Take care of your thyroid even in the light of the pandemic emergency. “Covid-19 disease can alter thyroid function creating further diagnostic and therapeutic problems”, recalls Luca Chiovato, president of the Italian thyroid association (Ait) and coordinator and scientific director of the ‘World Thyroid Week 2021’, which will take place from 24 to 30 May dedicated to ‘Thyroid and Covid pandemic’. An event promoted by the main endocrinological, medical and surgical scientific societies (info on the Facebook page dedicated World Thyroid Week and on the website www.settimanamondialedellatiroide.it.) “With the pandemic it is even more important to keep the thyroid in good health by contacting your doctor without neglecting any alarm bell – observes Chiovato -. This gland performs important functions for our body such as metabolism regulation, heart rhythm control, muscle strength and the correct functioning of the central and peripheral nervous system “. World Week – recalls a note – aims to answer the many questions that people with thyroid disease ask themselves in this period and to identify which are the thyroid pathologies that can make the patient more ‘fragile’ towards the disease from Sars-CoV-2. The initiative is supported with an unconditional contribution from Ibsa Farmaceutici Italia, Merck Serono and Eisai. “For patients with Graves’ disease, the pandemic represented a further difficulty in an already obstacle course. an excess of thyroid hormones and the inflammatory process that is the cause can also extend to the orbit causing the clinical picture commonly known as ‘exophthalmos’ – explains Francesco Frasca, representative of the European Thyroid Association (Eta) – In these cases a lot of work must be done also pay attention to anti-Covid vaccination because the typical therapy of Graves’ orbitopathy, high-dose intravenous cortisones, can nullify the effect of the vaccine if it is administered during the therapeutic cycle “. “The treatment of hyperthyroidism caused by Graves’ disease then requires frequent clinical checks to adjust the therapy which, during the most acute phases of the pandemic, were more difficult to implement both for the commitment of endocrinologists in the Covid emergency, and for the difficulties in accessing hospital services – Frasca remarks – To ensure the care of patients, telemedicine has been used in its various forms and, sometimes, the use of therapeutic schemes, such as that based on the simultaneous administration of anti-thyroid drugs. high dose and thyroxine, which allow less close clinical checks. “” The patient with Basedow’s orbitopathy – explains Emma Bernini, president of the Basedowiani and Thyroid Association – is a very fragile patient, often burdened by diagnostic and therapeutic delays due to the complexity of his illness which requires the support of a multidisciplinary medical team (endocrinologist, ophthalmologist, radiologist-radiotherapist, orbital irurgo, plastic surgeon). In these patients, most of them women, the damage is not only functional up to, in the most serious cases, loss of vision, but also aesthetic, due to the protrusion of the eyes and the consequent deformation of the facial features. This leads to a painful loss of identity which adds to the typical manifestations of the disease. Once the hyperthyroidism and the inflammatory process have been controlled – he remembers – the ‘reconstructive’ surgery of the gaze and face must therefore be considered an indispensable completion of the treatment. It is therefore desirable that the announced strengthening of the NHS will lead to the creation of these multidisciplinary teams in more and more hospitals. The pandemic has in fact taught us how difficult are the journeys of hope in the few specialized centers often present in distant regions “.” The Covid-19 pandemic has raised further questions in relation to the treatment of patients with thyroid cancer, especially in cases of more aggressive or advanced cancers that require latest generation drugs – says Franco Grimaldi, president of the Association of Endocrinologists (Ame) – and, in order to reduce the risk of infection in hospitals, protected diagnosis and treatment paths are recommended for these patients. In particular, in patients with advanced thyroid cancer and on therapy with tyrosine kinase (Tki) inhibitors, some important aspects must be considered: if they are affected by Covid-19 infectious disease, they should be considered fragile patients with a greater risk of outcomes. negative, including the possibility that the infection could further aggravate the side effects of Tki. These patients also require continuous clinical, biochemical and instrumental monitoring “, he observes.” Hashimoto’s thyroiditis, very frequent especially in women, despite being autoimmune in nature, is not a systemic disease and does not require immunosuppressive drugs for its treatment; therefore, it does not expose those affected to a higher risk of developing a serious disease from Covid-19 – continues Francesco Giorgino, president of the Italian Society of Endocrinology (Sie) – The cases in which Hashimoto’s thyroiditis occurs are an exception to this rule. associates with two endocrine diseases that more severely affect the body and whose treatment is much more complex: type 1 diabetes mellitus and Addison’s disease, which compromises an endocrine axis critical for survival in the case of