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Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study
F. Medas, C. Dobrinja, EA. Al-Suhaimi, J. Altmeier, S. Anajar, AE. Arikan, I. Azaryan, L. Bains, G. Basili, H. Bolukbasi, M. Bononi, F. Borumandi, MB. Bozan, G. Brenta, L. Brunaud, M. Brunner, A. Buemi, GL. Canu, F. Cappellacci, SB. Cartwright,...
Language English Country England, Great Britain
Document type Multicenter Study, Journal Article
- MeSH
- COVID-19 * epidemiology MeSH
- Humans MeSH
- Lymphatic Metastasis MeSH
- Thyroid Neoplasms * epidemiology surgery pathology MeSH
- Pandemics MeSH
- Cross-Sectional Studies MeSH
- Retrospective Studies MeSH
- Thyroid Nodule * epidemiology surgery diagnosis MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
BACKGROUND: Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. METHODS: In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. FINDINGS: Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). INTERPRETATION: Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. FUNDING: None.
2nd Department of Surgery Athens Naval and Veterans Hospital Athens Greece
3rd Department of Surgery Attikon University Hospital Athens Greece
3rd Faculty of Medicine Charles University Prague Czech Republic
3rd Surgery Department Aristotle University of Thessaloniki Thessaloniki Greece
ASL VCO Ospedale San Biagio Domodossola Italy
Azienda USL Toscana Nord Ovest UOSD Chirurgia della Tiroide Toscana Italy
Clinic for Endocrine Surgery University Clinical Center of Serbia Belgrade Serbia
Clinic for Surgical Oncology Institute of Oncology and Radiology of Serbia Belgrade Serbia
CMH Lahore Medical College and Institute of Dentistry Lahore Pakistan
Departamento de Cabeza y Cuello Instituto Nacional de Cancerología Mexico City Mexico
Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy
Department of Breast and Endocrine Surgery Kitasato University Hospital Sagamihara Japan
Department of Endocrine Surgery Evangelisches Klinikum Cologne Weyertal Cologne Germany
Department of Endocrinology and Nutrition Hospital Universitari Mútua Terrassa Terrassa Spain
Department of Endocrinology Tan Tock Seng Hospital Singapore
Department of ENT Head and Neck Surgery All India Institute of Medical Sciences Bhubaneswar India
Department of ENT University Hospitals Birmingham NHS Trust Birmingham UK
Department of General and Digestive Surgery Hospital Universitario de La Princesa Madrid Spain
Department of General Endocrine and Transplant Surgery Medical University of Gdańsk Gdańsk Poland
Department of General Surgery Division of Visceral Surgery Medical University Vienna Vienna Austria
Department of Head and Neck Surgery Hospital das Clínicas University of São Paulo São Paulo Brazil
Department of Head and Neck Surgery Medanta Gurugram India
Department of Head and Neck Surgry and Otorhinolaryngology AC Camargo Cancer Center São Paulo Brazil
Department of Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
Department of Nuclear Medicine PET CT Theageneio Cancer Hospital of Thessaloniki Thessaloniki Greece
Department of Otolaryngology Faculty of Medicine Chulalongkorn University Bangkok Thailand
Department of Otolaryngology Head and Neck Surgery Auckland City Hospital Auckland New Zealand
Department of Otolaryngology Head and Neck Surgery University of Toronto Toronto ON Canada
Department of Otorhinolaryngology Head and Neck Surgery Singapore General Hospital Singapore
Department of Pathophysiology Faculty of Medical Sciences University of Kragujevac Kragujevac Serbia
Department of Radiology Thien Hanh Hospital Buon Ma Thuot Vietnam
Department of Scientific Affairs Smart Health Tower Sulaimani Iraq
Department of Surgery Ajou University School of Medicine Suwon South Korea
Department of Surgery and Otolaryngology Oregon Health and Science University Portland OR USA
Department of Surgery Ankara University Faculty of Medicine Ankara Turkey
