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Thyroid Disorders and Coronavirus

How to prepare for COVID-19 with a thyroid condition

With Amy Chen MD and Jenna Mammen MD PhD

Having a thyroid disorder does not increase your risk for complications from COVID-19.

While we all need to be aware of COVID-19 and take precautions such as social distancing, there are certain people who are at a greater risk of catching the virus that causes the disease, or of having life-threatening complications if they do. Happily, people with thyroid disorders such as Graves’ Disease or Hashimoto’s Thyroiditis aren’t among them.

According to Jenna Mammen, MD, PhD, an endocrinologist at Johns Hopkins University, there has been a lot of confusion, especially online, over Hashimoto’s in particular.

Finally, some good news

“It is an autoimmune disorder, but it is not an immune-compromised state that would lead us to anticipate an additional problem with COVID-19,” she says. “Autoimmune conditions that affect vital organs such as the kidney are frequently treated with immunosuppressive agents which do cause susceptibility, but thyroid disease is not usually in that category.”

Some Graves’ disease patients may take a drug called methimazole, which can have a rare side effect of diminishing the white blood cell count. “That would make them more susceptible to infection,” says Dr. Mammen. “But, this risk is very rare, and especially uncommon in people on longer-term therapy at lower doses.”

Surgeries can increase COVID-19 risk for thyroid patients

There are, however, some endocrine patients who may require surgery to correct their condition, including those with thyroid cancers. The American Association of Endocrine Surgeons released recommendations about which procedures might be considered urgent or emergent, rather than elective. Depending on the patient, their location, and the COVID-19 situation in their community, surgeon and patient together may decide not to put off surgeries such as:

  • Procedures for hypoparathyroid conditions that cannot be controlled with medication
  • Those who have life-threatening or severely symptomatic Graves’ disease that cannot be controlled with medication
  • Patients with aggressive thyroid cancers that have short doubling times
  • Biopsies to confirm a suspected diagnosis of anaplastic thyroid cancer or thyroid lymphoma in order to direct appropriate treatment.

With elective surgeries on hold, Amy Chen MD, an endocrine surgeon at Emory University, says physicians and patients have to carefully consider what is elective and what is not. “What can be done in a month or two, or what really has to take place in two to four weeks?” she says. “Some thyroid surgeries can’t wait. But we want to decrease traffic to hospitals, and we want to keep patients out of them unless they need to be there.” 

For patients who have recently had surgery and are recovering, there is not yet data showing there is increased risk of infection, Dr. Chen notes. However,  with any surgery, the body has undergone a stressor. That alone may make some people more prone to infection and to experience harsher symptoms of any illness if they get it, including the Coronavirus, and to take longer to recover.

Worth the wait?

“The toughest part is when we have to tell a patient they have cancer and then say that they have to wait to have it treated,” says Dr. Chen. Even worse is when the patient and physician believe prompt surgery is worth the risk, but a hospital says “no” because on the surgical priority lists they create, thyroid cancer doesn’t rank very high. “On the one hand, this is positive – because it’s not as lethal as some cancers. But it puts us in an ethical bind. When we delay, I don’t have an exact answer of when we can schedule the surgery, and the cancer usually is growing, even if it is progressing slowly.”

Patients who undergo surgery face additional risks, most specifically from entering a building where, more likely than not, there are patients and workers who have the Coronavirus and are in various stages of contagion. Dr. Chen also says patients who hoped to have a loved one accompany them on the day of their surgery will be disappointed, as almost no visitors are allowed in hospitals right now.

The wait is not likely to be a year or until a vaccine is available, but rather a matter of weeks or months until the surge of cases has passed and there is a better handle on how to identify those who have the disease, sequester them, and treat their symptoms effectively, Dr. Chen says.

Make a risk assessment treatment plan with your physician

Dr. Mammen says decisions about who should have surgery can’t be made any way except individually one-by-one. “Some cancers are very indolent and don’t need operations right away. In fact, for small tumors less than 1 cm, research has clearly shown that observation, with surgery only for growth, is equivalent to early surgery in many cases.”

COVID-19 risks are mostly a factor for surgeons operating on patients who are unaware that they carry the virus, or healthy patients with asymptomatic COVID-19 positive surgeons or other hospital staff, says Dr. Mammen. “The COVID-19 risks are not associated with having cancer per se, but with the risks for transmission that are associated with any healthcare interaction or hospital visit.”

Dr. Mammen recommends that patients ask their doctors what needs to be done right now, and what can wait until later, when the healthcare system isn’t as stressed by the Coronavirus. “Weighing risks and benefits for individual surgeries requires choices,” she says, “and blanket answers are not appropriate.”

Restrictions on elective surgeries are being lifted as the Coronavirus plateaus in some areas

Currently, restrictions on elective surgeries are being lifted in some locations, and both the American Hospital Association (AHA) and the Centers for Medicare and Medicaid Services (CMS) have released recommendations for opening up hospitals to non-emergent, non-COVID-19-related services, including:

  • Adequate uninfected staff with access to enough personal protective equipment
  • A community that has passed the peak of its virus experience
  • Effective cleaning and disinfecting processes
  • Ways to maintain social distancing in the facility
  • Ensuring that patients and staff are properly screened for infection 
  • Hospitals must also collect COVID-19 related data so that they can continually reassess whether they are maintaining a healthy environment for both workers and patients
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