TY - JOUR
T1 - Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID)
T2 - a retrospective, international, multicentre, cross-sectional study
AU - THYCOVID Collaboration Group
AU - Medas, Fabio
AU - Dobrinja, Chiara
AU - Al-Suhaimi, Ebtesam Abdullah
AU - Altmeier, Julia
AU - Anajar, Said
AU - Arikan, Akif Enes
AU - Azaryan, Irina
AU - Bains, Lovenish
AU - Basili, Giancarlo
AU - Bolukbasi, Hakan
AU - Bononi, Marco
AU - Bozan, Mehmet Buğra
AU - Brenta, Gabriela
AU - Brunaud, Laurent
AU - Brunner, Maximilian
AU - Buemi, Antoine
AU - Canu, Gian Luigi
AU - Cappellacci, Federico
AU - Cartwright, Sara Burchfield
AU - Castells Fusté, Ignasi
AU - Cavalheiro, Beatriz
AU - Cavallaro, Giuseppe
AU - Chala, Andres
AU - Chan, Shun Yan Bryant
AU - Chaplin, John
AU - Cheema, Mustafa Sajjad
AU - Chiapponi, Costanza
AU - Chiofalo, Maria Grazia
AU - Chrysos, Emmanuel
AU - D'Amore, Annamaria
AU - de Cillia, Michael
AU - De Crea, Carmela
AU - de Manzini, Nicolò
AU - de Matos, Leandro Luongo
AU - De Pasquale, Loredana
AU - Del Rio, Paolo
AU - Demarchi, Marco Stefano
AU - Dhiwakar, Muthuswamy
AU - Donatini, Gianluca
AU - Dora, Jose Miguel
AU - D'Orazi, Valerio
AU - Doulatram Gamgaram, Viyey Kishore
AU - Eismontas, Vitalijus
AU - Kabiri, El Hassane
AU - El Malki, Hadj Omar
AU - Elzahaby, Islam
AU - Enciu, Octavian
AU - Eskander, Antoine
AU - Feroci, Francesco
A2 - Borumandi, Farzad
N1 - study gr member: Lehr-KH Saint John of God Hospital, Salzburg, Austria
PY - 2023/6
Y1 - 2023/6
N2 - BACKGROUND: Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours.METHODS: In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186.FINDINGS: Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039).INTERPRETATION: Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.FUNDING: None.
AB - BACKGROUND: Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours.METHODS: In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186.FINDINGS: Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039).INTERPRETATION: Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.FUNDING: None.
KW - Humans
KW - Male
KW - Female
KW - Thyroid Nodule/epidemiology
KW - Cross-Sectional Studies
KW - Pandemics
KW - Retrospective Studies
KW - Lymphatic Metastasis
KW - COVID-19/epidemiology
KW - Thyroid Neoplasms/epidemiology
U2 - 10.1016/S2213-8587(23)00094-3
DO - 10.1016/S2213-8587(23)00094-3
M3 - Original Article (Journal)
C2 - 37127041
SN - 2213-8587
VL - 11
SP - 402
EP - 413
JO - LANCET DIABETES & ENDOCRINOLOGY
JF - LANCET DIABETES & ENDOCRINOLOGY
IS - 6
ER -