Early Thyroid Surgery Feasible After COVID Infection, Study Finds

Thyroid surgery may be safely performed on patients with recent COVID-19 infection, as long as health care providers comprehensively and carefully screen patients before operating, wrote authors of a new single-center observational study published in Medicine.¹

What Did the Data Say?

Authors of the study followed 140 patients at Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, all of whom underwent thyroid tumor surgery between October 2022 and March 2023. Of these, 35 patients without a documented recent COVID-19 infection served as the control group. The remaining 105 patients had confirmed COVID-19 diagnoses and were divided into groups based on the interval between diagnosis and surgery. Patients in group 1 had surgery within 2 to 4 weeks of their COVID-19 diagnosis; patients in group 2 had surgery 4 to 8 weeks after their diagnosis; and patients in group 3 had surgery 8 weeks or more after their diagnosis.¹

The investigators found there was no statistically significant distinction in the incidence of postoperative adverse events (AEs; P = .81) or the pharyngalgia score (P = .57) among the different patient groups.¹

Pharyngalgia may feel like a pricking, throbbing, or aching pain in the throat and is what the authors described as the prevalent discomfort following thyroid surgery. Authors used pharyngalgia as a standardized patient-reported outcome measure for this study, albeit one based on the patients’ subjective experiences. The outcomes revealed a lack of significant disparity in the postoperative ordeal for patients, irrespective of their SARS-CoV-2 infection status or the time elapsed since infection.”¹

What Do Health Care Professionals Need to Know?

Though overall complication rates were low, investigators identified SARS-CoV-2 Immunoglobulin G (IgG) levels as a significant factor in postoperation risks. These, it turned out, are what the authors described as a critical positive correlation factor, signifying an escalated probability of postoperative AEs (r = 0.31, P = .02).¹

All patients had their IgG and Immunoglobulin M (IgM) levels tested the day before surgery. Most patients had IgM levels below the cutoff of 10 AU/mL, with levels declining over time after infection (P = .02). IgG levels, however, surpassed the critical threshold in most patients (median = 79.3 AU/m). Patients were divided into either a high IgG group or low IgG group based on their levels before surgery.

After surgery, researchers found that patients with high IgG levels were 7 times more likely to experience an AE (13.2%) compared with those in the group with low IgG levels (1.9%); however, the authors said the overall incidence of postoperative AEs in thyroid tumor cases was low, and its occurrence was correlated with the patient’s serum IgG levels in this study (r = 0.31, P < .01).

IgG levels did not have a statistically significant influence on vaccine inoculation status (P = .43), post-op pharyngalgia (P = .82), the proportion of pulmonary focal exudate (measured by CT scan of lung; P = .69), or the degree of tumor malignancy (P = .65).

Authors also found that patients whose preoperative CT scans showed lingering signs of infection were more likely to experience AEs postsurgery, reinforcing their conclusion that "careful patient selection and preoperative screenings are key to achieving positive patient outcomes,” they said.

Why Does This Matter?

When the COVID-19 pandemic began in early 2020, medical associations around the world recommended postponing any elective or nonemergency surgeries to lower the risk of COVID-19 infection for all involved. Thyroid and neck tumors, since they generally have a more favorable prognosis compared with other solid organ cancers, were included in these categories. Any delay in cancer treatment, though, risks tumor growth and disease upstaging and spreading.

Patients with thyroid cancer who have also had a COVID-19 infection face markedly elevated risks of complications or even mortality upon undergoing surgical procedures compared to their non-COVID-19 afflicted counterparts, the authors said.

Early pandemic data showed that the incidence of post-surgical complications in this patient group was lowest at 8 weeks after infection, and this became a standard waiting period. However, that data largely addressed variants of COVID-19 before the Omicron variant, which has a slightly abbreviated incubation period and milder pulmonary impairment¹ and is now the world’s dominant COVID-19 variant.

Authors of this study wanted to investigate whether the waiting period for patients with thyroid cancer who were also recovering from infection with the Omicron variant could be shortened safely. Their findings, though they require further study to confirm, suggest that a more nuanced, individualized approach to selection within this patient subgroup will improve outcomes.

“With a thorough preoperative assessment, early thyroid surgery following COVID-19 infection is feasible,” the authors said.¹

REFERENCES

1. Fei M, Shi Y, Qian K, Guo K, Wang Z. The influence of recent COVID-19 infection on patients undergoing thyroid surgery: clinical outcomes and patient perception observations. Medicine (Baltimore). 2025;104(49):e46400. doi:10.1097/MD.0000000000046400