Surgical management and outcome of patients with thyroid disease during the COVID-19 pandemic

Abstract

The COVID-19 pandemic has led to significant pressure on the healthcare system. An 80 per cent decrease in surgical activities and especially elective procedures has been suggested. Some patients with thyroid nodules/cancers have experienced a more than 4-month postponement of their planned operation. Patients who are shown to have a risk of thyroid cancer based on a fineneedle aspiration (FNA) are thus faced with a risk of cancer progression and becoming increasingly dysphoric. A risk-group analysis was conducted at the authors’ unit and, based on this, 50 thyroid operations undertaken during the pandemic. Before and during the hospitalization, measures were taken to protect both patients and healthcare workers. Unexplained fever or any other symptoms linked to COVID-19 led to isolation in a separate room and immediate screening for SARS-CoV-2. Patients were included prospectively from March to June 2020. They had to meet the following criteria: a FNA result indicating risk of cancer, aggressive signs, poorly controlled thyrotoxicosis, a benign nodule with compression and/or obvious increase in size, or patients with suspected carcinoma who were under enormous psychological stress. SPSSR version 19.0 (IBM, Armonk, New York, USA) was used for statistical analysis. Data are presented as median (i.q.r.) unless indicated otherwise. Demographic and clinical characteristics, surgical management, and outcome of the 50 thyroid procedures are shown in Table 1. The interval from onset of diagnostic work-up was 8.0 (20.0) months and the waiting time before surgery (74 160) days. Twenty-five patients (50 per cent) had a FNA suspicious of cancer before surgery. Ten patients had suspected lymph node metastasis and nine had compressive symptoms. Most common comorbidities are shown in Table 1. In terms of surgical procedure, 18 patients had a hemithyroidectomy and 32 underwent total thyroidectomy, of which six procedures were combined with lateral lymph node dissection. Among those with a malignant diagnosis, 36 patients were diagnosed with papillary carcinoma and one had invasive squamous cell carcinoma. Among the 36 patients with papillary carcinoma, 17 had extrathyroidal extension and 15 had metastatic nodes. Thirteen patients had benign thyroid disorders on final pathology. There were no surgical complications or COVID-19 infections; the mean duration of hospital stay after surgery was 2.2 days.