ArticleThe lancet. Diabetes & endocrinology2023
Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study.
Erratum issued Registry-linked trialOpen access · greenAbstract readMulticenter Study
In one paragraph
Article in The lancet. Diabetes & endocrinology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT05178186 (Impact of the COVID-19 Pandemic on Surgery for Thyroid Cancer), which is not on this map. Cited by 15 papers.
0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed
4.6field-weighted citation impact, top 5% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Impact of the COVID-19 Pandemic on Surgery for Thyroid Cancer: an International Multicenter Study
Who cites it
15 citing papers in PubMed, 20 citations in OpenAlex.
- A targeted proteomics assay for the preoperative diagnosis of thyroid nodules.Cell reports. Medicine · 2026Article
- Impact of delayed surgery in differentiated thyroid carcinoma and medullary thyroid carcinoma.Endocrine · 2025Article
- Short-term impact of delayed surgical treatment on the prognosis of patients with T1bN1-stage PTC: a retrospective cohort study.BMC cancer · 2025Article
- Association between long-term exposure to PMEnvironmental health : a global access science source · 2025Article
- Multi-omics analysis and metastasis risk factor prediction in N1b stage PTMC: insights into immune infiltration and therapeutic implications.Frontiers in immunology · 2025Article
- Ultrasound radiomics and genomics improve the diagnosis of cytologically indeterminate thyroid nodules.Frontiers in endocrinology · 2025Review
- The Horizon of Thyroid Imaging Reporting and Data System in the Diagnostic Performance of Thyroid Nodules: Clinical Application and Future Perspectives.TouchREVIEWS in endocrinology · 2024Review
- Indolent Behavior of Malignant Bethesda III Nodules Compared to Bethesda V/VI Nodules.The Journal of clinical endocrinology and metabolism · 2024Article
- Impact of the COVID-19 Pandemic on Thyroid Cancer Surgery.Current oncology (Toronto, Ont.) · 2024Article
- Article
- [Possibilities of the personalized approach to solitary thyroid nodules based on molecular profiling].Chirurgie (Heidelberg, Germany) · 2024Review
- Comparison of Clinical and Pathological Characteristics of Thyroid Cancer Surgery in the Pandemic Era.Medical journal of the Islamic Republic of Iran · 2024Article
- Endocrinological Involvement in Children and Adolescents Affected by COVID-19: A Narrative Review.Journal of clinical medicine · 2023Review
- Article
- Shared Decision-Making During Surgical Consultations for Indeterminate Thyroid Nodules.Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-facialeArticle
Corrections and comments
- Commented on by
- Erratum issued
- Erratum issued
Authors and funding
168 authors at 20 institutions in 31 countries.
Fabio MedasDepartment of Surgical Sciences, University of Cagliari, Cagliari, Italy. Electronic address: fabiomedas@unica.it.
Chiara DobrinjaDepartment of Medical and Surgical Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy.
Ebtesam Abdullah Al-SuhaimiBiology Department, College of Science, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Julia AltmeierEndocrine Surgery, Diakonie-Klinikum Stuttgart, Stuttgart, Germany.
Said AnajarDepartment of Otolaryngology-Head and Neck Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, Morocco.
Akif Enes ArikanDepartment of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Türkiye.
Irina AzaryanDivision of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Lovenish BainsDepartment of Surgery, Maulana Azad Medical College, New Delhi, India.
Giancarlo BasiliAzienda USL Toscana Nord-Ovest, UOSD Chirurgia della Tiroide, Toscana, Italy.
Hakan BolukbasiGeneral Surgery, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Türkiye.
Marco BononiDipartimento di Chirurgia Pietro Valdoni, Policlinico Umberto I Sapienza, Rome, Italy.
Farzad BorumandiDepartment of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St Richard's Hospital, Chichester and Worthing Hospital, Worthing, UK.
Mehmet Buğra BozanGeneral Surgery, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Türkiye.
Gabriela BrentaEndocrinology Department, Unidad Asistencial Dr César Milstein, Buenos Aires, Argentina.
Laurent BrunaudDepartment of Surgery CVMC, CHU Nancy-Brabois, Université de Lorraine, Nancy, France.
Maximilian BrunnerDepartment of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
Antoine BuemiDepartment of Surgery, Cliniques Universitaires Saint Luc, Bruxelles, Belgium.
Gian Luigi CanuDepartment of Surgical Sciences, University of Cagliari, Cagliari, Italy.
Federico CappellacciDepartment of Surgical Sciences, University of Cagliari, Cagliari, Italy.
Sara Burchfield CartwrightDepartment of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Ignasi Castells FustéEndocrinology Department, Granollers General Hospital, Barcelona, Spain.
Beatriz CavalheiroDepartamento de Cirurgia de Cabeça e Pescoço, Hospital São Camilo Oncologia-Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil.
