Covid-19
The rapidly expanding COVID-19 pandemic and associated global health crisis have impacted all areas of daily life, including medical treatment. Some groups of patients are considered to be facing more serious complications from SARS-CoV-2, including cancer patients [[1]]. Data are limited but suggest that the likelihood of a severe illness from COVID-19 is higher among adult patients with cancer, especially for those with active disease [[2]]. Thus, when performing thyroid surgery, surgeons must adopt a decision-making approach in response to the COVID-19 pandemic in order to balance the risks of postponing thyroid interventions versus the risks of COVID-19 exposure and possible complications.
Are patients who have had radioiodine therapy or thyroid surgery at higher risk of COVID-19 infection?
There is no evidence that patients who have recently had radioiodine therapy or thyroid surgery for benign (non-cancerous) thyroid disease are at increased risk of general viral (and therefore Covid-19) infection.
Is it safe to defer definitive (radioactive iodine or thyroid surgery) treatment for hyperthyroidism?
The NHS has instructed hospitals to postpone all non-urgent surgery, so it is unlikely that those awaiting thyroidectomy for benign disease will have thyroid surgery during the outbreak. In addition, it is highly likely that radioactive iodine therapy for hyperthyroidism will also need to be deferred. Most hospital trusts have already cancelled planned, elective radioactive iodine treatments. The BTA would like to reassure patients and doctors that in most cases, these measures are acceptable and safe.
At the time of the outbreak of corona virus heart disease, elective surgeries were almost postponed to minimize the risk of transmission. Since thyroid surgery usually does not cover immediate surgical interventions, during the COVID-19 pandemic nearly all of the patients who require thyroid surgery care are experiencing delays in the operation planning procedure.
How long should a patient wait to have elective surgery after they have had a confirmed COVID-19 infection?
If a patient tests positive for SARS-CoV-2, elective surgical procedures should be delayed until the patient is no longer infectious and has demonstrated recovery from COVID-19.
A patient may be infectious until either, based upon a CDC non-test-based strategy in mild-moderate cases of COVID-19: a) At least 24 hours since resolution of fever without the use of fever- reducing medications and improvement in respiratory symptoms, and b) at least 10 days since symptoms first appeared OR via a CDC non-test-based strategy in severe cases of COVID-19 or in immunocompromised patients: a) At least 10 days and up to 20 days have passed since symptom onset and b) At least 24 hours since resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms, and c) Symptoms (e.g., cough, shortness of breath) have improved.
The timing of elective surgery after recovery from COVID-19 uses both symptom- and severity-based categories. Please refer to the ASA-APSF Joint Statement on Elective Surgery and Anesthesia for Patients after COVID-19 Infection for further information. That statement includes suggested wait times from the date of COVID-19 diagnosis to surgery as:
Four weeks for an asymptomatic patient or recovery from only mild, non-respiratory symptoms.
Six weeks for a symptomatic patient (e.g., cough, dyspnea) who did not require hospitalization.
Eight to 10 weeks for a symptomatic patient who is diabetic, immunocompromised, or hospitalized.
Twelve weeks for a patient who was admitted to an intensive care unit due to COVID-19 infection.
References
https://www.ejso.com/article/S0748-7983(20)30649-1/fulltext
https://www.btf-thyroid.org/news/thyroid-disease-and-coronavirus-covid-19
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8288414/
https://www.asahq.org/in-the-spotlight/coronavirus-covid-19-information/elective-surgery
