Thyroid Surgery

during Covid-19 Era

Yohana, MD, PhD

Division Oncology, Head and Neck
Departement of Surgery- Faculty of Medicine
Hasan Sadikin General Hospital/ Universitas Padjadjaran
Bandung
 Introduction
• January 30, 2020 the World Health Organization (WHO) stated on its
Situation Report the Emergency Committee on the novel coronavirus
(2019-nCoV)→ International Health Regulations (IHR 2005)
→outbreak a public health emergency of international concern
• March 11, 2020 → Coronavirus disease 2019 (COVID-19) → pandemic
• This presents many challenges to those of us working in cancer
patients incl. thyroid
• Several guideline available.
• Change from time to time.
TRIAGE
• The potential shortage supplies
such as masks, gowns,gloves.
• The potential shortage of
hospital personnel due to
sickness, quarantine and duty at
home.
• The potential shortage hospital
beds, ICU beds and ventilators
• The desire to maximize social
distancingamongs our patients,
colleagues and staff.
Björn L.D.M. Brücher. COVID-19: Pandemic surgery guidance Available online at: www.4open-
sciences.org
Principles for scheduling thyroid cancers during and after the COVID-19 epidemic. * Loco-
regional aggressiveness defined as the presence of recurrent nerve paralysis, local invasion
with esophageal, vascular or tracheal involvement, or massive ganglion infiltration. (Anapl =
anaplastic, Lymph: lymphoma; MDT: multidisciplinary team).
G. Bauda, L. Brunaud. Endocrine surgery during and after the COVID-19 epidemic: Expert guidelines from AFCE
Journal of Visceral Surgery (2020), https://doi.org/10.1016/j.jviscsurg.2020.04.018
 Patients in whom surgery
for thyroid cancer is planned
• Patients with significant symptoms and/or rapidly progressive disease
should still be able access surgery or medullary thyroid cancer with rapidly
increase of calcitonin.
• For patients with cancers categorised as ‘low risk’ (where progression is
considered to be slow) surgery may be delayed until a time when it is
considered safer to proceed.
• Surgery may also be deferred for patients considered susceptible to severe
COVID-19 infection or who may need intensive care monitoring after
surgery.
• There will be variability in the provision of surgery across the Nation due
to the number of local COVID-19 patients and staff availability.
THANK YOU