Giuseppe CavallaroDepartment of Surgery, Sapienza University of Rome, Rome, Italy.
Andres ChalaHead and Neck Department Oncologos del Occidente, Universidad de Caldas, Manizales, Colombia.
Shun Yan Bryant ChanDepartment of Surgery, Tseung Kwan O Hospital, Hong Kong Special Administrative Region, China.
John ChaplinDepartment of Otolaryngology Head and Neck Surgery, Auckland City Hospital, Auckland, New Zealand.
Mustafa Sajjad CheemaCMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan.
Costanza ChiapponiDepartment of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Cologne, Germany; Department of Endocrine Surgery, Evangelisches Klinikum Cologne Weyertal, Cologne, Germany.
Maria Grazia ChiofaloHead and Neck Cancer Medical Oncology Department, Istituto Nazionale Tumori, IRCCS Fondazione G Pascale, Napoli, Italy.
Emmanuel ChrysosDepartment of Surgery, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece.
Annamaria D'AmoreDivision of Endocrine Surgery, Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Michael de CilliaDepartment of Surgery, Saint John of God Hospital, Salzburg, Austria.
Carmela De CreaUOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
Nicolò de ManziniDepartment of Medical and Surgical Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy.
Leandro Luongo de MatosDepartment of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
Loredana De PasqualeThyroid and Parathyroid Surgery Unit-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
Paolo Del RioGeneral Surgery Unit, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy.
Marco Stefano DemarchiDepartment of Thoracic and Endocrine Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
Muthuswamy DhiwakarDepartment of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Coimbatore, India.
Gianluca DonatiniGeneral and Endocrine Surgery, CHU Poitiers, Poitiers, France.
Jose Miguel DoraThyroid Unit, Hospital de Clínicas de Porto Alegre and Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Valerio D'OraziDepartment of Surgical Sciences, Sapienza University of Rome, Rome, Italy; Division of General Surgery-Section of Endocrine and Diabetic Foot Surgery, "Fabia Mater" Hospital, Rome, Italy.
Viyey Kishore Doulatram GamgaramEndocrinology and Nutrition, Hospital Regional Universitario, Málaga, Spain.
Vitalijus EismontasDepartment of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania; Health Research and Innovation Science Center, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania.
El Hassane KabiriDepartment of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco.
Hadj Omar El MalkiSurgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University, Rabat, Morocco.
Islam ElzahabySurgical Oncology, Mansoura University, Mansoura, Egypt.
Octavian EnciuElias University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Antoine EskanderDepartment of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
Francesco FerociDepartment of Surgery, General Surgery Unit, S Stefano Hospital, Prato, Italy.
David Figueroa-BohorquezHead and Neck Surgery, Hospital Universitario Nacional de Colombia, Bogotá DC, Colombia.
Dimitrios FilisDepartment of Surgery, Saint Andrew Hospital of Patras, Patras, Greece.
Gorostidi FrançoisOtolaryngology and Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Pedro Frías-FernándezSurgical Oncology, Tula's General Hospital, Tula de Allende, Mexico.
Armando Gamboa-DominguezDepartamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Volkan GencDepartment of Surgery, Ankara University Faculty of Medicine, Ankara, Turkey.
Davide GiordanoOtorhinolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Antonio Gómez-PedrazaNational Cancer Institute of Mexico, Mexico City, Mexico.
Giuseppa GraceffaDepartment of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
James GriffinOtolaryngology, Midlands Regional Hospital Tullamore, Tullamore, Ireland.
Sofia Cuco GuerreiroEndocrine Surgery, University Hospital Center of Central Lisbon, Hospital Curry Cabral, Lisboa, Portugal.
Karan GuptaDepartment of Head and Neck Surgery, Medanta, Gurugram, India.
Keshav Kumar GuptaDepartment of ENT, University Hospitals Birmingham NHS Trust, Birmingham, UK.
Angela GurradoDepartment of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy.
Jiannis HajiioannouENT Department, University Hospital of Larissa, Larissa, Greece.
Tommi HakalaDepartment of Surgery, Tampere University Hospital, Tampere, Finland.
Wirsma Arif HarahapDepartment of Surgery, Faculty of Medicine, Universitas Andalas, Padang City, Indonesia.
Lindsay HargitaiDepartment of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria.
Dana HartlDepartment of Surgery, Anesthesia and Interventional Radiology, Head and Neck Oncology Service, Thyroid Surgery Unit, Gustave Roussy, Villejuif, France.
Andrzej HellmannDepartment of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland.
Jiri HlozekDepartment of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, Prague, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Van Trung HoangDepartment of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam.
Maurizio IacoboneEndocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
Nadia InnaroUnit of Endocrine Surgery, AOU Mater Domini, Catanzaro, Italy.
Orestis IoannidisFourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital "Georgios Papanikolaou", Thessaloniki, Greece.