Department of Surgery Chinese University of Hong Kong Hong Kong Special Administrative Region China
Department of Surgery Cliniques Universitaires Saint Luc Bruxelles Belgium
Department of Surgery CVMC CHU Nancy Brabois Université de Lorraine Nancy France
Department of Surgery Eugenideio Hospital Athens Greece
Department of Surgery Faculty of Medicine Universitas Andalas Padang City Indonesia
Department of Surgery General Surgery Unit S Stefano Hospital Prato Italy
Department of Surgery General University Hospital of Patras Patras Greece
Department of Surgery Klaipeda University Hospital Klaipeda Lithuania
Department of Surgery Maulana Azad Medical College New Delhi India
Department of Surgery National Hospital Kandy Kandy Sri Lanka
Department of Surgery National University Hospital Singapore
Department of Surgery NSCB Medical College Jabalpur India
Department of Surgery Saint Andrew Hospital of Patras Patras Greece
Department of Surgery Saint John of God Hospital Salzburg Austria
Department of Surgery Sapienza University of Rome Rome Italy
Department of Surgery Tampere University Hospital Tampere Finland
Department of Surgery Tseung Kwan O Hospital Hong Kong Special Administrative Region China
Department of Surgery University of Nebraska Medical Center Omaha NE USA
Department of Surgery University of Toronto Toronto ON Canada
Department of Surgical Oncological and Oral Sciences University of Palermo Palermo Italy
Department of Surgical Sciences and Integrated Diagnostics University of Genoa Genova Italy
Department of Surgical Sciences Sapienza University of Rome Rome Italy
Department of Surgical Sciences University of Cagliari Cagliari Italy
Department of Thoracic Surgery 424 General Military Hospital Thessaloniki Greece
Department of Thoracic Surgery Mohammed 5 Military Teaching Hospital Rabat Morocco
Department of Thyroid Surgery REA Hospital Athens Greece
Department of Thyroid Surgery The 1st Affiliated Hospital of Jinan University Guangzhou China
Dipartimento di Chirurgia Pietro Valdoni Policlinico Umberto 1 Sapienza Rome Italy
Division of Endocrine Surgery General Surgery Department Ege University Hospital Izmir Turkey
Endocrine and Metabolic Surgery Bhargav Endocrine Hospital Vijayawada India
Endocrine Surgery Department of General Surgery Waikato Hospital Hamilton New Zealand
Endocrine Surgery Department Saint Petersburg State University Hospital Saint Petersburg Russia
Endocrine Surgery Diakonie Klinikum Stuttgart Stuttgart Germany
Endocrine Surgery Unit University Hospital of Pisa Pisa Italy
Endocrine Surgery Unit University of Perugia Santa Maria Hospital Terni Italy
Endocrine Surgery University Hospital Center of Central Lisbon Hospital Curry Cabral Lisboa Portugal
Endocrinology and Nutrition Hospital Regional Universitario Málaga Spain
Endocrinology Department Granollers General Hospital Barcelona Spain
Endocrinology Department Unidad Asistencial Dr César Milstein Buenos Aires Argentina
ENT Department University Hospital of Larissa Larissa Greece
Faculty of Medicine University of Colombo Colombo Sri Lanka
Galilee Medical Center Azrieli Faculty of Medicine Bar Ilan University Safed Israel
General and Endocrine Surgery CHU Poitiers Poitiers France
General Surgery Department Universitat de Barcelona Hospital Clínic de Barcelona Barcelona Spain
General Surgery Hospital Universitario Principe de Asturias Alcala de Henares Spain
General Surgery Kahramanmaras Sutcu Imam University Faculty of Medicine Kahramanmaras Türkiye
General Surgery Unit Department of Medicine and Surgery Parma University Hospital Parma Italy
Head and Neck Department Hospital de Oncología Centro Médico Nacional Siglo XXI Mexico City Mexico
Head and Neck Department Oncologos del Occidente Universidad de Caldas Manizales Colombia
Head and Neck Surgery Brest University Hospital Brest France
Head and Neck Surgery Department Hospital Ana Nery Santa Cruz do Sul Brazil
