Managing Patients With Thyroid Cancer During the COVID-19 Pandemic
Posted: Thursday, May 14, 2020
Despite the lack of guidelines for managing patients with cancer during a pandemic, patients with thyroid cancer can be managed based on risk-group analysis and overall risk of progression to life-threatening issues. In a recent article published in Head and Neck, Ashok R. Shaha, MD, of Memorial Sloan Kettering Cancer Center, New York, offered some general principles for decision-making based on clinical observations regarding the surgical treatment of patients with thyroid cancer amid the COVID-19 pandemic.
“If we use the analogy of management of thyroid cancer during pregnancy and delaying the treatment by 9 to 10 months, it would be the same philosophy of managing these patients during the COVID‐19 pandemic. Clearly, some patients will require urgent or active intervention in a timely fashion,” stated Dr. Shaha.
Patients with large tumors and bulky nodal disease should be managed based on the duration of nodal metastasis as well as the proximity of the tumor to vital structures. A similar plan may be followed for patients with recurrent thyroid carcinoma, and these patients can be observed for an extended period. Patients with large goiters, even with tracheal deviation and mild compression, can avoid surgery as well, unless they begin to experience major compression symptoms or airway obstruction.
Patients with indeterminate thyroid nodules may be monitored before surgical intervention is needed. Those with low- or intermediate-risk thyroid carcinomas may be able to wait to have surgery. In addition, patients with microcarcinomas may remain under active surveillance or defer intervention. Benign thyroid conditions such as Hashimoto’s thyroiditis or Graves’ disease may be managed with the aid of telemedicine to allow physicians to remain in contact with their patients. The American Thyroid Association guidelines should still be followed regarding incidental thyroid nodules, and fine-needle aspiration should be avoided for nonsuspicious nodules.
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