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.

1st Propedeutic Department of Surgery Aristotle University of Thessaloniki AHEPA University Hospital Thessaloniki Greece

2nd Department of Surgery Athens Naval and Veterans Hospital Athens Greece

3rd Department of Surgery Attikon University Hospital Athens Greece

3rd Surgery Department Aristotle University of Thessaloniki Thessaloniki Greece

4th Department of Surgery Medical School Aristotle University of Thessaloniki General Hospital Georgios Papanikolaou Thessaloniki Greece

ASL VCO Ospedale San Biagio Domodossola Italy

Azienda USL Toscana Nord Ovest UOSD Chirurgia della Tiroide Toscana Italy

Biology Department College of Science Institute for Research and Medical Consultations Imam Abdulrahman Bin Faisal University Dammam Saudi Arabia

Central Research Laboratory Clinical Medical Multidisciplinary Center of St Luke 6 Vernadsky Crimean Federal University Simferopol Russia

Clinic for Endocrine Surgery University Clinical Center of Serbia Belgrade Serbia; School of Medicine Belgrade Serbia

Clinic for Surgical Oncology Institute of Oncology and Radiology of Serbia Belgrade Serbia

Clinic of Otorhinolaryngology and Head and Neck Surgery Central Military Hospital Ružomberok Ružomberok Slovakia

Clinical University Hospital Santiago de Compostela University of Santiago de Compostela Santiago de Compostela Spain

CMH Lahore Medical College and Institute of Dentistry Lahore Pakistan

Departamento de Cabeza y Cuello Instituto Nacional de Cancerología Mexico City Mexico

Departamento de Cirurgia de Cabeça e Pescoço Hospital São Camilo Oncologia Instituto Brasileiro de Controle do Câncer São Paulo Brazil

Departamento de Patología Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico

Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy; Department of Otorhinolaryngology Head and Neck Surgery IRCCS Humanitas Research Hospital Rozzano Italy

Department of Breast and Endocrine Surgery Kitasato University Hospital Sagamihara Japan

Department of Endocrin Pathology Unit University of Health Sciences Faculty of Medicine Bakırköy Dr Sadi Konuk Training and Research Hospital Istanbul Turkey

Department of Endocrine and Ultrasound Guided Surgery Ospedale del Mare ASl Napoli 1 Centro Naples Italy

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 Division of Endocrine Surgery Complexo Hospitalario Universitario de Vigo Vigo Spain

Department of General and Digestive Surgery Hospital Universitario de La Princesa Madrid Spain

Department of General and Visceral Surgery Friedrich Alexander University Erlangen Nuremberg Erlangen Germany

Department of General Emergency and New Technologies University Hospital of Modena Baggiovara Civil Hospital Modena Italy

Department of General Endocrine and Transplant Surgery Medical University of Gdańsk Gdańsk Poland

Department of General Minimally Invasive and Endocrine Surgery Wroclaw Medical University Wroclaw Poland

Department of General Surgery Acibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Türkiye

Department of General Surgery Division of Visceral Surgery Medical University Vienna Vienna Austria

Department of General Visceral Cancer and Transplant Surgery University Hospital Cologne Cologne Germany; Department of Endocrine Surgery Evangelisches Klinikum Cologne Weyertal Cologne Germany

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 Medical and Surgical Sciences University of Trieste Cattinara Teaching Hospital Trieste Italy

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 Oral and Maxillofacial Surgery University Hospitals Sussex NHS Foundation Trust St Richard's Hospital Chichester and Worthing Hospital Worthing UK

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 Cheikh Khalifa International University Hospital Mohammed 6 University of Health Sciences Casablanca Morocco

Department of Otolaryngology Head and Neck Surgery Faculty of Medicine Srinakharinwirot University Bangkok Thailand

Department of Otolaryngology Head and Neck Surgery Kovai Medical Center and Hospital Coimbatore India

Department of Otolaryngology Head and Neck Surgery University of Toronto Toronto ON Canada