Head and Neck Surgery Hospital Universitario Nacional de Colombia Bogotá DC Colombia
Institute of Pathology and Forensic Medicine Medical Military Academy Belgrade Serbia
National Cancer Institute of Mexico Mexico City Mexico
Oncology Center Medica Sur Hospital Mexico City Mexico
Otolaryngology Department Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran
Otolaryngology Midlands Regional Hospital Tullamore Tullamore Ireland
Otorhinolaryngology Unit Azienda USL IRCCS di Reggio Emilia Reggio Emilia Italy
School of Medicine Belgrade Serbia
Service of Endocrinology Hospital Privado Universitario de Córdoba Córdoba Argentina
South Infirmary Victoria University Hospital Cork Ireland
Surgery Bitenc Ljubljana Slovenia
Surgery Department 'A' Ibn Sina Hospital Medical School Mohammed 5 University Rabat Morocco
Surgical Oncology Mansoura University Mansoura Egypt
Surgical Oncology Tula's General Hospital Tula de Allende Mexico
Surgical Pathology Department Instituto de Patologia de Araçatuba Araçatuba Brazil
The Royal Melbourne Hospital and Epworth Hospital Melbourne VIC Australia
Thoracic Surgery Azienda Ospedaliera di Perugia Perugia Italy
Unit of Endocrine Surgery AOU Mater Domini Catanzaro Italy
Unit of Endocrine Surgery Head and Neck Parc Tauli Hospital Universitari Sabadell Spain
UOC Chirurgia Endocrina e Metabolica Fondazione Policlinico Universitario A Gemelli IRCCS Rome Italy
References provided by Crossref.org
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- $a Medas, Fabio $u Department of Surgical Sciences, University of Cagliari, Cagliari, Italy. Electronic address: fabiomedas@unica.it
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- $a Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study / $c F. Medas, C. Dobrinja, EA. Al-Suhaimi, J. Altmeier, S. Anajar, AE. Arikan, I. Azaryan, L. Bains, G. Basili, H. Bolukbasi, M. Bononi, F. Borumandi, MB. Bozan, G. Brenta, L. Brunaud, M. Brunner, A. Buemi, GL. Canu, F. Cappellacci, SB. Cartwright, I. Castells Fusté, B. Cavalheiro, G. Cavallaro, A. Chala, SYB. Chan, J. Chaplin, MS. Cheema, C. Chiapponi, MG. Chiofalo, E. Chrysos, A. D'Amore, M. de Cillia, C. De Crea, N. de Manzini, LL. de Matos, L. De Pasquale, P. Del Rio, MS. Demarchi, M. Dhiwakar, G. Donatini, JM. Dora, V. D'Orazi, VK. Doulatram Gamgaram, V. Eismontas, EH. Kabiri, HO. El Malki, I. Elzahaby, O. Enciu, A. Eskander, F. Feroci, D. Figueroa-Bohorquez, D. Filis, G. François, P. Frías-Fernández, A. Gamboa-Dominguez, V. Genc, D. Giordano, A. Gómez-Pedraza, G. Graceffa, J. Griffin, SC. Guerreiro, K. Gupta, KK. Gupta, A. Gurrado, J. Hajiioannou, T. Hakala, WA. Harahap, L. Hargitai, D. Hartl, A. Hellmann, J. Hlozek, VT. Hoang, M. Iacobone, N. Innaro, O. Ioannidis, JHI. Jang, JC. Xavier-Junior, M. Jovanovic, RM. Kaderli, F. Kakamad, K. Kaliszewski, M. Karamanliev, H. Katoh, A. Košec, B. Kovacevic, LP. Kowalski, R. Králik, SK. Yadav, A. Kumorová, S. Lampridis, K. Lasithiotakis, JC. Leclere, EKF. Leong, MK. Leow, JY. Lim, LS. Lino-Silva, SYW. Liu, NP. Llorach, CP. Lombardi, J. López-Gómez, E. Lori, L. Quintanilla-Dieck, R. Lucchini, A. Madani, D. Manatakis, I. Markovic, G. Materazzi, H. Mazeh, G. Mercante, GY. Meyer-Rochow, O. Mihaljevic, JA. Miller, M. Minuto, M. Monacelli, F. Mulita, B. Mullineris, JL. Muñoz-de-Nova, F. Muradás Girardi, S. Nader, T. Napadon, C. Nastos, C. Offi, O. Ronen, L. Oragano, A. Orois, Y. Pan, E. Panagiotidis, RB. Panchangam, T. Papavramidis, PK. Parida, A. Paspala, ÒV. Pérez, S. Petrovic, M. Raffaelli, CF. Ramacciotti, T. Ratia Gimenez, Á. Rivo Vázquez, JL. Roh, L. Rossi, A. Sanabria, A. Santeerapharp, A. Semenov, S. Seneviratne, A. Serdar, P. Sheahan, SC. Sheppard, RL. Slotcavage, C. Smaxwil, SY. Kim, S. Sorrenti, E. Spartalis, C. Sriphrapradang, M. Testini, Y. Turk, G. Tzikos, K. Vabalayte, K. Vargas-Osorio, RS. Vázquez Rentería, D. Velázquez-Fernández, SMP. Vithana, L. Yücel, ED. Yulian, P. Zahradnikova, P. Zarogoulidis, E. Ziablitskaia, A. Zolotoukho, PG. Calò, THYCOVID Collaboration Group