J H Isabelle JangDepartment of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore.
Jose Candido Xavier-JuniorSurgical Pathology Department, Instituto de Patologia de Araçatuba, Araçatuba, Brazil.
Milan JovanovicClinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade, Serbia.
Reto Martin KaderliDepartment of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Fahmi KakamadDepartment of Scientific Affairs, Smart Health Tower, Sulaimani, Iraq.
Krzysztof KaliszewskiDepartment of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland.
Martin KaramanlievDepartment of Surgical Oncology, University Hospital "Georgi Stranski", Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria.
Hiroshi KatohDepartment of Breast and Endocrine Surgery, Kitasato University Hospital, Sagamihara, Japan.
Andro KošecDepartment of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.
Bozidar KovacevicInstitute of Pathology and Forensic Medicine, Medical Military Academy, Belgrade, Serbia.
Luiz Paulo KowalskiDepartment of Head and Neck Surgry and Otorhinolaryngology, AC Camargo Cancer Center, São Paulo, Brazil.
Robert KrálikDepartment of Surgical Oncology, St Elisabeth Cancer Institute, Medical Faculty of Comenius University, Bratislava, Slovakia.
Sanjay Kumar YadavDepartment of Surgery, NSCB Medical College, Jabalpur, India.
Adriána KumorováClinic of Otorhinolaryngology and Head and Neck Surgery, Central Military Hospital Ružomberok, Ružomberok, Slovakia.
Savvas LampridisDepartment of Thoracic Surgery, 424 General Military Hospital, Thessaloniki, Greece.
Konstantinos LasithiotakisDepartment of Surgery, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece.
Jean-Christophe LeclereHead and Neck Surgery, Brest University Hospital, Brest, France.
Eugene Kwong Fei LeongDepartment of Surgery, National University Hospital, Singapore.
Melvin Khee-Shing LeowDepartment of Endocrinology, Tan Tock Seng Hospital, Singapore.
James Y LimDepartment of Surgery and Otolaryngology, Oregon Health and Science University, Portland, OR, USA.
Leonardo S Lino-SilvaOncology Center, Medica Sur Hospital, Mexico City, Mexico.
Shirley Yuk Wah LiuDepartment of Surgery, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
Núria Perucho LlorachUnit of Endocrine Surgery Head and Neck Parc Tauli, Hospital Universitari, Sabadell, Spain.
Celestino Pio LombardiDivision of Endocrine Surgery, Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Javier López-GómezHead and Neck Department, Hospital de Oncología Centro Médico Nacional Siglo XXI, Mexico City, Mexico.
Eleonora LoriDepartment of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
Lourdes Quintanilla-DieckDepartment of Pediatric Otolaryngology, Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA.
Roberta LucchiniEndocrine Surgery Unit, University of Perugia, Santa Maria Hospital, Terni, Italy.
Amin MadaniDepartment of Surgery, University of Toronto, Toronto, ON, Canada.
Dimitrios ManatakisSecond Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece.
Ivan MarkovicClinic for Surgical Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia.
Gabriele MaterazziEndocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy.
Haggi MazehDepartment of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Giuseppe MercanteDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy.
Goswin Yason Meyer-RochowEndocrine Surgery, Department of General Surgery, Waikato Hospital, Hamilton, New Zealand.
Olgica MihaljevicDepartment of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
Julie A MillerThe Royal Melbourne Hospital and Epworth Hospital, Melbourne, VIC, Australia.
Michele MinutoDepartment of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy.
Massimo MonacelliThoracic Surgery, Azienda Ospedaliera di Perugia, Perugia, Italy.
Francesk MulitaDepartment of Surgery, General University Hospital of Patras, Patras, Greece.
Barbara MullinerisDepartment of General, Emergency and New Technologies, University Hospital of Modena, Baggiovara Civil Hospital, Modena, Italy.
José Luis Muñoz-de-NovaDepartment of General and Digestive Surgery, Hospital Universitario de La Princesa, Madrid, Spain.
Fábio Muradás GirardiHead and Neck Surgery Department, Hospital Ana Nery, Santa Cruz do Sul, Brazil.
Saki NaderOtolaryngology Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Tangjaturonrasme NapadonDepartment of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Constantinos NastosThird Department of Surgery, Attikon University Hospital, Athens, Greece.
Chiara OffiDepartment of Endocrine and Ultrasound-Guided Surgery, Ospedale del Mare, ASl Napoli 1 Centro, Naples, Italy.
Ohad RonenGalilee Medical Center, Azrieli Faculty of Medicine Bar Ilan University, Safed, Israel.
Luigi OraganoASL VCO, Ospedale San Biagio, Domodossola, Italy.
Aida OroisDepartment of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Terrassa, Spain.
