Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study
Issued Date
2023-06-01
Resource Type
eISSN
22138595
Scopus ID
2-s2.0-85159650772
Pubmed ID
37127041
Journal Title
The lancet. Diabetes & endocrinology
Volume
11
Issue
6
Start Page
402
End Page
413
Rights Holder(s)
SCOPUS
Bibliographic Citation
The lancet. Diabetes & endocrinology Vol.11 No.6 (2023) , 402-413
Suggested Citation
Medas F., Dobrinja C., Al-Suhaimi E.A., Altmeier J., Anajar S., Arikan A.E., Azaryan I., Bains L., Basili G., Bolukbasi H., Bononi M., Borumandi F., Bozan M.B., Brenta G., Brunaud L., Brunner M., Buemi A., Canu G.L., Cappellacci F., Cartwright S.B., Castells Fusté I., Cavalheiro B., Cavallaro G., Chala A., Chan S.Y.B., Chaplin J., Cheema M.S., Chiapponi C., Chiofalo M.G., Chrysos E., D'Amore A., de Cillia M., De Crea C., de Manzini N., de Matos L.L., De Pasquale L., Del Rio P., Demarchi M.S., Dhiwakar M., Donatini G., Dora J.M., D'Orazi V., Doulatram Gamgaram V.K., Eismontas V., Kabiri E.H., El Malki H.O., Elzahaby I., Enciu O., Eskander A., Feroci F., Figueroa-Bohorquez D., Filis D., François G., Frías-Fernández P., Gamboa-Dominguez A., Genc V., Giordano D., Gómez-Pedraza A., Graceffa G., Griffin J., Guerreiro S.C., Gupta K., Gupta K.K., Gurrado A., Hajiioannou J., Hakala T., Harahap W.A., Hargitai L., Hartl D., Hellmann A., Hlozek J., Hoang V.T., Iacobone M., Innaro N., Ioannidis O., Jang J.H.I., Xavier-Junior J.C., Jovanovic M., Kaderli R.M., Kakamad F., Kaliszewski K., Karamanliev M., Katoh H., Košec A., Kovacevic B., Kowalski L.P., Králik R., Yadav S.K., Kumorová A., Lampridis S., Lasithiotakis K., Leclere J.C., Leong E.K.F., Leow M.K.S., Lim J.Y., Lino-Silva L.S., Liu S.Y.W., Llorach N.P., Lombardi C.P., López-Gómez J. Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study. The lancet. Diabetes & endocrinology Vol.11 No.6 (2023) , 402-413. 413. doi:10.1016/S2213-8587(23)00094-3 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/82966
Title
Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study
Author(s)
Medas F.
Dobrinja C.
Al-Suhaimi E.A.
Altmeier J.
Anajar S.
Arikan A.E.
Azaryan I.
Bains L.
Basili G.
Bolukbasi H.
Bononi M.
Borumandi F.
Bozan M.B.
Brenta G.
Brunaud L.
Brunner M.
Buemi A.
Canu G.L.
Cappellacci F.
Cartwright S.B.
Castells Fusté I.
Cavalheiro B.
Cavallaro G.
Chala A.
Chan S.Y.B.
Chaplin J.
Cheema M.S.
Chiapponi C.
Chiofalo M.G.
Chrysos E.
D'Amore A.
de Cillia M.
De Crea C.
de Manzini N.
de Matos L.L.
De Pasquale L.
Del Rio P.
Demarchi M.S.
Dhiwakar M.
Donatini G.
Dora J.M.
D'Orazi V.
Doulatram Gamgaram V.K.
Eismontas V.
Kabiri E.H.
El Malki H.O.
Elzahaby I.
Enciu O.
Eskander A.
Feroci F.
Figueroa-Bohorquez D.
Filis D.
François G.
Frías-Fernández P.
Gamboa-Dominguez A.
Genc V.
Giordano D.
Gómez-Pedraza A.
Graceffa G.
Griffin J.
Guerreiro S.C.
Gupta K.
Gupta K.K.
Gurrado A.
Hajiioannou J.
Hakala T.
Harahap W.A.
Hargitai L.
Hartl D.
Hellmann A.
Hlozek J.
Hoang V.T.
Iacobone M.
Innaro N.
Ioannidis O.
Jang J.H.I.
Xavier-Junior J.C.
Jovanovic M.
Kaderli R.M.
Kakamad F.
Kaliszewski K.
Karamanliev M.
Katoh H.
Košec A.
Kovacevic B.
Kowalski L.P.
Králik R.
Yadav S.K.
Kumorová A.
Lampridis S.
Lasithiotakis K.
Leclere J.C.
