Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study
Errata to this article were published (Lancet Diabetes Endocrinol, Sep 2023 ↗ · 25 Sep 2026 ↗)
Authors' conclusion
Our 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.
Study context
- Population
- Patients who underwent surgery for indeterminate thyroid nodules, 157 centres in 49 countries, 2019–2021
- Participants
- 22,974 patients157 centres
- Exposure
- Surgery for indeterminate thyroid nodules across pandemic phases: prepandemic vs pandemic escalation vs pandemic decrease
- Outcome
- Number of surgeries for indeterminate thyroid nodules per phase; in thyroid cancers, tumours >10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases and tumours at high risk of structural disease recurrence
Methodological detailsinternational, multicentre
- International
- Multicentre
Main finding
As reported in the abstract
Prepandemic
2.0
median · IQR 0.9–3.7
Pandemic escalation
1.4
median · IQR 0.6–3.4
Pandemic decrease
2.3
median · IQR 1.0–5.0
Pandemic escalation vs Prepandemic: P < 0.0001 · Pandemic escalation vs Pandemic decrease: P < 0.0001
Observational data: associations, not effects.
Further findings
| Outcome | Prepandemic | Pandemic decrease | OR (95% CI) | P value | |
|---|---|---|---|---|---|
| Thyroid tumours >10 mmPandemic decreasevs Prepandemic | 69.0% | 71.5% | 1.1 (1.0–1.3) | P = 0.042 | |
| Lymph node metastasesPandemic decreasevs Prepandemic | 9.3% | 12.5% | 1.4 (1.2–1.7) | P = 0.0001 | |
| Tumours at high risk of structural disease recurrencePandemic decreasevs Prepandemic | 5.7% | 7.7% | 1.4 (1.1–1.7) | P = 0.0039 | |
| 0.512Odds ratio (log scale) |
- Thyroid tumours >10 mm: 2554 of 3704 vs 1515 of 2119
- Tumours at high risk of structural disease recurrence: 203 of 3584 vs 155 of 2006
Original publication
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