Yongqin PanDepartment of Thyroid Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Emmanouil PanagiotidisDepartment of Nuclear Medicine/PET CT, Theageneio Cancer Hospital of Thessaloniki, Thessaloniki, Greece.
Ramakanth Bhargav PanchangamEndocrine and Metabolic Surgery, Bhargav Endocrine Hospital, Vijayawada, India.
Theodosios PapavramidisFirst Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
Pradipta Kumar ParidaDepartment of ENT-Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India.
Anna PaspalaDepartment of Surgery, Eugenideio Hospital, Athens, Greece.
Òscar Vidal PérezGeneral Surgery Department, Universitat de Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain.
Sabrina PetrovicSurgery Bitenc, Ljubljana, Slovenia.
Marco RaffaelliUOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
Constanza Fernanda RamacciottiService of Endocrinology, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
Tomas Ratia GimenezGeneral Surgery, Hospital Universitario Principe de Asturias, Alcala de Henares, Spain.
Ángel Rivo VázquezDepartment of General and Digestive Surgery, Division of Endocrine Surgery, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.
Jong-Lyel RohDepartment of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Leonardo RossiEndocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy.
Alvaro SanabriaDepartment of Surgery, Universidad de Antioquia, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia.
Alena SanteerapharpDepartment of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand.
Arseny SemenovEndocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia.
Sanjeewa SeneviratneFaculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Altinay SerdarDepartment of Endocrin Pathology Unit, University of Health Sciences, Faculty of Medicine, Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Patrick SheahanSouth Infirmary Victoria University Hospital, Cork, Ireland.
Sean C SheppardDepartment of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France.
Rachel L SlotcavageDepartment of Surgery and Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Constantin SmaxwilEndocrine Surgery, Diakonie-Klinikum Stuttgart, Stuttgart, Germany.
Soo Young KimDepartment of Surgery, Ajou University School of Medicine, Suwon, South Korea.
Salvatore SorrentiDepartment of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
Eleftherios SpartalisDepartment of Thyroid Surgery, REA Hospital, Athens, Greece.
Chutintorn SriphrapradangDepartment of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Mario TestiniDepartment of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy.
Yigit TurkDivision of Endocrine Surgery, General Surgery Department, Ege University Hospital, Izmir, Turkey.
George TzikosFirst Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
Kristina VabalayteEndocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia.
Kelly Vargas-OsorioClinical University Hospital Santiago de Compostela University of Santiago de Compostela, Santiago de Compostela, Spain.
Rafael Sebastián Vázquez RenteríaDepartamento de Cabeza y Cuello, Instituto Nacional de Cancerología, Mexico City, Mexico.
David Velázquez-FernándezEndocrine Surgery Unit, Department of Surgery, National Institute for Medical Sciences and Nutrition, Mexico City, Mexico.
Sanura Malinda Pallegoda VithanaDepartment of Surgery, National Hospital Kandy, Kandy, Sri Lanka.
Levent YücelDepartment of Otorhinolaryngology, University of Health Sciences, Gülhane Research and Training Hospital, Ankara, Turkey.
Erwin Danil YulianDivision of Surgical Oncology, Department of Surgery, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
Petra ZahradnikovaDepartment of Paediatric Surgery, Medical Faculty of Comenius University, National Institute of Children's Diseases, Bratislava, Slovakia.
Paul ZarogoulidisThird Surgery Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Evgeniia ZiablitskaiaCentral Research Laboratory, Clinical Medical Multidisciplinary Center of St Luke VI Vernadsky Crimean Federal University, Simferopol, Russia.
Anna ZolotoukhoEndocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia.
Pietro Giorgio CalòDepartment of Surgical Sciences, University of Cagliari, Cagliari, Italy.
THYCOVID Collaboration Group
University of Cagliari · ITAzienda Ospedaliera Universitaria Pisana · ITSapienza University of Rome · ITUniversity of Bari Aldo Moro · ITAgostino Gemelli University Polyclinic · ITAHEPA University Hospital · GRCHA University · KRCMH Lahore Medical College and Institute of Dentistry · PKFirst Affiliated Hospital of Jinan University · CNGdańsk Medical University · PLHadassah Medical Center · ILInstituto Nacional de Cancerología · MXInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán · MXIstituti di Ricovero e Cura a Carattere Scientifico · ITKovai Medical Center and Hospital · INMedical University of Vienna · ATMútua Terrassa · ESPham Ngoc Thach Hospital · VNRamathibodi Hospital · THSingapore General Hospital · SG
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSince 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.
methodsIn 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.
findingsData 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).
interpretationOur 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.
fundingNone.
Indexed as
COVID-19Thyroid NeoplasmsThyroid NoduleCross-Sectional StudiesFemaleHumansLymphatic MetastasisMalePandemicsRetrospective Studies
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NCT05178186ClinicalTrials.gov
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