Analyzing How COVID-19 Pandemic Impacted Surgery for Indeterminate Thyroid Nodules

The following is a summary of “Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study,” published in the June 2023 issue of Diabetes and Endocrinology by Medas et al.

Since its emergence in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, resulting in diagnosis and treatment delays and an increase in advanced-stage neoplasms worldwide. This study’s objectives were to quantify the decrease in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic and to determine whether surgical delays contributed to an increase in the incidence of aggressive tumors.

In this international, retrospective, cross-sectional study, centers were invited to participate on 22 June 2022; each center joining the study was asked to provide data from medical records on all thyroidectomies performed consecutively from 1 January 2019 to 31 December 2021. According to when they underwent surgery, patients with indeterminate thyroid nodules were divided into three groups: from 1 January 2019 to 29 February 2020 (global pre-pandemic phase), from 1 March 2020 to 31 May 2021 (pandemic escalation phase), and from 1 June to 31 December 2021 (pandemic decrease phase). For each phase, the primary outcomes were the number of surgeries for indeterminate thyroid nodules and, in patients with a postoperative diagnosis of thyroid cancer, the incidence of tumors larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumors with a high risk of structural disease recurrence. Comparing the likelihood of aggressive thyroid features between the first and third study phases using univariate analysis.

Data were collected from 157 centers (n=49 countries) on 87,467 patients who underwent surgery for benign and malignant thyroid disease, of which 22,974 patients (18,052 [78.6%] female patients and 4,922 [21.4%] male patients) underwent surgery for indeterminate thyroid nodules. Researchers observed a significant decrease in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per center, 14 [IQR 06–34] vs. the pre-pandemic phase (20 [09–37]; P<0.0001) and pandemic decrease phase (23 [10–50]; P<0.0001). Compared with the pre-pandemic phase, in the pandemic decrease phase, Researchers observed an increased occurrence of thyroid tumors larger than 10 mm (2,554 [69·0%] of 3,704 vs. 1515 [71·5%] of 2,119; 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 tumors at high risk of structural disease recurrence (203 [5·7%] of 3,584 vs. 155 [7·7%] of 2,006; OR 1·4 [1·1–1·7]; P=0·0039).

Source: sciencedirect.com/science/article/pii/S2213858723000943