Thyroid surgery during the COVID-19 pandemic: difficulties - how to improve

Abstract

In December 2019, the new coronavirus infection (COVID-19) was declared a pandemic by the World Health Organization after rapidly spreading over the world in just a few months. All elective operations and nonemergency treatments have been postponed worldwide. However, some patients require surgical therapy as well, and the time spent waiting should not have a negative impact on the surgical outcome or disease course. Following the initial onset of the COVID-19 epidemic, instructions for proper and safe surgery for healthcare staff and patients should develop. Thyroid surgeries have decreased during the COVID-19 pandemic. Most of them can be postponed for a long time. Assessment of thyroid nodules recommends clinical examination, imaging studies, fine needle aspiration (FNA) and vocal cord examination. All these procedures are necessary, and sometimes they cannot be postponed. To determine the best timing, a thorough preoperative assessment should be undertaken, taking into account both oncological and anatomical features. Furthermore, COVID-19 status must be negative prior to any intervention, and hospital infrastructure must be ready to deal with the demanding situation.

Keywords: Covid-19 pandemic; fine needle aspiration cytology; preoperative diagnosis; thyroid surgery; translaryngeal ultrasonography.

Figure 1:

Placement of the ultrasound transducer on the neck. (1) Hyoid bone, (2) ultrasound transducer, (3) thyroid cartilage, (4) cricoid cartilage, (5) cricothyroid muscle, and (6) trachea.

Figure 2:

TLUS of the vocal cords in the open (quiet) position in the B-scan. (1) The true vocal cords, (2) short muscles of the neck, and (3) thyroid cartilage.

Figure 3:

TLUS of the of right vocal cord palsy. (1) Right vocal cord is static and (2) left vocal cord is moving.