Updated clinical management guidance during the COVID-19 pandemic: thyroid nodules and cancer

Abstract

Health care settings, including nuclear medicine (NM) departments promptly adjusted their standard operating procedures to cope with the unprecedented crisis caused by COVID-19 pandemic. Nuclear thyroidology has adopted changes, predicated on a careful risk–benefit analysis, in order to prevent a potential spread of the virus while being at the same time effective, safe and preserving their quality of essential services. Since most thyroid nodules are benign, and malignant neoplasms are characterized by an indolent natural history, it is generally safe to delay diagnostic and therapeutic procedures. In this respect, the main adjustments that nuclear thyroidology has adopted are summarized into the following: general workplace adjustments including remote work for NM staff; postponing appointments for consultation, diagnostic and therapeutic purposes and rescheduling based on individualized risk stratification; telemedicine; preparation for possible issues on radiopharmaceuticals synthesis and delivery; preventing measures and protocols to minimize or avoid potential COVID-19 infection of patients and medical staff. This document should be considered as an updated guidance on how clinical management of thyroid nodules and thyroid cancer has been altered, remodelled, and adapted to the new circumstances in the COVID-19 era, based on the rapidly growing volume of scientific information regarding the new coronavirus.

Impact of COVID-19 Pandemic on Thyroid Surgery in a University Hospital in South Korea

“…Since thyroid cancer has a good prognosis compared to other solid organ cancers, recent guidelines recommended that diagnosis and thyroid cancer surgery could be delayed during the COVID-19 pandemic [ 11 , 12 , 13 , 14 , 15 ]. However, due to delayed diagnosis and treatment during the pandemic, thyroid cancer tended to progress to worse pathologic status, such as extrathyroidal extension and lymph node metastasis, even if most thyroid cancers typically exhibited indolent behavior.…”

Examining the impact of several factors including COVID‐19 on thyroid fine‐needle aspiration biopsy

“…The impact of COVID‐19‐related features (infection history and vaccination features) remains a poorly researched topic regarding the classification of thyroid nodules. From previously published studies, it seems that the pandemic has considerably impacted the diagnosis and treatment of thyroid nodules 32,33 . However, the impact does not appear to have significantly compromised the accuracy of diagnoses or affected the management.…”

“…Our COVID‐19 data, which shows the distribution of Bethesda‐I and Bethesda category II–VI results among patients with varying COVID‐19 histories, vaccine types, and booster doses, does not indicate a significant difference in the distribution based on these factors. According to the studies by Giannoula et al 32 and Vrachimis et al, 33 it has been suggested that delaying TFNAB for most asymptomatic thyroid nodules due to COVID‐19 does not negatively impact the outcomes in thyroid cancers, provided that symptoms and signs of urgent intervention are taken into account. The research by Rossi et al supports these conclusions, showing no difference in the diagnostic accuracy of TFNAB of thyroid nodules based on vaccination status and even during the pandemic 34 …”

“…From previously published studies, it seems that the pandemic has considerably impacted the diagnosis and treatment of thyroid nodules. 32,33 severity and the timing of infection, might limit the depth of our understanding. The study's cross-sectional nature does not allow an assessment of the long-term impact of the virus or vaccines on the thyroid, which could be crucial in this evolving pandemic.…”

“…According to the studies by Giannoula et al32 and Vrachimis et al,33 it has been suggested that delaying TFNAB for most asymptomatic thyroid nodules due to COVID-19 does not negatively impact the outcomes in thyroid cancers, provided that symptoms and signs of urgent intervention are taken into account. The research by Rossi et al supports these conclu-Although the study offers comprehensive insights into the impact of several factors, including COVID-19, on thyroid nodule diagnostics, it has several limitations.…”