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Medas F, Dobrinja C, Al-Suhaimi EA, Altmeier J, Anajar S, Arikan AE, Azaryan I, Bains L, Basili G, Bolukbasi H, Bononi M, Borumandi F, Bozan MB, Brenta G, Brunaud L, Brunner M, Buemi A, Canu GL, Cappellacci F, Cartwright SB, Castells Fusté I, Cavalheiro B, Cavallaro G, Chala A, Chan SYB, Chaplin J, Cheema MS, Chiapponi C, Chiofalo MG, Chrysos E, D'Amore A, de Cillia M, De Crea C, de Manzini N, de Matos LL, De Pasquale L, Del Rio P, Demarchi MS, Dhiwakar M, Donatini G, Dora JM, D'Orazi V, Doulatram Gamgaram VK, Eismontas V, Kabiri EH, El Malki HO, Elzahaby I, Enciu O, Eskander A, Feroci F, Figueroa-Bohorquez D, Filis D, François G, Frías-Fernández P, Gamboa-Dominguez A, Genc V, Giordano D, Gómez-Pedraza A, Graceffa G, Griffin J, Guerreiro SC, Gupta K, Gupta KK, Gurrado A, Hajiioannou J, Hakala T, Harahap WA, Hargitai L, Hartl D, Hellmann A, Hlozek J, Hoang VT, Iacobone M, Innaro N, Ioannidis O, Jang JHI, Xavier-Junior JC, Jovanovic M, Kaderli RM, Kakamad F, Kaliszewski K, Karamanliev M, Katoh H, Košec A, Kovacevic B, Kowalski LP, Králik R, Yadav SK, Kumorová A, Lampridis S, Lasithiotakis K, Leclere JC, Leong EKF, Leow MKS, Lim JY, Lino-Silva LS, Liu SYW, Llorach NP, Lombardi CP, López-Gómez J, Lori E, Quintanilla-Dieck L, Lucchini R, Madani A, Manatakis D, Markovic I, Materazzi G, Mazeh H, Mercante G, Meyer-Rochow GY, Mihaljevic O, Miller JA, Minuto M, Monacelli M, Mulita F, Mullineris B, Muñoz-de-Nova JL, Muradás Girardi F, Nader S, Napadon T, Nastos C, Offi C, Ronen O, Oragano L, Orois A, Pan Y, Panagiotidis E, Panchangam RB, Papavramidis T, Parida PK, Paspala A, Pérez ÒV, Petrovic S, Raffaelli M, Ramacciotti CF, Ratia Gimenez T, Rivo Vázquez Á, Roh JL, Rossi L, Sanabria A, Santeerapharp A, Semenov A, Seneviratne S, Serdar A, Sheahan P, Sheppard SC, Slotcavage RL, Smaxwil C, Kim SY, Sorrenti S, Spartalis E, Sriphrapradang C, Testini M, Turk Y, Tzikos G, Vabalayte K, Vargas-Osorio K, Vázquez Rentería RS, Velázquez-Fernández D, Vithana SMP, Yücel L, Yulian ED, Zahradnikova P, Zarogoulidis P, Ziablitskaia E, Zolotoukho A, Calò PG. Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study. Lancet Diabetes Endocrinol 2023; 11:402-413. [PMID: 37127041 PMCID: PMC10147315 DOI: 10.1016/s2213-8587(23)00094-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/02/2023] [Accepted: 03/15/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. METHODS In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. FINDINGS Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). INTERPRETATION Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. FUNDING None.
