HISTORY OF THYROID CANCER – IS IT A RISK FACTOR FOR CORONAVIRUS INFECTION?
Previous treatment of thyroid cancer (thyroidectomy with or without lymph node dissection with or without radioiodine ablation therapy) is not associated with a higher risk of infection from the coronavirus (COVID-19)
ADJUVANT RADIOIODINE ABLATION THERAPY – IS IT SAFE TO POSTPONE IT?
Adjuvant radioiodine ablation therapy following surgery for thyroid cancer is not urgent and can be safely postponed. Although radioiodine ablation therapy itself does not increase the risk of infection, subsequent radiation protection issues could seriously complicate the care of any patient who subsequently became infected.
TSH SUPPRESSIVE THERAPY – IS IT ASSOCIATED WITH AN INCREASED RISK FOR CORONAVIRUS (COVID-19) INFECTION?
TSH suppressive therapy is a tool to prevent tumor recurrence. Suppressive doses of thyroxine are typically administered in order to achieve low TSH levels (<0.1 mU/l). TSH suppressive therapy should be continued since it is not associated with an increased risk of VOVID-19 infection.
PLANNING SURGERY FOR THYROID CANCER – WHAT’S THE OPTIMAL TIMING?
Thyroid cancer surgery can be safely postponed in the majority of patients until the pandemic is contained. Coronavirus (COVID-19) infection is potentially dangerous.
This is true in particular for high-risk groups (aged people, with comorbidities).
However, unpredictable and adverse outcomes can be observed even in young patients without underlying diseases.
For these reasons, in the vast majority of patients with thyroid cancer, surgery should be postponed, with very few exceptions:
• Aggressive tumor recurrence with very short doubling time
• Rare aggressive subtypes of thyroid cancer, such as anaplastic thyroid carcinoma. In these cases, radical surgery is often not possible. If diagnosis is not possible (based on cytology findings following fine-needle aspiration), open (surgical) biopsy will be required
• Suspicion for thyroid lymphoma. Open (surgical) biopsy will establish the diagnosis, thereby allowing the further treatment of the patient (combined chemo-/radiation therapy)
It should be emphasized that in most patients, thyroid cancer has an extremely ‘benign’ biological behavior. Therefore, postponing surgery is safer than performing thyroidectomy during the potentially dangerous pandemic. Disease progression during this short time interval is highly unlikely.
CHEMOTHERAPHY FOR THYROID CANCER – IS IT A RISK FACTOR FOR THE CORONAVIRUS INFECTION?
The administration of chemotherapy/thyrosine-kinase inhibitors for thyroid cancer is associated with an increased risk of severe/complicated illness from coronavirus. Fortunately, chemotherapy is rarely administered in patients with thyroid cancer. These high-risk patients should follow strict protective measures.
ESES / BTF