Thyroid surgery during coronavirus-19 pandemic phases I, II and III: lessons learned in China, South Korea, Iran and Italy

Abstract

Objective We compared demographic and clinic-pathological variables related to the number of surgeries for thyroid conditions or for cancer, morbidity, and fine needle aspiration (FNA) practices among Covid19 pandemic phases I, II, III and the same seasonal periods in 2019. Methods The prospective database of the Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, China was used for this study. Covid19 emergency levels were stratified according to the World Health Organization: phase I (January 25–February 25, 2020), phase II (February 26–March 19), phase III (March 20–April 20). Results There were fewer outpatient FNAs and surgeries in 2020 than in 2019. There were no thyroid surgeries during phase I. There were also fewer surgeries for cancer with a significant reduction of advanced stage cancer treatments, mainly stage T1b N1a in phase II and T3bN1b in phase III. Operative times and postoperative stays were significantly shorter during the pandemic compared to our institutional baseline. In phase III, vocal cord paralysis (VCP) increased to 4.3% of our baseline numbers ( P = 0.001). There were no cases of Covid19-related complications during the perioperative period. No patients required re-admission to the hospital. Conclusion The Covid19 outbreak reduced thyroid surgery patient volumes. The decrease of Covid19 emergency plans contributed to unexpected outcomes (reduction of early stage cancer treatment, decreased operative times and hospital stays, increased VCP rate). Electronic supplementary material The online version of this article (10.1007/s40618-020-01407-1) contains supplementary material, which is available to authorized users.

Thyroid fine-needle aspiration trends before, during, and after the lockdown: what we have learned so far from the COVID-19 pandemic

“…Globally, we observed a drastic drop in the number of thyroid FNA requests (Table 1, Figs 1, 2), as evidenced by the fact that only 19 FNAs were performed, with a weekly average of 1.8 thyroid aspirates. This is in line with recent international experiences in which a significant drop in thyroid FNA during the COVID-19 pandemic was observed [24,25].…”

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.…”

“…Three main reports, one from Italy, one from the kingdom of Jordan and one from China, documented the experience of Surgery Divisions on thyroid cancer management [73][74][75].…”

“…In the largest study relative to the impact of COVID-19 on thyroid surgery to date [75], it was demonstrated the reduction of thyroid surgery volumes, also for thyroid malignancies, across the three phases of the COVID-19 outbreak (with the phase I indicating the time frame associated to the COVID-19 highest alert). The reduction of early stage cancer treatments, the decreased operative times and hospital stays, and the increased vocal cord paralysis (VCP) rate were other results of the study [75].…”