MOROSÁN ALLO YJ1*, MAMANI VELA Z1, SELVAGGIO L1, RIDOLFO A1, PARISI C1, LO TARTARO M2, FAINGOLD C1, BRENTA G1
Durante la pandemia COVID-19 hubo una conducta conservadora en patología nodular tiroidea. Se desconoce la repercusión de esta medida en adultos mayores, en quienes el cáncer de tiroides (CT) suele ser más agresivo.
Con el objetivo de analizar el impacto de la pandemia en el diagnóstico y tratamiento de la patología nodular tiroidea en individuos ≥ 60 años, se revisaron datos retrospectivos de pacientes derivados consecutivamente a cirugía de tiroides desde 01/2019 a 02/2023.
Se consideraron 4 períodos (P): P1: 01/2019-02/2020 (PRE-COVID-19); P2: 03/2020-05/2021 (primer COVID-19); P3: 06/2021-12/2021 (segundo COVID-19) y P4: 01/2022-02/2023 (POST-COVID-19).
Se estableció la relación entre número de cirugías de tiroides y generales (CG) y retraso en días entre la biopsia del nódulo tiroideo y la cirugía de tiroides. Se registraron datos demográficos, pre (estratificación de riesgo por ecografía (US) ACR TI-RADS y citología) y postoperatorios (extensión de la cirugía e histología). En caso de CT se consignó: presentación avanzada, estratificación de riesgo de sobrevida (AJCC/TNM 8va) y recurrencia (American Thyroid Association). Se utilizó CHI2 y ANOVA para comparar datos entre períodos.
De 4153 pacientes (edad 69,9±6, 83% mujeres) derivados a CG, 84 (2%) correspondieron a cirugía de tiroides. La proporción cirugía tiroidea/CG fue en P1: 2,4% (n:33/1352), P2: 0,8% (n:7/820), P3: 2,5% (n:15/592) y P4: 2,08% (n:29/1389). El índice de proporciones de P2/P1 (0,33 (IC 95% 0,16-0,79)) mostró un 67% de reducción de cirugía tiroidea en el P2 retornando a valores PRE-COVID-19 en P3 y P4. El retraso a cirugía tiroidea fue similar entre períodos (mediana, rango intercuartilo: 135, 85-280 días). Los nódulos ACR TI-RADS 5, fueron más frecuentes en P4 vs P1 (12/29: 41% vs 4/28: 14%, p=0,012) así como el hallazgo de CT P4 vs P1 (18/29: 62% vs 12/33: 36%, p=0,043).
En el primer período COVID-19 disminuyó la cirugía tiroidea y postpandemia retornó predominando los nódulos sospechosos de malignidad en coincidencia con un aumento de la detección de CT.
Thyroid nodules management was more conservatively conducted during the COVID-19 pandemic. However, this strategy in older adults, in whom thyroid cancer may be more aggressive, has not yet been evaluated.
The aim of this study was to analyze the impact of the pandemic on the diagnosis of thyroid nodular goiter in older adults.
Patients ≥ 60 years of age referred for thyroid surgery (TS) were retrospectively reviewed from January 2019 to February 2023 in a tertiary care center for older adults. The study was subdivided into four periods (P): P1: January 2019-February 2020 (PRE-COVID-19); P2: March 2020 to May 2021 (first COVID-19); P3: June 2021 to December 2021 (second COVID-19 or pandemic decline) and P4: January 2022 to February 2023 (POST-COVID-19). The relationship between the number of TS and general surgeries (GS) was established. Additionally, a delay in days between thyroid nodule biopsy and TS was calculated. Demographic, pre (risk stratification by ultrasound (US) ACR TI-RADS and cytology) and postoperative (extent of surgery and histology) data were recorded. In case of thyroid cancer, size ≥ 4 cm, macroscopic extrathyroidal extension or distant metastases were considered an advanced presentation. For differentiated thyroid cancer, risk of mortality according to AJCC/TNM 8th edition (TNM) and risk of recurrence according to American Thyroid Association (ATA) were reported. CHI2 and ANOVA were used to compare data between the four periods.
Of 4153 GS over the study period, 84 (2%) patients were referred to TS (age 69.9±6, 83% female). Of this group, 33 (39.2%) had surgery in P1; 7 (8.3%) in P2; 15 (18%) in P3 and 29 (34.5%) in P4. The ratio of TS to GS was lower in P2: 0.8% (n:7/820) compared to P1: 2.4% (n:33/1352), P3: 2.5% (n:15/592) and P4: 2.08% (n:29/1389). The P2/P1 ratio index (0.33 (95% CI 0.16-0.79)) showed a 67% reduction in TS in the first COVID-19 period that returned to values similar to the prepandemic (P1) at P3 and 4. The delay in days to TS was (median, interquartile range) 135; 85-280, similar between periods. In total, there were 79.7% total thyroidectomies: 40.4% malignant tumors, of which 26% were advanced at the time of presentation, while 9.1% were microcarcinomas. Of 30 differentiated thyroid cancers: 66% were in stage I, 10% in stage II, 3% in stage III and 20% in TNM stage IV. Low risk of ATA was found in 71%, while the rest (29%) were all categorized as high risk. Comparing between periods, thyroid cancer was more frequent in P4 vs. P1 (18/29: 62% vs. 12/33: 36%, p=0.043). Coincidentally, the percentage of biopsied nodules with ACR TI-RADS category 5, corresponding to greater suspicion of cancer, was also higher in P4 vs P1 (12/29: 41% vs 4/28: 14%, p=0.012). Advanced thyroid cancer in P4 vs P1 (6/18: 33% vs 4/12: 33%) did not reach a significant difference (p=ns). In conclusion, during the first COVID-19 period, there was a marked decrease in the number of indications for thyroid surgery. Subsequently, this returned to normal, but unlike the prepandemic, the surgical indication for nodules suspected of malignancy predominated in coincidence with a higher finding of thyroid cancer in relation to benign pathology.