There are no specific data on the evolution of COVID-19 in patients with thyroid cancer, nor how it affects them in particular. However, in itself, this type of cancer does not cause a suppression of the immune system, which is the primary condition for being considered a high-risk population.

This changes if you have recently received chemotherapy, radiotherapy, or surgery (surgeries performed before the pandemic do not add up as a risk factor, only recent ones) since this type of treatment weakens the immune system, making you more susceptible to any disease. Check with your head and neck cancer surgeon about the susceptibility of your current condition.

However, regardless of the case, the situation cannot be taken lightly as there are still many things that we do not know about the virus, so it is best to take precautionary measures.

How to continue treatment during the pandemic?

Depending on the country you are in, the conditions for carrying out your treatment plan may vary. However, bodies in the international medical community, such as the British Thyroid Foundation, have put together some suggestions for different clinical scenarios of thyroid cancer patients. These are the suggestions:

• Patients who have completed treatment for thyroid cancer: Patients who have received prior treatment for thyroid cancer, such as surgery, with or without iodotherapy, are not considered to be at increased risk for COVID-19 infection.
• Patients with scheduled surgery: Patients with significant symptoms and/or rapidly progressive disease should be able to access surgery. For patients with cancers classified as “low risk” where progression is considered slow, surgery may be delayed until such time as 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 monitoring after surgery.
• Radioactive iodine therapy: Since the pandemic began, most medical centers have discontinued I-131 treatments due to the overload of patients brought on by COVID-19 and concerns about the potential spread. In most cases, radioactive iodine therapy is not urgent and can be safely delayed. However, as deconfusion progresses in many countries, it is possible to restart treatment, consult your thyroid cancer surgeon about this possibility.
• TSH Suppressive Therapy: Patients receiving suppressive doses of thyroxine (i.e., have a TSH target of <0.1mU / l) should continue with their current dose. Being on suppressive doses of levothyroxine does not increase the risk of COVID-19 infection.
• Tyrosine kinase inhibitors and chemotherapy: Patients receiving inhibitors or chemotherapy may have an increased risk of developing severe coronavirus disease because their immune system is weakened due to a decrease in the number of white blood cells. In these cases, the continuation or modification of the treatment plan will depend on the recommendations of your head and neck surgeon or clinical oncologist.
• Previous radiation therapy: Patients who previously received external beam radiation therapy to the neck may be at increased risk for severe coronavirus disease and should also consider self-isolation.

Have a plan in case you get sick

Establish who could take care of you in case of illness and keep in touch with family, friends, neighbors, and health professionals during this time by email or phone, especially if you live alone.

If you become consciously exposed to the virus or begin to experience symptoms such as a sore throat, dry cough, fever, or shortness of breath, seek medical help as soon as possible and try to contact your care team by phone before personally visiting any center.

If I have had COVID-19, will I be able to continue cancer treatment?

If you have tested positive for COVID-19, you should talk to your head and neck cancer oncologist or surgeon about the impact of this on your cancer treatment. In many centers, a negative COVID-19 test is recommended before chemotherapy, or another cancer treatment begins again.

However, some patients with COVID-19 continue to test positive even after recovering from their symptoms. In this situation, your health care team will consider the risks and benefits of restarting thyroid cancer treatment despite the positive test.

When you resume your cancer treatment, it is important that you wear a mask when attending the clinic or treatment center and that you maintain good hand hygiene by using a disinfectant or handwash before and after visits.

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