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Chiara Dobrinja
- Department of Medical and Surgical Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy
| | - Ebtesam Abdullah Al-Suhaimi
- Biology Department, College of Science, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Julia Altmeier
- Endocrine Surgery, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
| | - Said Anajar
- Department of Otolaryngology-Head and Neck Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Akif Enes Arikan
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Türkiye
| | - Irina Azaryan
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Giancarlo Basili
- Azienda USL Toscana Nord-Ovest, UOSD Chirurgia della Tiroide, Toscana, Italy
| | - Hakan Bolukbasi
- General Surgery, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Türkiye
| | - Marco Bononi
- Dipartimento di Chirurgia Pietro Valdoni, Policlinico Umberto I Sapienza, Rome, Italy
| | - Farzad Borumandi
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St Richard's Hospital, Chichester and Worthing Hospital, Worthing, UK
| | - Mehmet Buğra Bozan
- General Surgery, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Türkiye
| | - Gabriela Brenta
- Endocrinology Department, Unidad Asistencial Dr César Milstein, Buenos Aires, Argentina
| | - Laurent Brunaud
- Department of Surgery CVMC, CHU Nancy-Brabois, Université de Lorraine, Nancy, France
| | - Maximilian Brunner
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Antoine Buemi
- Department of Surgery, Cliniques Universitaires Saint Luc, Bruxelles, Belgium
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | | | | | | - Beatriz Cavalheiro
- Departamento de Cirurgia de Cabeça e Pescoço, Hospital São Camilo Oncologia-Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil
| | | | - Andres Chala
- Head and Neck Department Oncologos del Occidente, Universidad de Caldas, Manizales, Colombia
| | - Shun Yan Bryant Chan
- Department of Surgery, Tseung Kwan O Hospital, Hong Kong Special Administrative Region, China
| | - John Chaplin
- Department of Otolaryngology Head and Neck Surgery, Auckland City Hospital, Auckland, New Zealand
| | | | - Costanza Chiapponi
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Cologne, Germany; Department of Endocrine Surgery, Evangelisches Klinikum Cologne Weyertal, Cologne, Germany
| | - Maria Grazia Chiofalo
- Head and Neck Cancer Medical Oncology Department, Istituto Nazionale Tumori, IRCCS Fondazione G Pascale, Napoli, Italy
| | - Emmanuel Chrysos
- Department of Surgery, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
| | - Annamaria D'Amore
- Division of Endocrine Surgery, Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michael de Cillia
- Department of Surgery, Saint John of God Hospital, Salzburg, Austria
| | - Carmela De Crea
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Nicolò de Manzini
- Department of Medical and Surgical Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy
| | - Leandro Luongo de Matos
- Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Unit-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Paolo Del Rio
- General Surgery Unit, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Muthuswamy Dhiwakar
- Department of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Coimbatore, India
| | | | - Jose Miguel Dora
- Thyroid Unit, Hospital de Clínicas de Porto Alegre and Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Valerio D'Orazi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy; Division of General Surgery-Section of Endocrine and Diabetic Foot Surgery, "Fabia Mater" Hospital, Rome, Italy
| | | | - Vitalijus Eismontas
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania; Health Research and Innovation Science Center, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
| | - El Hassane Kabiri
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Hadj Omar El Malki
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University, Rabat, Morocco
| | | | - Octavian Enciu
- Elias University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Francesco Feroci
- Department of Surgery, General Surgery Unit, S Stefano Hospital, Prato, Italy
| | | | - Dimitrios Filis
- Department of Surgery, Saint Andrew Hospital of Patras, Patras, Greece
| | - Gorostidi François
- Otolaryngology and Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Armando Gamboa-Dominguez
- Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Volkan Genc
- Department of Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Davide Giordano
- Otorhinolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giuseppa Graceffa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - James Griffin
- Otolaryngology, Midlands Regional Hospital Tullamore, Tullamore, Ireland
| | - Sofia Cuco Guerreiro
- Endocrine Surgery, University Hospital Center of Central Lisbon, Hospital Curry Cabral, Lisboa, Portugal
| | - Karan Gupta
- Department of Head and Neck Surgery, Medanta, Gurugram, India
| | - Keshav Kumar Gupta
- Department of ENT, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | | | - Tommi Hakala
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Wirsma Arif Harahap
- Department of Surgery, Faculty of Medicine, Universitas Andalas, Padang City, Indonesia
| | - Lindsay Hargitai
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Dana Hartl
- Department of Surgery, Anesthesia and Interventional Radiology, Head and Neck Oncology Service, Thyroid Surgery Unit, Gustave Roussy, Villejuif, France
| | - Andrzej Hellmann
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Jiri Hlozek
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, Prague, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Van Trung Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Nadia Innaro
