC group had significantly lower postoperative FIS scores from 3 to 12 months after surgery than the benign group (all p < 0.05). Women with TC in the TT group had significantly higher RCAC scores than TL group at time points from 1 months to 2 years postoperatively, and had significantly lower postoperative FIS scores from 1 to 18 months after surgery (all p < 0.05). During the 2-year follow-up, 78 women became pregnant and 13 (16.7%) suffered pregnancy loss. No significant differences in adverse pregnancy outcomes were found between the TC group and benign thyroid disease group, or those between the TT group and the TL group of women with TC. Women with planned pregnancy and preconception counseling had significantly lower rates of pregnancy loss than those with unplanned pregnancy and no preconception counseling (4.0% vs. 22.6% and 11.7% vs. 33.3%, both p < 0.05). Conclusions: It is important to address reproductive concern and fertility intention postoperatively in young women with TC. Preconception counseling and planned pregnancy may be associated with a reduced risk of pregnancy loss after thyroid surgery.