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- $a BACKGROUND: Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. METHODS: In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. FINDINGS: Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). INTERPRETATION: Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. FUNDING: None.
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- 700 1_
- $a Dobrinja, Chiara $u Department of Medical and Surgical Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy
- 700 1_
- $a Al-Suhaimi, Ebtesam Abdullah $u Biology Department, College of Science, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- 700 1_
- $a Altmeier, Julia $u Endocrine Surgery, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
- 700 1_
- $a Anajar, Said $u Department of Otolaryngology-Head and Neck Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, Morocco
- 700 1_
- $a Arikan, Akif Enes $u Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Türkiye
- 700 1_
- $a Azaryan, Irina $u Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- 700 1_
- $a Bains, Lovenish $u Department of Surgery, Maulana Azad Medical College, New Delhi, India
- 700 1_
- $a Basili, Giancarlo $u Azienda USL Toscana Nord-Ovest, UOSD Chirurgia della Tiroide, Toscana, Italy
- 700 1_
- $a Bolukbasi, Hakan $u General Surgery, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Türkiye
- 700 1_
- $a Bononi, Marco $u Dipartimento di Chirurgia Pietro Valdoni, Policlinico Umberto I Sapienza, Rome, Italy
- 700 1_
- $a Borumandi, Farzad $u Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St Richard's Hospital, Chichester and Worthing Hospital, Worthing, UK
- 700 1_
- $a Bozan, Mehmet Buğra $u General Surgery, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Türkiye
- 700 1_
- $a Brenta, Gabriela $u Endocrinology Department, Unidad Asistencial Dr César Milstein, Buenos Aires, Argentina
- 700 1_
- $a Brunaud, Laurent $u Department of Surgery CVMC, CHU Nancy-Brabois, Université de Lorraine, Nancy, France
- 700 1_
- $a Brunner, Maximilian $u Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
- 700 1_
- $a Buemi, Antoine $u Department of Surgery, Cliniques Universitaires Saint Luc, Bruxelles, Belgium
- 700 1_
- $a Canu, Gian Luigi $u Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
- 700 1_
- $a Cappellacci, Federico $u Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
- 700 1_
- $a Cartwright, Sara Burchfield $u Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
- 700 1_
- $a Castells Fusté, Ignasi $u Endocrinology Department, Granollers General Hospital, Barcelona, Spain
- 700 1_
- $a Cavalheiro, Beatriz $u Departamento de Cirurgia de Cabeça e Pescoço, Hospital São Camilo Oncologia-Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil
- 700 1_
- $a Cavallaro, Giuseppe $u Department of Surgery, Sapienza University of Rome, Rome, Italy
- 700 1_
- $a Chala, Andres $u Head and Neck Department Oncologos del Occidente, Universidad de Caldas, Manizales, Colombia
- 700 1_
- $a Chan, Shun Yan Bryant $u Department of Surgery, Tseung Kwan O Hospital, Hong Kong Special Administrative Region, China
- 700 1_
- $a Chaplin, John $u Department of Otolaryngology Head and Neck Surgery, Auckland City Hospital, Auckland, New Zealand
- 700 1_
- $a Cheema, Mustafa Sajjad $u CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
- 700 1_
- $a Chiapponi, Costanza $u Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Cologne, Germany; Department of Endocrine Surgery, Evangelisches Klinikum Cologne Weyertal, Cologne, Germany
- 700 1_
- $a Chiofalo, Maria Grazia $u Head and Neck Cancer Medical Oncology Department, Istituto Nazionale Tumori, IRCCS Fondazione G Pascale, Napoli, Italy
- 700 1_
- $a Chrysos, Emmanuel $u Department of Surgery, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
- 700 1_
