Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

THYCOVID Collaboration Group, Fabio Medas, Chiara Dobrinja, Ebtesam Abdullah Al-Suhaimi, Julia Altmeier, Said Anajar, Akif Enes Arikan, Irina Azaryan, Lovenish Bains, Giancarlo Basili, Hakan Bolukbasi, Marco Bononi, Farzad Borumandi (Study group member), Mehmet Buğra Bozan, Gabriela Brenta, Laurent Brunaud, Maximilian Brunner, Antoine Buemi, Gian Luigi Canu, Federico CappellacciSara Burchfield Cartwright, Ignasi Castells Fusté, Beatriz Cavalheiro, Giuseppe Cavallaro, Andres Chala, Shun Yan Bryant Chan, John Chaplin, Mustafa Sajjad Cheema, Costanza Chiapponi, Maria Grazia Chiofalo, Emmanuel Chrysos, Annamaria D'Amore, Michael de Cillia, Carmela De Crea, Nicolò de Manzini, Leandro Luongo de Matos, Loredana De Pasquale, Paolo Del Rio, Marco Stefano Demarchi, Muthuswamy Dhiwakar, Gianluca Donatini, Jose Miguel Dora, Valerio D'Orazi, Viyey Kishore Doulatram Gamgaram, Vitalijus Eismontas, El Hassane Kabiri, Hadj Omar El Malki, Islam Elzahaby, Octavian Enciu, Antoine Eskander, Francesco Feroci

Research output: Contribution to journalOriginal Article (Journal)peer-review

Abstract

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.

Original languageEnglish
Pages (from-to)402-413
Number of pages12
JournalLANCET DIABETES & ENDOCRINOLOGY
Volume11
Issue number6
DOIs
Publication statusPublished - Jun 2023

Keywords

  • Humans
  • Male
  • Female
  • Thyroid Nodule/epidemiology
  • Cross-Sectional Studies
  • Pandemics
  • Retrospective Studies
  • Lymphatic Metastasis
  • COVID-19/epidemiology
  • Thyroid Neoplasms/epidemiology

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