Table 1.
Procedures that should be adapted during the COVID-19 emergency for thyroid nodules/cancer and radioactive iodine treatment.
| Recommendations | Alternatives | Exceptions |
|---|---|---|
| Thyroid nodules | ||
| Postponement of scheduled outpatient imaging/functional test (Ultrasonography (US), 99mTc/123I/131I-scintigraphy with or without %uptake) and fine needle aspiration cytology | Tele-consultation | Patients with significant symptoms, indicating critical events (e.g. pressure to trachea, breathing difficulties) suggesting large goiter should undergo imaging for further assessment (always with precaution and risk/benefit assessment). |
| Discuss with referring physician the options of rescheduling and performing as scheduled and come to a consensus | Patients with a history, clinical characteristics and laboratory examinations indicating aggressive thyroid disease e.g. anaplastic, medullary, metastatic or other diseases e.g. lymphoma | |
| Paediatric patients with non-incidental cervical findings | ||
| Postponement of all radioactive iodine (131I) therapeutic administration for benign conditions | Rebook and consider a bridging with ATDs until definitive therapy unless contraindicated | Patients contraindicated for ATD's |
| Thyroid cancer | ||
| Postponement of diagnostic appointments for all patients with un-/newly diagnosed thyroid cancer and those under suppressive treatment. | Tele- consultation | Patients with a history, clinical characteristics and laboratory examinations indicating aggressive thyroid disease e.g. anaplastic, medullary, metastatic or other diseases e.g. lymphoma |
| Paediatric population with non-incidental cervical findings | ||
| Postponement of any scheduled outpatient examinations including biochemical and serological labs | High risk patients (and all patients with biochemical incomplete, structural incomplete, or indeterminate response) after careful risk/benefit assessment. | |
| Postponement of any scheduled outpatient imaging/functional test (US, post-surgical scintigraphy with or without % uptake or PET) | Discuss with referring physician rescheduling and performing as scheduled and come to a consensus | Patients with significant symptoms, indicating critical for life events (e.g. pressure to trachea, breathing difficulties) suggesting large goiter (always with precaution and risk/benefit assessment). |
| Postponement of any scheduled outpatient follow up examinations | Consider serum Tg and TgAbs measurements with or without exogenous TSH stimulation for selected patients. | Patients with local disease possibly infiltrating the trachea or the esophagus, or suspicious liver or bone spread. |
| Postponement of all non-urgent surgery, even those for cytologically confirmed differentiated thyroid cancer | Patients with large goiter causing regional critical for life events (e.g. pressure to trachea, breathing difficulties) or with rapidly growing thyroid nodules/ cancer | |
| Paediatric patients with worrisome rate of progression | ||
| Postponement of radioactive iodine (131I) therapy, either as remnant ablation or as adjuvant treatment (as defined in the Martinique principles (37). | 131I therapy for which a patient has already begun pre-treatment such as administration of redifferentiating agents or T4 withdrawal | |
| High risk patients for known disease (as defined in the Martinique principles (37). | ||
| Patients on suppressive doses of levothyroxine (i.e. have a TSH target according to their risk profile) should continue their current dose | Dose-adjustment via Tele-consultation | Patients with non-previously existing symptoms of hypo/hyperthyroidism |