Endocrine Abstracts

Background: The COVID-19 outbreak in Italy forced the health system to cancel all non-urgent outpatient activities, to avoid further spreading of the disease inside the healthcare facilities. At our institution, for cancer patients the hospital allowed treatments and consultations: the medical team, however, identified patients whose procedures could be postponed. Even after May 2020, the capacity for non-urgent thyroid surgeries was reduced. These events enhanced our efforts to reduce overdiagnosis and overtreatment of non-threatening thyroid cancers, as was already suggested by current practice guidelines. The aim of this analysis was to describe the features of patients submitted to thyroid surgery with a final diagnosis of cancer before and after the Italian lockdown.

Methods: Single-center, subgroup analysis of a prospective observational study (NCT04031339), approved by the institutional review board. The records on all patients being followed up in our center were analyzed. The cohort was split in two groups: the first one, before the COVID-19 lockdown (March 2019-February 2020, group A), and the second one during and after the lockdown (March 2020-February 2021, group B). The early response to treatment was assessed 6 to 12 months after initial treatment, according to the American Thyroid Association guidelines.

Results: Group A consisted of 58 patients, while group B of 38 patients, due to a reduction of the number of thyroid surgeries. There were no difference in age (group A: 48 years, 36-61; group B: 52 years, 33-61;P=0.9), gender distributions (females 74.1% and 65.8%, respectively), and known risk factors (i.e., family history of thyroid cancer, previous neck irradiation). Also, the histotype distribution was similar in the two cohorts (P=0.46). However, in the cohort of patients submitted to surgery after COVID-19 outbreak, the median tumor size was higher: 14 mm (IQR 10-25 mm) vs 9 mm (IQR 6-20 mm;P=0.01), and the rate of microcarcinomas was lower (12 [31.6%] vs 33 [56.9%], P=0.02). Furthermore, the ATA risk stratification distribution was different (P=0.036), with less low-risk and more high-risk cancers (19.4% vs 5.5%). This is consistent with a reduction in overtreatment of low-risk diseases. However, the early response to treatment was not affected (P=0.73), as the vast majority of patients had no evidence of persistent disease after treatment (A, 51.7% and B, 57.9%).

Conclsions: The “forced” reduction of thyroid surgeries due to COVID-19 outbreak improved the adherence to international practice guidelines, with decreased overtreatment: the short-term outcomes were not negatively impacted.