Department of Otorhinolaryngology and Head and Neck Surgery University Hospital Center Sestre Milosrdnice Zagreb Croatia

Department of Otorhinolaryngology and Head and Neck Surgery University Hospital of Nîmes Nîmes France

Department of Otorhinolaryngology and Maxillofacial Surgery Military University Hospital Prague Czech Republic; 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Otorhinolaryngology Head and Neck Surgery CHA Bundang Medical Center CHA University Seongnam South Korea

Department of Otorhinolaryngology Head and Neck Surgery Singapore General Hospital Singapore

Department of Otorhinolaryngology University of Health Sciences Gülhane Research and Training Hospital Ankara Turkey

Department of Paediatric Surgery Medical Faculty of Comenius University National Institute of Children's Diseases Bratislava Slovakia

Department of Pathophysiology Faculty of Medical Sciences University of Kragujevac Kragujevac Serbia

Department of Pediatric Otolaryngology Head and Neck Surgery Oregon Health and Science University Portland OR USA

Department of Precision and Regenerative Medicine and Ionian Area University of Bari Aldo Moro Bari Italy

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 Department of Internal Medicine University of Arkansas for Medical Sciences Little Rock AR USA

Department of Surgery and Otolaryngology Oregon Health and Science University Portland OR USA

Department of Surgery Anesthesia and Interventional Radiology Head and Neck Oncology Service Thyroid Surgery Unit Gustave Roussy Villejuif France

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 Hadassah Medical Center Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel

Department of Surgery Klaipeda University Hospital Klaipeda Lithuania; Health Research and Innovation Science Center Faculty of Health Sciences Klaipeda University 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 Universidad de Antioquia CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello Medellín Colombia

Department of Surgery University Hospital of Heraklion Medical School University of Crete Crete Greece

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 Oncology St Elisabeth Cancer Institute Medical Faculty of Comenius University Bratislava Slovakia

Department of Surgical Oncology University Hospital Georgi Stranski Faculty of Medicine Medical University of Pleven Pleven Bulgaria

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 Sapienza University of Rome Rome Italy; Division of General Surgery Section of Endocrine and Diabetic Foot Surgery Fabia Mater Hospital Rome Italy

Department of Surgical Sciences University of Cagliari Cagliari Italy

Department of Thoracic and Endocrine Surgery Geneva University Hospitals and University of Geneva Geneva Switzerland

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

Department of Visceral Surgery and Medicine Inselspital Bern University Hospital University of Bern Bern Switzerland

Dipartimento di Chirurgia Pietro Valdoni Policlinico Umberto 1 Sapienza Rome Italy

Division of Endocrine Surgery Department of Gastroenterologic Endocrine Metabolic and Nephro Urologic Sciences Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy

Division of Endocrine Surgery General Surgery Department Ege University Hospital Izmir Turkey

Division of Endocrinology Diabetes and Metabolism Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OH USA

Division of Surgical Oncology Department of Surgery Dr Cipto Mangunkusumo General Hospital Jakarta Indonesia

Elias University Emergency Hospital Carol Davila University of Medicine and Pharmacy Bucharest Romania

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 Department of Surgery National Institute for Medical Sciences and Nutrition Mexico City Mexico

Endocrine Surgery Unit Department of Surgery Oncology and Gastroenterology University of Padova Padova Italy

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

General Surgery University of Health Sciences Kanuni Sultan Suleyman Training and Research Hospital Istanbul Türkiye

Head and Neck Cancer Medical Oncology Department Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli 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 and Head and Neck Surgery Centre Hospitalier Universitaire Vaudois Lausanne Switzerland

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

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

Thyroid and Parathyroid Surgery Unit Otolaryngology Unit ASST Santi Paolo e Carlo Department of Health Sciences Università degli Studi di Milano Milan Italy

Thyroid Unit Hospital de Clínicas de Porto Alegre and Federal University of Rio Grande do Sul Porto Alegre Brazil

