Endocrine surgery during COVID-19 pandemic: do we need an update of indications in Italy?

Abstract

The ongoing spread of the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) poses a significant threat to global health. As the coronavirus outbreak began spreading, hospitals were forced to relocate resources to treat the growing number of COVID-19 patients. As a consequence, doctors across the country canceled tens of thousands of nonurgent surgeries. However, recognizing that the COVID-19 situation may be highly variable and fluid in different communities across the country, elective surgery could be still allowed in some centers for patients included in the high-priority class. The majority of endocrine disorders requiring surgical treatment in patients identifiable as first-priority class, or needing hospitalization within 30 days, are generally represented by malignant thyroid tumors, hyperthyroidism, hyperparathyroidism, and some adrenal disorders. The need for urgent intervention is evaluated on a case-by-case basis according to the severity of the symptoms, the likelihood of progression, and global clinical judgment. On the basis of the above indications, during the last 4 weeks, we performed 18 planned surgical treatments in patients with thyroid cancer (total thyroidectomies, plus lymph node dissection if needed) or multinodular toxic goiter. In no case, postoperative ventilatory support was needed, and the average hospital stay was 3 days. The negative COVID-19 status for all the treated patients was appropriately evaluated beforehand. Nobody knows how long the current COVID-19 pandemic will be lasting. Certainly, we will be requested in the next future to incrementally offer surgical services for endocrine disorders that have been deferred for the COVID-19 pandemic. Keywords COVID-19 • Endocrine surgery • Thyroid cancer • Endocrine emergencies Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) poses a significant threat to global health [1]. On January 30, 2020, the World Health Organization designated an outbreak of a novel coronavirus not seen before in humans to be a "public health emergency of international concern." Within the first 2 months of the outbreak, the epidemic spread rapidly around the country and the world. As of March 8, 2020, a total of 80,868 confirmed cases and 3101

Impact of COVID-19 on the thyroid gland: an update

“…ACE2 and TMPRSS2 expression levels are high in thyroid and more than in lungs [50] Abnormal immune responses and cytokine storm associated to COVID-19 may induce thyroid gland inflammation [50,54] Two mechanisms (i.e. indirect and direct) might account for the changes in the thyroid gland and HPT axis [9][10][11][12][13] COVID-19-related thyroid disorders could include thyrotoxicosis, hypothyroidism, nonthyroidal illness syndrome COVID-19-related SAT is generally comparable to classical SAT and it can occur after or during COVID-19 [36] Thyrotoxicosis in absence of neck pain is frequent in patients hospitalized for COVID-19 [42] Low TSH and T3 and thyrotoxicosis appear to be predictors of poor outcome of patients hospitalized for COVID-19 [7] Treatment plans for thyroid cancer are considerably changing in the direction of more teleconsultations and less diagnostic and therapeutical procedures [70][71][72][73][74][75] Further research is necessary to explore the impact of the limitation of scheduled clinical activities on outcomes of thyroid cancer patients and whether thyroid cancer (or treatment-specific factors) increase vulnerability to COVID-19…”

“…Moreover, during the COVID-19 pandemic, conventional strategies of care for thyroid nodule and cancer has been upset by the transmission risk of SARS-CoV-2 associated with in-person visits and diagnostic and therapeutical procedures. Some research teams have published their personal experiences on this topic to date [70][71][72][73][74][75]85]. Differences in results and management of care likely reflect differences in local SARS-CoV-2 transmission rates and the ability of the health systems to manage.…”

“…Three main reports, one from Italy, one from the kingdom of Jordan and one from China, documented the experience of Surgery Divisions on thyroid cancer management [73][74][75].…”

“…Elective surgery was allowed for patients included in the priority class (as defined on the basis of the Italian Plan for the Management of Waiting Lists 2019/2021) so that in a time period of four weeks 14 total thyroidectomies (plus lymph node dissection if needed) for thyroid cancer were performed [73]. However, this figure corresponded to about one-third of the usual amount of activity in the same time frame in the pre-COVID-19 era [73].…”

A literature survey of the robotic technologies during the COVID-19 pandemic

“…In general, the patient’s staying length can be decreased by robotic surgery, which directly increases the availability for other patients. It is particularly valuable during the pandemic [ [63] , [64] , [65] , [66] ]. As mentioned, currently it is widely agreed that robot can play as a shield, which separates the medical staff and patient physically.…”