The evaluation for a thyroid nodule in a pregnant patient is pretty much the same as that for nonpregnant women. If the pregnant woman has a normal TSH or is hypothyroid then a fine needle aspiration can be done in the routine way. Fine needle aspiration does not present any risk to the developing baby. If the TSH is below normal range, the fine needle aspiration is typically deferred until after pregnancy and sometimes even after the cessation of lactation. Thyroid uptake scans are not recommended for evaluation during pregnancy or lactation. If a nodule is proven to be thyroid cancer, then the decision making needs to be done in close conjunction with the surgeon. If the thyroid cancer does not appear to be aggressive, then waiting until after delivery for surgical removal is likely to be the recommendation. If surgery is required because of an aggressive growing thyroid cancer during pregnancy, the ideal time to perform that is in the second trimester. The first trimester induction of anesthesia puts the patient at risk for developmental abnormalities. These risks are much lower in the second trimester. Third trimester operations have the risk of inducing premature labor. So, second trimester is the ideal time if the surgery cannot be delayed until after delivery. If thyroid cancer treatment is delayed on the suspicion or confirmation of thyroid cancer, then the TSH should be kept at low range, typically .1 to 1.0 for the duration of the pregnancy. As with all thyroid surgery, an experienced thyroid surgeon can reduce the inherent risks. As time under anesthesia is an important risk factor in pregnant women, a high-volume thyroid surgeon can more efficiently perform a thyroidectomy and reduce anesthesia time for the operation. Higher risk thyroidectomies, such as in a pregnant patient, should not be done by anyone other than a high-volume, experienced thyroid surgeon! Check out this advice on choosing a thyroid surgeon!