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

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Søreide K, Hallet J, Matthews JB, et al. Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br J Surg. 2020;107:1250–1261. PubMed PMC

Morris EJA, Goldacre R, Spata E, et al. Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study. Lancet Gastroenterol Hepatol. 2021;6:199–208. PubMed PMC

Ricciardiello L, Ferrari C, Cameletti M, et al. Impact of SARS-CoV-2 pandemic on colorectal cancer screening delay: effect on stage shift and increased mortality. Clin Gastroenterol Hepatol. 2021;19:1410–1417. PubMed PMC

Ng JS, Hamilton DG. Assessing the impact of the COVID-19 pandemic on breast cancer screening and diagnosis rates: a rapid review and meta-analysis. J Med Screen. 2022;29:209–218. PubMed PMC

Kajiwara Saito M, Morishima T, Ma C, Koyama S, Miyashiro I. Diagnosis and treatment of digestive cancers during COVID-19 in Japan: a cancer registry-based study on the impact of COVID-19 on cancer care in Osaka (CanReCO) PLoS One. 2022;17 PubMed PMC

Koca B, Yildirim M. Delay in breast cancer diagnosis and its clinical consequences during the coronavirus disease pandemic. J Surg Oncol. 2021;124:261–267. PubMed PMC

Kuzuu K, Misawa N, Ashikari K, et al. Gastrointestinal cancer stage at diagnosis before and during the COVID-19 pandemic in Japan. JAMA Netw Open. 2021;4 PubMed PMC

Brugel M, Letrillart L, Evrard C, et al. Impact of the COVID-19 pandemic on disease stage and treatment for patients with pancreatic adenocarcinoma: a French comprehensive multicentre ambispective observational cohort study (CAPANCOVID) Eur J Cancer. 2022;166:8–20. PubMed PMC

Glasbey J, Ademuyiwa A, Adisa A, et al. Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study. Lancet Oncol. 2021;22:1507–1517. PubMed PMC

Metzger K, Mrosek J, Zittel S, et al. Treatment delay and tumor size in patients with oral cancer during the first year of the COVID-19 pandemic. Head Neck. 2021;43:3493–3497. PubMed PMC

Kiong KL, Diaz EM, Gross ND, Diaz EM, Jr, Hanna EY. The impact of COVID-19 on head and neck cancer diagnosis and disease extent. Head Neck. 2021;43:1890–1897. PubMed PMC

Medas F, Ansaldo GL, Avenia N, et al. Impact of the COVID-19 pandemic on surgery for thyroid cancer in Italy: nationwide retrospective study. Br J Surg. 2021;108:e166–e167. PubMed PMC

Agcaoglu O, Sezer A, Makay O, et al. Management of endocrine surgical disorders during COVID-19 pandemic: expert opinion for non-surgical options. Updates Surg. 2022;74:325–335. PubMed PMC

Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27:1341–1346. PubMed

Pizzimenti C, Mazzeo F, Militi GB, et al. Reporting thyroid cytology in a globalized world. Endocrines. 2021;2:311–319.

Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133. PubMed PMC

Grani G, Ciotti L, Del Gatto V, et al. The COVID-19 outbreak and de-escalation of thyroid cancer diagnosis and treatment. Endocrine. 2022;78:387–391. PubMed PMC

Medas F, Ansaldo GL, Avenia N, et al. The THYCOVIT (thyroid surgery during COVID-19 pandemic in Italy) study: results from a nationwide, multicentric, case-controlled study. Updates Surg. 2021;73:1467–1475. PubMed PMC

Ikeda N, Yamamoto H, Taketomi A, et al. The impact of COVID-19 on surgical procedures in Japan: analysis of data from the National Clinical Database. Surg Today. 2022;52:22–35. PubMed PMC

Liu H, Zhan L, Guo L, et al. More aggressive cancer behaviour in thyroid cancer patients in the post-COVID-19 pandemic era: a retrospective study. Int J Gen Med. 2021;14:7197–7206. PubMed PMC

