Outcomes Following Thyroid and Parathyroid Surgery in Pregnant Women
Abstract
OBJECTIVES: To perform the first population-based measurement of clinical and economic outcomes after thyroid and parathyroid surgery in pregnant women and identify the characteristics of this population and the predictors of outcome. DESIGN: Retrospective cross-sectional study. SETTING: Health Care Utilization Project Nationwide Inpatient Sample (HCUP-NIS), a 20% sample of nonfederal US hospitals. PATIENTS: All pregnant women, compared with age-matched nonpregnant women, who underwent thyroid and parathyroid procedures from 1999 to 2005. MAIN OUTCOME MEASURES: Fetal, maternal, and surgical complications, in-hospital mortality, median length of stay, and hospital costs. RESULTS: A total of 201 pregnant women underwent thyroid (n = 165) and parathyroid (n = 36) procedures and were examined together. The mean age was 29 years, 60% were white, 25% were emergent or urgent admissions, and 46% had thyroid cancer. Compared with nonpregnant women (n = 31 155), pregnant patients had a higher rate of endocrine (15.9 vs 8.1%; P < .001) and general complications (11.4 vs 3.6%; P < .001), longer unadjusted lengths of stay (2 days vs 1 day; P < .001), and higher unadjusted hospital costs ($6873 vs $5963; P = .007). The fetal and maternal complication rates were 5.5% and 4.5%, respectively. On multivariate regression analysis, pregnancy was an independent predictor of higher combined surgical complications (odds ratio, 2; P < .001), longer adjusted length of stay (0.3 days longer; P < .001), and higher adjusted hospital costs ($300; P < .001). Other independent predictors of outcome were surgeon volume, patient race or ethnicity, and insurance status. CONCLUSIONS: Pregnant women have worse clinical and economic outcomes following thyroid and parathyroid surgery than nonpregnant women, with disparities in outcomes based on race, insurance, and access to high-volume surgeons.
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Thyroidectomy in the second trimester of pregnancy carries a 4.5%-5.5% risk of preterm labor.
“Optimally, thyroidectomy is performed in the second trimester; however, although it is the safest time, it is not without risk (4.5%-5.5% risk of preterm labor) (67,68).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [68]
Thyroidectomy in the first and third trimesters of pregnancy is associated with teratogenic effects from anesthetic agents, increased risk of fetal loss in the first trimester, and increased risk of preterm labor in the third trimester.
“Thyroidectomy is best avoided in the first and third trimesters of pregnancy because of teratogenic effects associated with anesthetic agents and increased risk of fetal loss in the first trimester and increased risk of preterm labor in the third.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [68]
Thyroid surgery in pregnancy is associated with a higher rate of complications, including hypoparathyroidism and recurrent laryngeal nerve injury.
“Thyroid surgery in pregnancy is also associated with a higher rate of complications, including hypoparathyroidism and recurrent laryngeal nerve (RLN) injury (68).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [68]
Thyroidectomy in the first trimester of pregnancy is associated with increased risk of fetal loss.
“Thyroidectomy is best avoided in the first and third trimesters of pregnancy because of teratogenic effects associated with anesthetic agents and increased risk of fetal loss in the first trimester and increased risk of preterm labor in the third.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [68]
Anesthetic agents have teratogenic effects.
“Thyroidectomy is best avoided in the first and third trimesters of pregnancy because of teratogenic effects associated with anesthetic agents and increased risk of fetal loss in the first trimester and increased risk of preterm labor in the third.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [68]
In a population-based U.S. study, pregnant women had worse clinical and economic outcomes following thyroid (and parathyroid) surgery than nonpregnant women, with disparities based on race/ethnicity, insurance, and access to high-volume surgeons.
“In a population-based U.S. study, pregnant women had worse clinical and economic outcomes following thyroid (and parathyroid) surgery than nonpregnant women, with disparities in outcomes based on race/ethnicity, insurance, and access to high-volume surgeons (68).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [68]
Thyroidectomy in the third trimester of pregnancy is associated with increased risk of preterm labor.
“Thyroidectomy is best avoided in the first and third trimesters of pregnancy because of teratogenic effects associated with anesthetic agents and increased risk of fetal loss in the first trimester and increased risk of preterm labor in the third.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [68]
Although the second trimester is the safest time for thyroidectomy in pregnancy, it is not without risk, with a 4.5%-5.5% risk of preterm labor.
“Although it is the safest time, it is not without risk (4.5%-5.5% risk of preterm labor) (67,68).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [68]
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References 34 · Cited by 126
- Authors
- Kuy, S.
- Affiliations
- Yale University (US)
- Corresponding author
- Kuy, SreyRam
- ORCID
- Kuy, SreyRam
- Venue
- Archives of Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2009-05-18
- Volume
- 144
- Issue
- 5
- Pages
- 399
- ISSN
- 0004-0010 (ISSN-L)
- OpenAlex
- W2056733459
- Cited by
- 126
- References
- 34
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 3 · 2023: 1 · 2022: 6 · 2021: 5 · 2020: 9 · 2019: 8 · 2018: 3 · 2017: 7 · 2016: 7 · 2015: 14 · 2014: 5 · 2013: 10 · 2012: 13
- FWCI
- 13.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- thyroid surgery, parathyroidectomy, pregnancy, surgical complications, fetal complications, maternal complications, in-hospital mortality, length of hospital stay, hospital costs, surgeon volume, racial disparities, insurance status, thyroid cancer, endocrine complications
- MeSH terms
- Adult, Cross-Sectional Studies, Female, Humans, Length of Stay, Parathyroid Diseases, Pregnancy, Regression Analysis, Retrospective Studies, Risk Factors, Thyroid Diseases, Chi-Square Distribution, Treatment Outcome, Hospital Mortality
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