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.
Subject(s)
COVID-19 , Thyroid Neoplasms , Thyroid Nodule , Humans , Male , Female , Thyroid Nodule/epidemiology , Thyroid Nodule/surgery , Thyroid Nodule/diagnosis , Cross-Sectional Studies , Pandemics , Retrospective Studies , Lymphatic Metastasis , COVID-19/epidemiology , Thyroid Neoplasms/epidemiology , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathologyABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Hyperthyroidism/diagnosis , Immunoassay , Biotin/pharmacokinetics , Thyroid Function Tests/statistics & numerical data , Adrenoleukodystrophy/complications , Adrenal Insufficiency/complications , Diagnosis, DifferentialSubject(s)
Hyperthyroidism/diagnosis , Immunoassay/methods , Thyroid Function Tests/methods , HumansABSTRACT
No disponible
Subject(s)
Adult , Humans , Male , Hypokalemia/blood , Hypokalemia/complications , Hypertension/complications , Hypertension/pathology , Paralysis/pathology , Alkalosis/blood , Rhabdomyolysis/complicationsABSTRACT
La aparición de un nódulo tiroideo se ha convertido en un hecho cotidiano en la práctica clínica diaria. Habitualmente, la adecuada evaluación del nódulo tiroideo requiere la realización de diversas pruebas diagnósticas y múltiples citas médicas, con la consiguiente demora diagnóstica. La instauración de una consulta de alta resolución de nódulo tiroideo evita en gran medida estos inconvenientes, condensando en una única cita todas las pruebas necesarias para la correcta evaluación del nódulo tiroideo. En este trabajo revisamos cuál debe ser la estructura diagnóstica y funcional de una consulta de alta resolución de nódulo tiroideo
Appearance of a thyroid nodule has become a daily occurrence in clinical practice. Adequate thyroid nodule assessment requires several diagnostic tests and multiple medical appointments, which results in a substantial delay in diagnosis. Implementation of a high-resolution thyroid nodule clinic largely avoids these drawbacks by condensing in a single appointment all tests required for adequate evaluation of thyroid nodule. This paper reviews the diagnostic and functional structure of a high-resolution thyroid nodule clinic
Subject(s)
Humans , Thyroid Nodule/diagnosis , Thyroid Neoplasms/diagnosis , Diagnosis, Differential , Thyroid Function Tests , Thyroid Nodule/classification , Hospital Units/organization & administrationABSTRACT
Appearance of a thyroid nodule has become a daily occurrence in clinical practice. Adequate thyroid nodule assessment requires several diagnostic tests and multiple medical appointments, which results in a substantial delay in diagnosis. Implementation of a high-resolution thyroid nodule clinic largely avoids these drawbacks by condensing in a single appointment all tests required for adequate evaluation of thyroid nodule. This paper reviews the diagnostic and functional structure of a high-resolution thyroid nodule clinic.
Subject(s)
Outpatient Clinics, Hospital/organization & administration , Thyroid Nodule/diagnosis , Biomarkers, Tumor , Biopsy, Fine-Needle/methods , Diagnosis, Differential , Early Detection of Cancer , Endocrinology , Humans , Interdisciplinary Communication , Pathology, Clinical , Patient Care Team , Radiology , Radionuclide Imaging , Spain , Thyroid Hormones/blood , Thyroid Neoplasms/diagnosis , Thyroid Nodule/blood , Thyroid Nodule/diagnostic imaging , Thyroid Nodule/pathology , Thyrotropin/blood , Ultrasonography , Unnecessary Procedures , Watchful WaitingABSTRACT
PURPOSE: To assess the clinical value of paratracheal lymph nodes (PLNs) as a novel sonographic finding in autoimmune thyroiditis (AT). METHODS: A total of 309 consecutive patients underwent sonographic examinations of the thyroid between 1998 and 2003. A single radiologist assessed the sonographic findings of AT and PLNs. All patients underwent serological tests for antimicrosomal antibodies (AMAs). Patients with clinical, cytological, or laboratory findings of thyroiditis formed the AT group with a positive AMA test (n = 199). Controls were patients with no signs of nodular thyroid disease, normal thyrotropin, negative AMA, and benign cytology (n = 110). RESULTS: PLNs were seen in 184 of 199 patients in the AT group and in 28 of 110 controls (P < 0.001) (sensitivity of 93.4%, specificity of 74.5% in the diagnosis of AT). PLNs in controls were fewer (2.8 +/- 1.5 versus 4.7 +/- 2.6; P < 0.001) and smaller (8.2 +/- 2.4 mm versus 10.7 +/- 3.3 mm; P < 0.001) than in the AT group. CONCLUSION: PLNs are often present in patients with AT and are detectable with sonography. Radiologists should be aware of the importance of including the paratracheal region in the evaluation of the thyroid gland.