Leong E.K.F.
Leow M.K.S.
Lim J.Y.
Lino-Silva L.S.
Liu S.Y.W.
Llorach N.P.
Lombardi C.P.
López-Gómez J.
Dobrinja C.
Al-Suhaimi E.A.
Altmeier J.
Anajar S.
Arikan A.E.
Azaryan I.
Bains L.
Basili G.
Bolukbasi H.
Bononi M.
Borumandi F.
Bozan M.B.
Brenta G.
Brunaud L.
Brunner M.
Buemi A.
Canu G.L.
Cappellacci F.
Cartwright S.B.
Castells Fusté I.
Cavalheiro B.
Cavallaro G.
Chala A.
Chan S.Y.B.
Chaplin J.
Cheema M.S.
Chiapponi C.
Chiofalo M.G.
Chrysos E.
D'Amore A.
de Cillia M.
De Crea C.
de Manzini N.
de Matos L.L.
De Pasquale L.
Del Rio P.
Demarchi M.S.
Dhiwakar M.
Donatini G.
Dora J.M.
D'Orazi V.
Doulatram Gamgaram V.K.
Eismontas V.
Kabiri E.H.
El Malki H.O.
Elzahaby I.
Enciu O.
Eskander A.
Feroci F.
Figueroa-Bohorquez D.
Filis D.
François G.
Frías-Fernández P.
Gamboa-Dominguez A.
Genc V.
Giordano D.
Gómez-Pedraza A.
Graceffa G.
Griffin J.
Guerreiro S.C.
Gupta K.
Gupta K.K.
Gurrado A.
Hajiioannou J.
Hakala T.
Harahap W.A.
Hargitai L.
Hartl D.
Hellmann A.
Hlozek J.
Hoang V.T.
Iacobone M.
Innaro N.
Ioannidis O.
Jang J.H.I.
Xavier-Junior J.C.
Jovanovic M.
Kaderli R.M.
Kakamad F.
Kaliszewski K.
Karamanliev M.
Katoh H.
Košec A.
Kovacevic B.
Kowalski L.P.
Králik R.
Yadav S.K.
Kumorová A.
Lampridis S.
Lasithiotakis K.
Leclere J.C.
Leong E.K.F.
Leow M.K.S.
Lim J.Y.
Lino-Silva L.S.
Liu S.Y.W.
Llorach N.P.
Lombardi C.P.
López-Gómez J.
Author's Affiliation
National University of Medical Sciences
University of Health Sciences
Mohammed VI University of Health Sciences (UM6SS)
Klinički Bolnički Centar Sestre Milosrdnice
Hospital Universitario Nacional de Colombia
Acibadem Mehmet Ali Aydinlar Universitesi
Université de Lorraine
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Netaji Subash Chandra Bose Medical College & Hospital
Klinicki Centar Srbije
Universitas Andalas
424 General Military Training Hospital
Vojnomedicinska Akademija
Klaipėdos Universitetas
Universidad de Caldas
Universitatea de Medicina si Farmacie Carol Davila din Bucuresti
Sapienza Università di Roma
Università degli Studi di Cagliari
Fundacion Clinica Medica Sur
National University Hospital
St Richard's Hospital
Università degli Studi di Milano
Imam Abdulrahman bin Faisal University, College of Science
Institut de Cancerologie Gustave Roussy
University Hospitals Birmingham NHS Foundation Trust
Hospital Curry Cabral
Central Military Hospital, Ruzomberok
Centre Hospitalier Universitaire Vaudois
Azienda Ospedaliera Universitaria Policlinico Umberto I
Università degli studi di Bari Aldo Moro
Tseung Kwan O Hospital
Kitasato University Hospital
Centre Hospitalier Universitaire de Poitiers
A.C.Camargo Cancer Center
Instituto Nacional de Cancerologia, México
Università degli Studi di Palermo, Scuola di Medicina e Chirurgia
Mohammed V University in Rabat
Università degli Studi di Trieste
Singapore General Hospital
Military Hospital Mohammed V
Istituto Nazionale Tumori IRCCS - Fondazione G Pascale, Napoli
University of Toronto
Oregon Health & Science University
Charles University
KSU Medical School
University of Nebraska Medical Center
The Ohio State University Wexner Medical Center
School of Medicine
Hospital de Clinicas de Porto Alegre
Hospital Regional Universitario Carlos Haya
Cliniques Universitaires Saint-Luc
Ankara Üniversitesi
Gdanski Uniwersytet Medyczny
Mansoura University
Auckland City Hospital
Medizinische Universität Wien
Heraklion University Hospital
University Hospital of Larissa
University Hospital Bern
Fundacion Hospital Asil de Granollers
Hôpitaux Universitaires de Genève
Diakonie-Klinikum Stuttgart
Maulana Azad Medical College
Instituto Nacional de la Nutrición Salvador Zubiran
University Hospital of Tampere
Uniklinik Köln
Instituto Mexicano del Seguro Social
Universidade de São Paulo
Azienda Ospedaliero - Universitaria di Parma
