Thyroid cancer in the Era of COVID-19

Abstract

The recent coronavirus infectious disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is placing health systems in serious challenges worldwide. Shocking statistics each day has prompted the World Health Organization to officially declare the COVID-19 outbreak as a pandemic in March 2020. Preliminary studies have shown increased mortality in patients with solid cancers and infection by SARS-CoV-2. Until now, the evidence on the behavior of COVID-19 in patients with a history of thyroid cancer remains scarce, and most of the recommendations given are based on common sense. Therefore, in this viewpoint, we present a brief review of several challenges we are frequently facing during this pandemic and a series of recommendations based on what we have implemented in our clinical practice at a university hospital currently mostly dedicated to COVID-19.

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

“…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.…”

“…High patient-selection for FNAB and surgery was pursued by Smulever et al [71] with consequent considerable decrease in these procedures of more than 98%, compared to the same period in 2019. 131 I was postponed in all pending cancer cases with an intermediate risk of recurrence and only 3% of patients (7 of 223 cancer patients monitored since the COVID-19 pandemic began) with structural incomplete response underwent conventional pre-COVID-19 follow-up [71]. On the other hand, most of thyroid cancer patients were offered telemedicine or contacted to postpone the medical visit [71].…”

“…131 I was postponed in all pending cancer cases with an intermediate risk of recurrence and only 3% of patients (7 of 223 cancer patients monitored since the COVID-19 pandemic began) with structural incomplete response underwent conventional pre-COVID-19 follow-up [71]. On the other hand, most of thyroid cancer patients were offered telemedicine or contacted to postpone the medical visit [71]. Smulever et al [71] also reported their experience on advanced thyroid cancer: seven patients were unable to start multikinase inhibitors (MKIs) because of local health issues; the remaining 15 patients obtained frequent telehealth and inperson consultations, with resulting increase in telemedicine controls by 147%, and decrease in-office appointments to 35.5%.…”

“…On the other hand, most of thyroid cancer patients were offered telemedicine or contacted to postpone the medical visit [71]. Smulever et al [71] also reported their experience on advanced thyroid cancer: seven patients were unable to start multikinase inhibitors (MKIs) because of local health issues; the remaining 15 patients obtained frequent telehealth and inperson consultations, with resulting increase in telemedicine controls by 147%, and decrease in-office appointments to 35.5%. Moreover, only two patients underwent external beam radiation (EBR) therapy, performed on brain and pelvic metastasis [71].…”

“…Smulever et al [71] also reported their experience on advanced thyroid cancer: seven patients were unable to start multikinase inhibitors (MKIs) because of local health issues; the remaining 15 patients obtained frequent telehealth and inperson consultations, with resulting increase in telemedicine controls by 147%, and decrease in-office appointments to 35.5%. Moreover, only two patients underwent external beam radiation (EBR) therapy, performed on brain and pelvic metastasis [71]. Considering their intrinsic frailty and the negative impact on the immune system of both MKIs and EBR therapy, it is strongly suggested that patients under systemic treatment or recent EBR therapy be considered as a risk group for COVID-19 infection and poor outcomes [71].…”