- $a D'Amore, Annamaria $u Division of Endocrine Surgery, Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- 700 1_
- $a de Cillia, Michael $u Department of Surgery, Saint John of God Hospital, Salzburg, Austria
- 700 1_
- $a De Crea, Carmela $u UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- 700 1_
- $a de Manzini, Nicolò $u Department of Medical and Surgical Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy
- 700 1_
- $a de Matos, Leandro Luongo $u Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
- 700 1_
- $a De Pasquale, Loredana $u Thyroid and Parathyroid Surgery Unit-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- 700 1_
- $a Del Rio, Paolo $u General Surgery Unit, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
- 700 1_
- $a Demarchi, Marco Stefano $u Department of Thoracic and Endocrine Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- 700 1_
- $a Dhiwakar, Muthuswamy $u Department of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Coimbatore, India
- 700 1_
- $a Donatini, Gianluca $u General and Endocrine Surgery, CHU Poitiers, Poitiers, France
- 700 1_
- $a Dora, Jose Miguel $u Thyroid Unit, Hospital de Clínicas de Porto Alegre and Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- 700 1_
- $a D'Orazi, Valerio $u Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy; Division of General Surgery-Section of Endocrine and Diabetic Foot Surgery, "Fabia Mater" Hospital, Rome, Italy
- 700 1_
- $a Doulatram Gamgaram, Viyey Kishore $u Endocrinology and Nutrition, Hospital Regional Universitario, Málaga, Spain
- 700 1_
- $a Eismontas, Vitalijus $u Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania; Health Research and Innovation Science Center, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
- 700 1_
- $a Kabiri, El Hassane $u Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
- 700 1_
- $a El Malki, Hadj Omar $u Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University, Rabat, Morocco
- 700 1_
- $a Elzahaby, Islam $u Surgical Oncology, Mansoura University, Mansoura, Egypt
- 700 1_
- $a Enciu, Octavian $u Elias University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- 700 1_
- $a Eskander, Antoine $u Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- 700 1_
- $a Feroci, Francesco $u Department of Surgery, General Surgery Unit, S Stefano Hospital, Prato, Italy
- 700 1_
- $a Figueroa-Bohorquez, David $u Head and Neck Surgery, Hospital Universitario Nacional de Colombia, Bogotá DC, Colombia
- 700 1_
- $a Filis, Dimitrios $u Department of Surgery, Saint Andrew Hospital of Patras, Patras, Greece
- 700 1_
- $a François, Gorostidi $u Otolaryngology and Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- 700 1_
- $a Frías-Fernández, Pedro $u Surgical Oncology, Tula's General Hospital, Tula de Allende, Mexico
- 700 1_
- $a Gamboa-Dominguez, Armando $u Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- 700 1_
- $a Genc, Volkan $u Department of Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
- 700 1_
- $a Giordano, Davide $u Otorhinolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- 700 1_
- $a Gómez-Pedraza, Antonio $u National Cancer Institute of Mexico, Mexico City, Mexico
- 700 1_
- $a Graceffa, Giuseppa $u Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
- 700 1_
- $a Griffin, James $u Otolaryngology, Midlands Regional Hospital Tullamore, Tullamore, Ireland
- 700 1_
- $a Guerreiro, Sofia Cuco $u Endocrine Surgery, University Hospital Center of Central Lisbon, Hospital Curry Cabral, Lisboa, Portugal
- 700 1_
- $a Gupta, Karan $u Department of Head and Neck Surgery, Medanta, Gurugram, India
- 700 1_
- $a Gupta, Keshav Kumar $u Department of ENT, University Hospitals Birmingham NHS Trust, Birmingham, UK
- 700 1_
- $a Gurrado, Angela $u Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
- 700 1_
- $a Hajiioannou, Jiannis $u ENT Department, University Hospital of Larissa, Larissa, Greece
