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 - Borumandi, Farzad

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 - Zolotoukho, Anna

AU - Семенов, Арсений Андреевич

AU - Вабалайте, Кристина Викторовна

AU - Романчишен, Анатолий Филиппович

N1 - Copyright © 2023 Elsevier Ltd. All rights reserved.

PY - 2023/6/1

Y1 - 2023/6/1

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.

U2 - 10.1016/S2213-8587(23)00094-3

DO - 10.1016/S2213-8587(23)00094-3

M3 - Article

C2 - 37127041

VL - 11

SP - 402

EP - 413

JO - The Lancet Diabetes and Endocrinology

JF - The Lancet Diabetes and Endocrinology

SN - 2213-8587

IS - 6

ER -