Thyroid cancer in the age of COVID-19

Abstract

COVID-19 has modified the way we practice medicine. For thyroid cancer, there have been several significant impacts. Firstly, diagnosis has been delayed due to social isolation, reduced access to investigations and staff redeployment. Secondly, treatment planning has needed to take into account the risk to patients and/or staff of nosocomial transmission of the virus. Finally, there are some specific concerns with respect to interactions between the virus, its treatments and cancer. This mini review aims to address each of these impacts and to provide some guidance and confidence to our patients and colleagues during this challenging time.

Impact of COVID-19 on the thyroid gland: an update

“…ACE2 and TMPRSS2 expression levels are high in thyroid and more than in lungs [50] Abnormal immune responses and cytokine storm associated to COVID-19 may induce thyroid gland inflammation [50,54] Two mechanisms (i.e. indirect and direct) might account for the changes in the thyroid gland and HPT axis [9][10][11][12][13] COVID-19-related thyroid disorders could include thyrotoxicosis, hypothyroidism, nonthyroidal illness syndrome COVID-19-related SAT is generally comparable to classical SAT and it can occur after or during COVID-19 [36] Thyrotoxicosis in absence of neck pain is frequent in patients hospitalized for COVID-19 [42] Low TSH and T3 and thyrotoxicosis appear to be predictors of poor outcome of patients hospitalized for COVID-19 [7] Treatment plans for thyroid cancer are considerably changing in the direction of more teleconsultations and less diagnostic and therapeutical procedures [70][71][72][73][74][75] Further research is necessary to explore the impact of the limitation of scheduled clinical activities on outcomes of thyroid cancer patients and whether thyroid cancer (or treatment-specific factors) increase vulnerability to COVID-19…”

“…Moreover, during the COVID-19 pandemic, conventional strategies of care for thyroid nodule and cancer has been upset by the transmission risk of SARS-CoV-2 associated with in-person visits and diagnostic and therapeutical procedures. Some research teams have published their personal experiences on this topic to date [70][71][72][73][74][75]85]. Differences in results and management of care likely reflect differences in local SARS-CoV-2 transmission rates and the ability of the health systems to manage.…”

“…Tsang et al [70] reported that in 2020 72% of consultation were driven by telehealth, compared to only 4.9% of consultations in 2019. Moreover, they experienced a considerable decline in the number of fine-needle aspiration biopsies (FNAB) performed, about 60% compared to 2019 [70]. Treatment for high-risk thyroid cancers (including 131 I ablation) was maintained [70].…”

“…Moreover, they experienced a considerable decline in the number of fine-needle aspiration biopsies (FNAB) performed, about 60% compared to 2019 [70]. Treatment for high-risk thyroid cancers (including 131 I ablation) was maintained [70]. Surgery for proven thyroid cancer has not been delayed, with similar numbers in the same months of 2019 and 2020 [70].…”

“…Treatment for high-risk thyroid cancers (including 131 I ablation) was maintained [70]. Surgery for proven thyroid cancer has not been delayed, with similar numbers in the same months of 2019 and 2020 [70].…”