- 700 1_
- $a Hakala, Tommi $u Department of Surgery, Tampere University Hospital, Tampere, Finland
- 700 1_
- $a Harahap, Wirsma Arif $u Department of Surgery, Faculty of Medicine, Universitas Andalas, Padang City, Indonesia
- 700 1_
- $a Hargitai, Lindsay $u Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
- 700 1_
- $a Hartl, Dana $u Department of Surgery, Anesthesia and Interventional Radiology, Head and Neck Oncology Service, Thyroid Surgery Unit, Gustave Roussy, Villejuif, France
- 700 1_
- $a Hellmann, Andrzej $u Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
- 700 1_
- $a Hlozek, Jiri $u Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, Prague, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
- 700 1_
- $a Hoang, Van Trung $u Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
- 700 1_
- $a Iacobone, Maurizio $u Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- 700 1_
- $a Innaro, Nadia $u Unit of Endocrine Surgery, AOU Mater Domini, Catanzaro, Italy
- 700 1_
- $a Ioannidis, Orestis $u Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital "Georgios Papanikolaou", Thessaloniki, Greece
- 700 1_
- $a Jang, J H Isabelle $u Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
- 700 1_
- $a Xavier-Junior, Jose Candido $u Surgical Pathology Department, Instituto de Patologia de Araçatuba, Araçatuba, Brazil
- 700 1_
- $a Jovanovic, Milan $u Clinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade, Serbia
- 700 1_
- $a Kaderli, Reto Martin $u Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- 700 1_
- $a Kakamad, Fahmi $u Department of Scientific Affairs, Smart Health Tower, Sulaimani, Iraq
- 700 1_
- $a Kaliszewski, Krzysztof $u Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
- 700 1_
- $a Karamanliev, Martin $u Department of Surgical Oncology, University Hospital "Georgi Stranski", Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria
- 700 1_
- $a Katoh, Hiroshi $u Department of Breast and Endocrine Surgery, Kitasato University Hospital, Sagamihara, Japan
- 700 1_
- $a Košec, Andro $u Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- 700 1_
- $a Kovacevic, Bozidar $u Institute of Pathology and Forensic Medicine, Medical Military Academy, Belgrade, Serbia
- 700 1_
- $a Kowalski, Luiz Paulo $u Department of Head and Neck Surgry and Otorhinolaryngology, AC Camargo Cancer Center, São Paulo, Brazil
- 700 1_
- $a Králik, Robert $u Department of Surgical Oncology, St Elisabeth Cancer Institute, Medical Faculty of Comenius University, Bratislava, Slovakia
- 700 1_
- $a Yadav, Sanjay Kumar $u Department of Surgery, NSCB Medical College, Jabalpur, India
- 700 1_
- $a Kumorová, Adriána $u Clinic of Otorhinolaryngology and Head and Neck Surgery, Central Military Hospital Ružomberok, Ružomberok, Slovakia
- 700 1_
- $a Lampridis, Savvas $u Department of Thoracic Surgery, 424 General Military Hospital, Thessaloniki, Greece
- 700 1_
- $a Lasithiotakis, Konstantinos $u Department of Surgery, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
- 700 1_
- $a Leclere, Jean-Christophe $u Head and Neck Surgery, Brest University Hospital, Brest, France
- 700 1_
- $a Leong, Eugene Kwong Fei $u Department of Surgery, National University Hospital, Singapore
- 700 1_
- $a Leow, Melvin Khee-Shing $u Department of Endocrinology, Tan Tock Seng Hospital, Singapore
- 700 1_
- $a Lim, James Y $u Department of Surgery and Otolaryngology, Oregon Health and Science University, Portland, OR, USA
- 700 1_
- $a Lino-Silva, Leonardo S $u Oncology Center, Medica Sur Hospital, Mexico City, Mexico
- 700 1_
- $a Liu, Shirley Yuk Wah $u Department of Surgery, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- 700 1_
- $a Llorach, Núria Perucho $u Unit of Endocrine Surgery Head and Neck Parc Tauli, Hospital Universitari, Sabadell, Spain
- 700 1_
- $a Lombardi, Celestino Pio $u Division of Endocrine Surgery, Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- 700 1_
