The impact of the COVID-19 pandemic on thyroid nodular disease: a retrospective study in a single center in the western part of Romania

Abstract

IntroductionThe COVID-19 pandemic had a significant impact on the healthcare system, leading to a prioritization of hospital admissions in many countries. Romania was no exception, and it had to restrict patient access to medical services in hospitals with chronic diseases and oncological pathology, including thyroid cancer. This study aimed to compare the clinical and pathological factors of patients with nodular thyroid disease diagnosed and surgically treated during the two years before and after the COVID-19 pandemic, in a single medical institution.MethodsThe retrospective study included 1505 patients who were diagnosed and operated on for nodular thyroid disease between January 2018 and December 2021. The patients were divided into two groups: the “PRECOVID” group (January 2018 to February 2020), and the “POSTCOVID” group (March 2020 to December 2021). The analyzed parameters included patients’ gender, age, preoperative diagnosis, type of surgical intervention, and pathological diagnosis.ResultsA significant decrease was observed in the number of surgeries performed for thyroid nodular disease during the COVID-19 pandemic period (450 versus 1055 cases, p<0.00001). There was a significant decrease in the number of surgical reinterventions (0.9% in the POSTCOVID group versus 2.9% in the PRECOVID group, p=0.01) and a significant increase in the number of total thyroidectomies (84.9% in the POSTCOVID group versus 80.1% in the PRECOVID group, p=0.02). We also observed a higher incidence of malignant/borderline tumors in the POSTCOVID group compared to the PRECOVID group (p=0.04) and a significantly higher frequency of aggressive forms of thyroid cancer in the POSTCOVID group (p=0.0006).DiscussionThe COVID-19 pandemic had a significant impact on the surgical management of nodular thyroid disease, resulting in a decrease in surgeries and a change in the type of surgical interventions performed. The higher incidence of malignant/borderline tumors diagnosed during the pandemic highlights the importance of timely diagnosis and treatment of thyroid nodules to prevent cancer progression.

Papillary Thyroid Cancer Trends in the Wake of the COVID-19 Pandemic: Is There a Shift toward a More Aggressive Entity?

“…When the post-pandemic group was compared to the pre-pandemic group, the current study found that the number of thyroid surgeries had increased and that the cancer rate in the final histopathology was not only higher, but also more invasive and had more aggressive pathological findings. This finding partially aligned with findings from Asia and Romania, which described a reduction in total thyroidectomy numbers but an increase in aggressive thyroid variants [8,23,26]. However, the rise in cancers with more aggressive behavior cannot be explained by delayed diagnosis and treatments for two reasons: firstly, the circumstances of COVID-19 management in Abu Dhabi, where there was no restriction for citizens to access healthcare facilities; secondly, the fact that PTC is relatively slowgrowing and may be survived without immediate treatment, as reported by Ito et al in the biggest prospective series of active surveillance patients at Kuma Hospital over 22 years.…”

“…The rapid rise in patients confirmed to have COVID-19 compelled most healthcare systems worldwide to modify and prioritize hospital admissions starting in March 2020. Emergency measures and lockdowns, implemented between 15 March 2020 and 15 May 2020, constrained hospital entry for patients with chronic pathology, a situation observed globally and documented in various publications [ 8 , 9 ]. Specific protocols and guidelines were developed quickly, advising the postponement of various surgical treatments, including endocrine oncology [ 10 , 11 , 12 ].…”