Wroclaw Medical University
Centre Hospitalier Universitaire de Brest
Medical University - Pleven
Chinese University of Hong Kong
Tan Tock Seng Hospital
Univerzita Komenského v Bratislave
Friedrich-Alexander-Universität Erlangen-Nürnberg
Università degli Studi di Padova
Smart Health Tower
Midland Regional Hospital Tullamore
Thien Hanh Hospital
A.O.U. Mater Domini
Hospital Universitari
Santo Stefano Hospital
Medanta
General St. Andrew Hospital of Patras
Reggio Emilia
Unidad Asistencial Dr. César Milstein
Saint John of God Hospital
Departamento de Cirurgia de Cabeça e Pescoço
Instituto de Patologia de Araçatuba
Kovai Medical Center and Hospital
University of Health Sciences
Mohammed VI University of Health Sciences (UM6SS)
Klinički Bolnički Centar Sestre Milosrdnice
Hospital Universitario Nacional de Colombia
Acibadem Mehmet Ali Aydinlar Universitesi
Université de Lorraine
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Netaji Subash Chandra Bose Medical College & Hospital
Klinicki Centar Srbije
Universitas Andalas
424 General Military Training Hospital
Vojnomedicinska Akademija
Klaipėdos Universitetas
Universidad de Caldas
Universitatea de Medicina si Farmacie Carol Davila din Bucuresti
Sapienza Università di Roma
Università degli Studi di Cagliari
Fundacion Clinica Medica Sur
National University Hospital
St Richard's Hospital
Università degli Studi di Milano
Imam Abdulrahman bin Faisal University, College of Science
Institut de Cancerologie Gustave Roussy
University Hospitals Birmingham NHS Foundation Trust
Hospital Curry Cabral
Central Military Hospital, Ruzomberok
Centre Hospitalier Universitaire Vaudois
Azienda Ospedaliera Universitaria Policlinico Umberto I
Università degli studi di Bari Aldo Moro
Tseung Kwan O Hospital
Kitasato University Hospital
Centre Hospitalier Universitaire de Poitiers
A.C.Camargo Cancer Center
Instituto Nacional de Cancerologia, México
Università degli Studi di Palermo, Scuola di Medicina e Chirurgia
Mohammed V University in Rabat
Università degli Studi di Trieste
Singapore General Hospital
Military Hospital Mohammed V
Istituto Nazionale Tumori IRCCS - Fondazione G Pascale, Napoli
University of Toronto
Oregon Health & Science University
Charles University
KSU Medical School
University of Nebraska Medical Center
The Ohio State University Wexner Medical Center
School of Medicine
Hospital de Clinicas de Porto Alegre
Hospital Regional Universitario Carlos Haya
Cliniques Universitaires Saint-Luc
Ankara Üniversitesi
Gdanski Uniwersytet Medyczny
Mansoura University
Auckland City Hospital
Medizinische Universität Wien
Heraklion University Hospital
University Hospital of Larissa
University Hospital Bern
Fundacion Hospital Asil de Granollers
Hôpitaux Universitaires de Genève
Diakonie-Klinikum Stuttgart
Maulana Azad Medical College
Instituto Nacional de la Nutrición Salvador Zubiran
University Hospital of Tampere
Uniklinik Köln
Instituto Mexicano del Seguro Social
Universidade de São Paulo
Azienda Ospedaliero - Universitaria di Parma
Wroclaw Medical University
Centre Hospitalier Universitaire de Brest
Medical University - Pleven
Chinese University of Hong Kong
Tan Tock Seng Hospital
Univerzita Komenského v Bratislave
Friedrich-Alexander-Universität Erlangen-Nürnberg
Università degli Studi di Padova
Smart Health Tower
Midland Regional Hospital Tullamore
Thien Hanh Hospital
A.O.U. Mater Domini
Hospital Universitari
Santo Stefano Hospital
Medanta
General St. Andrew Hospital of Patras
Reggio Emilia
Unidad Asistencial Dr. César Milstein
Saint John of God Hospital
Departamento de Cirurgia de Cabeça e Pescoço
Instituto de Patologia de Araçatuba
Kovai Medical Center and Hospital
Other Contributor(s)
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.None.