serious intercurrent illnesses such as that from Covid-19. These patients are considered truly fragile and, rightly, have a priority for vaccination using RNA formulations that ensure greater protection “.” The same applies to the association with other systemic autoimmune diseases such as lupus – he continues – So, the good news is that, except in cases associated with more serious or systemic autoimmune diseases, there is no valid reason to consider patients with Hashimoto’s thyroiditis fragile against Covid-19 disease, even when they are on thyroxine therapy for treat their hypothyroidism “.” The data currently available on the pediatric population suffering from thyroid disease such as congenital or acquired hypothyroidism and hyperthyroidism are reassuring. In fact, there is no greater risk of contracting Sars-Cov2 infection, nor that these patients may have a worse prognosis in case of infection ”, says Maria Cristina Vigone, Secretary General of the Italian Society of Pediatric Endocrinology and Diabetology (Siedp). “However, patients with decompensated thyroid function, especially in the case of hyperthyroidism, even if they are no longer susceptible to Sars-Cov2 infection, may have more complications in the case of infections. For this reason, in all pediatric endocrinology centers, a great effort has been made to ensure continuity of care with scheduled periodic visits or by activating alternative methods such as telephone consultations, video consultations and telemedicine services. The screening of congenital hypothyroidism has not undergone interruptions or delays, as well as the treatment of newborns affected by this pathology. “” The Covid-19 disease has proved to be particularly aggressive and with high mortality in elderly patients and especially in the over 80s “, explains Fabio Monzani, representative of the Italian Society of Gerontology and Geriatrics (Sigg). “Preliminary data obtained from a national registry developed under the aegis of Sigg document a particularly high prevalence of the euthyroid sick syndrome, over 50% in hospitalized elderly patients. The appearance of this picture, while representing a defense of the organism in case of serious diseases, has a negative prognostic value because it is associated with a higher mortality. “” The pandemic, which has been going on for over a year, has reduced the recourse on the part of patients to prevention programs and periodic checks both as regards benign thyroid pathologies and, and this is more worrying, malignant ones “, warns Celestino Pio Lombardi, president of the Italian Unitary Society of Endocrine Surgery, Siuec.” The fear to go to the hospital for outpatient visits and exams, the scheduling of appointments and, in many cases, the temporary suspension of services or the transformation of the wards for ‘Covid’ hospitalizations, has caused both diagnostic delays and the lengthening of the times to carry out thyroidectomy operations, often necessary. The risk, in the case of tumorous thyroid nodules – he remembers – is the increase in size which not only can worsen the subsequent course, but can make it impossible to resort to minimally invasive and more conservative thyroid surgery, with sometimes post-operative and aesthetic consequences important. The new challenge is therefore to ‘make up for lost time’ by intensifying the activity of endocrine surgery centers. “” Nuclear medicine intervenes in thyroid diseases not only for the diagnosis, but, above all, for the radioactive iodine therapy of hyperthyroidism and thyroid tumors, once treated surgically “, remembers Maria Cristina Marzola, director of the Italian Association of Nuclear Medicine (Aimn).” From an analysis carried out by the Aimn Youth group it emerged that, during the pandemic, a reduction in all nuclear medicine benefits. About 19% of this loss concerns therapeutic performance, in 50% and more of the cases represented by radioactive iodine therapy for thyroid cancer. This was due both to the reduction in surgical interventions on the thyroid gland and to the possibility, also shared internationally, of postponing radioactive iodine therapy for a few months in cases of low-risk differentiated thyroid carcinoma. At the same time, the Nuclear Medicine centers have raised the levels of protection and isolation of patients to prevent those who took radioactive iodine for therapeutic purposes from being infected by the virus “.” The quality of the relationship and communication between doctor and patient is a factor of great importance for directing the diagnostic and therapeutic process and also for the success of the treatment “, says Anna Maria Biancifiori, president of the committee of the Endocrine Patients’ Associations (Cape).” Patients have needs for contact, relationship and dialogue even in situations more compromised and carers, under the heavy workload imposed by the pandemic, did not always have the resources and time to respond to these needs and undoubtedly, the treatments have slowed down “.” At the same time – he adds – the waiting lists are they are significantly stretched due to the workload of hospitals. Attention to all pathologies, in particular to oncological ones, must return to the center of the Government’s agenda – warns Biancifiori – since the latest data fear the risk that in the coming years the mortality of patients affected by cancer will increase by 20 about% as a result of the pandemic “.