Morris LG, Myssiorek D. Improved detection does not fully explain the rising incidence of well-differentiated thyroid cancer: a population-based analysis. Am J Surg. 2010;200:454–461. PubMed PMC

Johnson BA, Waddimba AC, Ogola GO, Fleshman JW, Jr, Preskitt JT. A systematic review and meta-analysis of surgery delays and survival in breast, lung and colon cancers: implication for surgical triage during the COVID-19 pandemic. Am J Surg. 2021;222:311–318. PubMed PMC

Ishibashi F, Shida D, Suzuki S, Nagai M, Mochida K, Morishita T. A delay in the diagnosis of colorectal cancer screened by fecal immunochemical tests during the COVID-19 pandemic: a longitudinal cohort study. Int J Colorectal Dis. 2022;37:2543–2546. PubMed PMC

Deliere AE, Kuchta KM, Pesce CE, Kopkash KA, Yao KA. Impact of surgical delay on tumor upstaging and outcomes in estrogen receptor-negative ductal carcinoma in situ patients. J Am Coll Surg. 2022;235:788–798. PubMed

Kapp KA, Cheng A-L, Bruton CM, Ahmadiyeh N. Impact of COVID-19 restrictions on stage of breast cancer at presentation and time to treatment at an urban safety-net hospital. Ann Surg Oncol. 2022;29:6189–6196. PubMed PMC

Scharf C, Brancaccio G, Di Stefani A, et al. The association between COVID-19 lockdowns and melanoma diagnosis and thickness: a multicenter retrospective study from Europe. J Am Acad Dermatol. 2022;87:648–649. PubMed PMC

Cantini L, Mentrasti G, Russo GL, et al. Evaluation of COVID-19 impact on delaying diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario. ESMO Open. 2022;7 PubMed PMC

Fujita S, Sakuramoto S, Miyawaki Y, et al. Impact of the first era of the coronavirus disease 2019 pandemic on gastric cancer patients: a single-institutional analysis in Japan. Int J Clin Oncol. 2022;27:930–939. PubMed PMC

Giovanella L, Ruggeri RM, Ovčariček PP, Campenni A, Treglia G, Deandreis D. Prevalence of thyroid dysfunction in patients with COVID-19: a systematic review. Clin Transl Imaging. 2021;9:233–240. PubMed PMC

Muller I, Cannavaro D, Dazzi D, et al. SARS-CoV-2-related atypical thyroiditis. Lancet Diabetes Endocrinol. 2020;8:739–741. PubMed PMC

Trimboli P, Cappelli C, Croce L, Scappaticcio L, Chiovato L, Rotondi M. COVID-19-associated subacute thyroiditis: evidence-based data from a systematic review. Front Endocrinol (Lausanne) 2021;12 PubMed PMC

Inoue K, Noh JY, Yoshihara A, et al. Delayed follow-up visits and thyrotropin among patients with levothyroxine during the COVID-19 pandemic. J Endocr Soc. 2021;6 PubMed PMC

Rianto BUD, Wibowo AS, Herdini C. The difference in thyroid stimulating hormone levels between differentiated carcinoma and benign enlargement. Int Arch Otorhinolaryngol. 2020;24:e73–e79. PubMed PMC

Wu Z, Xi Z, Xiao Y, et al. TSH-TSHR axis promotes tumor immune evasion. J Immunother Cancer. 2022;10 PubMed PMC

Jackson D, Handelsman RS, Farrá JC, Lew JI. Increased incidental thyroid cancer in patients with subclinical chronic lymphocytic thyroiditis. J Surg Res. 2020;245:115–118. PubMed

Trimboli P, Ferrarazzo G, Cappelli C, Piccardo A, Castellana M, Barizzi J. Thyroid nodules with indeterminate FNAC according to the Italian classification system: prevalence, rate of operation, and impact on risk of malignancy. An updated systematic review and meta-analysis. Endocr Pathol. 2022;33:457–471. PubMed PMC

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ClinicalTrials.gov
NCT05178186