- $a López-Gómez, Javier $u Head and Neck Department, Hospital de Oncología Centro Médico Nacional Siglo XXI, Mexico City, Mexico
- 700 1_
- $a Lori, Eleonora $u Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
- 700 1_
- $a Quintanilla-Dieck, Lourdes $u Department of Pediatric Otolaryngology, Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA
- 700 1_
- $a Lucchini, Roberta $u Endocrine Surgery Unit, University of Perugia, Santa Maria Hospital, Terni, Italy
- 700 1_
- $a Madani, Amin $u Department of Surgery, University of Toronto, Toronto, ON, Canada
- 700 1_
- $a Manatakis, Dimitrios $u Second Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
- 700 1_
- $a Markovic, Ivan $u Clinic for Surgical Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
- 700 1_
- $a Materazzi, Gabriele $u Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
- 700 1_
- $a Mazeh, Haggi $u Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- 700 1_
- $a Mercante, Giuseppe $u Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
- 700 1_
- $a Meyer-Rochow, Goswin Yason $u Endocrine Surgery, Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
- 700 1_
- $a Mihaljevic, Olgica $u Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- 700 1_
- $a Miller, Julie A $u The Royal Melbourne Hospital and Epworth Hospital, Melbourne, VIC, Australia
- 700 1_
- $a Minuto, Michele $u Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy
- 700 1_
- $a Monacelli, Massimo $u Thoracic Surgery, Azienda Ospedaliera di Perugia, Perugia, Italy
- 700 1_
- $a Mulita, Francesk $u Department of Surgery, General University Hospital of Patras, Patras, Greece
- 700 1_
- $a Mullineris, Barbara $u Department of General, Emergency and New Technologies, University Hospital of Modena, Baggiovara Civil Hospital, Modena, Italy
- 700 1_
- $a Muñoz-de-Nova, José Luis $u Department of General and Digestive Surgery, Hospital Universitario de La Princesa, Madrid, Spain
- 700 1_
- $a Muradás Girardi, Fábio $u Head and Neck Surgery Department, Hospital Ana Nery, Santa Cruz do Sul, Brazil
- 700 1_
- $a Nader, Saki $u Otolaryngology Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- 700 1_
- $a Napadon, Tangjaturonrasme $u Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- 700 1_
- $a Nastos, Constantinos $u Third Department of Surgery, Attikon University Hospital, Athens, Greece
- 700 1_
- $a Offi, Chiara $u Department of Endocrine and Ultrasound-Guided Surgery, Ospedale del Mare, ASl Napoli 1 Centro, Naples, Italy
- 700 1_
- $a Ronen, Ohad $u Galilee Medical Center, Azrieli Faculty of Medicine Bar Ilan University, Safed, Israel
- 700 1_
- $a Oragano, Luigi $u ASL VCO, Ospedale San Biagio, Domodossola, Italy
- 700 1_
- $a Orois, Aida $u Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Terrassa, Spain
- 700 1_
- $a Pan, Yongqin $u Department of Thyroid Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- 700 1_
- $a Panagiotidis, Emmanouil $u Department of Nuclear Medicine/PET CT, Theageneio Cancer Hospital of Thessaloniki, Thessaloniki, Greece
- 700 1_
- $a Panchangam, Ramakanth Bhargav $u Endocrine and Metabolic Surgery, Bhargav Endocrine Hospital, Vijayawada, India
- 700 1_
- $a Papavramidis, Theodosios $u First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
- 700 1_
- $a Parida, Pradipta Kumar $u Department of ENT-Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
- 700 1_
- $a Paspala, Anna $u Department of Surgery, Eugenideio Hospital, Athens, Greece
- 700 1_
- $a Pérez, Òscar Vidal $u General Surgery Department, Universitat de Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
- 700 1_
- $a Petrovic, Sabrina $u Surgery Bitenc, Ljubljana, Slovenia
- 700 1_
- $a Raffaelli, Marco $u UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- 700 1_
- $a Ramacciotti, Constanza Fernanda $u Service of Endocrinology, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- 700 1_
- $a Ratia Gimenez, Tomas $u General Surgery, Hospital Universitario Principe de Asturias, Alcala de Henares, Spain
- 700 1_
- $a Rivo Vázquez, Ángel $u Department of General and Digestive Surgery, Division of Endocrine Surgery, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
- 700 1_
- $a Roh, Jong-Lyel $u Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
- 700 1_
- $a Rossi, Leonardo $u Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
- 700 1_
- $a Sanabria, Alvaro $u Department of Surgery, Universidad de Antioquia, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
- 700 1_
- $a Santeerapharp, Alena $u Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
- 700 1_
- $a Semenov, Arseny $u Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
- 700 1_
- $a Seneviratne, Sanjeewa $u Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- 700 1_
- $a Serdar, Altinay $u Department of Endocrin Pathology Unit, University of Health Sciences, Faculty of Medicine, Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
- 700 1_
- $a Sheahan, Patrick $u South Infirmary Victoria University Hospital, Cork, Ireland
- 700 1_
- $a Sheppard, Sean C $u Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
- 700 1_
- $a Slotcavage, Rachel L $u Department of Surgery and Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- 700 1_
- $a Smaxwil, Constantin $u Endocrine Surgery, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
- 700 1_
- $a Kim, Soo Young $u Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
- 700 1_
- $a Sorrenti, Salvatore $u Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
- 700 1_
- $a Spartalis, Eleftherios $u Department of Thyroid Surgery, REA Hospital, Athens, Greece
- 700 1_
- $a Sriphrapradang, Chutintorn $u Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- 700 1_
- $a Testini, Mario $u Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
- 700 1_
- $a Turk, Yigit $u Division of Endocrine Surgery, General Surgery Department, Ege University Hospital, Izmir, Turkey
- 700 1_
- $a Tzikos, George $u First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
- 700 1_
- $a Vabalayte, Kristina $u Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
- 700 1_
- $a Vargas-Osorio, Kelly $u Clinical University Hospital Santiago de Compostela University of Santiago de Compostela, Santiago de Compostela, Spain
- 700 1_
- $a Vázquez Rentería, Rafael Sebastián $u Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología, Mexico City, Mexico
- 700 1_
- $a Velázquez-Fernández, David $u Endocrine Surgery Unit, Department of Surgery, National Institute for Medical Sciences and Nutrition, Mexico City, Mexico
- 700 1_
- $a Vithana, Sanura Malinda Pallegoda $u Department of Surgery, National Hospital Kandy, Kandy, Sri Lanka
- 700 1_
- $a Yücel, Levent $u Department of Otorhinolaryngology, University of Health Sciences, Gülhane Research and Training Hospital, Ankara, Turkey
- 700 1_
- $a Yulian, Erwin Danil $u Division of Surgical Oncology, Department of Surgery, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- 700 1_
- $a Zahradnikova, Petra $u Department of Paediatric Surgery, Medical Faculty of Comenius University, National Institute of Children's Diseases, Bratislava, Slovakia
- 700 1_
- $a Zarogoulidis, Paul $u Third Surgery Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- 700 1_
- $a Ziablitskaia, Evgeniia $u Central Research Laboratory, Clinical Medical Multidisciplinary Center of St Luke VI Vernadsky Crimean Federal University, Simferopol, Russia
- 700 1_
- $a Zolotoukho, Anna $u Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
- 700 1_
- $a Calò, Pietro Giorgio $u Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
- 710 2_
- $a THYCOVID Collaboration Group
- 773 0_
- $w MED00186388 $t The lancet. Diabetes & endocrinology $x 2213-8595 $g Roč. 11, č. 6 (2023), s. 402-413
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