- Unit of Endocrine Surgery, AOU Mater Domini, Catanzaro, Italy
| | - Orestis Ioannidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital "Georgios Papanikolaou", Thessaloniki, Greece
| | - J H Isabelle Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
| | | | - Milan Jovanovic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade, Serbia
| | - Reto Martin Kaderli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fahmi Kakamad
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Iraq
| | - Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Martin Karamanliev
- Department of Surgical Oncology, University Hospital "Georgi Stranski", Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria
| | - Hiroshi Katoh
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, Sagamihara, Japan
| | - Andro Košec
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Bozidar Kovacevic
- Institute of Pathology and Forensic Medicine, Medical Military Academy, Belgrade, Serbia
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgry and Otorhinolaryngology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Robert Králik
- Department of Surgical Oncology, St Elisabeth Cancer Institute, Medical Faculty of Comenius University, Bratislava, Slovakia
| | | | - Adriána Kumorová
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Central Military Hospital Ružomberok, Ružomberok, Slovakia
| | - Savvas Lampridis
- Department of Thoracic Surgery, 424 General Military Hospital, Thessaloniki, Greece
| | - Konstantinos Lasithiotakis
- Department of Surgery, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
| | | | | | | | - James Y Lim
- Department of Surgery and Otolaryngology, Oregon Health and Science University, Portland, OR, USA
| | | | - Shirley Yuk Wah Liu
- Department of Surgery, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Núria Perucho Llorach
- Unit of Endocrine Surgery Head and Neck Parc Tauli, Hospital Universitari, Sabadell, Spain
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Javier López-Gómez
- Head and Neck Department, Hospital de Oncología Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - Eleonora Lori
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Lourdes Quintanilla-Dieck
- Department of Pediatric Otolaryngology, Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Roberta Lucchini
- Endocrine Surgery Unit, University of Perugia, Santa Maria Hospital, Terni, Italy
| | - Amin Madani
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Dimitrios Manatakis
- Second Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
| | - Ivan Markovic
- Clinic for Surgical Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | | | - Haggi Mazeh
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Olgica Mihaljevic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Julie A Miller
- The Royal Melbourne Hospital and Epworth Hospital, Melbourne, VIC, Australia
| | - Michele Minuto
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy
| | | | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Barbara Mullineris
- Department of General, Emergency and New Technologies, University Hospital of Modena, Baggiovara Civil Hospital, Modena, Italy
| | - José Luis Muñoz-de-Nova
- Department of General and Digestive Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Saki Nader
- Otolaryngology Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Chiara Offi
- Department of Endocrine and Ultrasound-Guided Surgery, Ospedale del Mare, ASl Napoli 1 Centro, Naples, Italy
| | - Ohad Ronen
- Galilee Medical Center, Azrieli Faculty of Medicine Bar Ilan University, Safed, Israel
| | | | - Aida Orois
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Yongqin Pan
- Department of Thyroid Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Emmanouil Panagiotidis
- Department of Nuclear Medicine/PET CT, Theageneio Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Theodosios Papavramidis
- First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Pradipta Kumar Parida
- Department of ENT-Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anna Paspala
- Department of Surgery, Eugenideio Hospital, Athens, Greece
| | - Òscar Vidal Pérez
- General Surgery Department, Universitat de Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Marco Raffaelli
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Tomas Ratia Gimenez
- General Surgery, Hospital Universitario Principe de Asturias, Alcala de Henares, Spain
| | - Ángel Rivo Vázquez
- Department of General and Digestive Surgery, Division of Endocrine Surgery, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Leonardo Rossi
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Alena Santeerapharp
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Arseny Semenov
- Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | | | - Altinay Serdar
- Department of Endocrin Pathology Unit, University of Health Sciences, Faculty of Medicine, Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Sean C Sheppard
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Rachel L Slotcavage
- Department of Surgery and Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Soo Young Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Chutintorn Sriphrapradang
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | - Yigit Turk
- Division of Endocrine Surgery, General Surgery Department, Ege University Hospital, Izmir, Turkey
| | - George Tzikos
- First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Kristina Vabalayte
- Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | - Kelly Vargas-Osorio
- Clinical University Hospital Santiago de Compostela University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - David Velázquez-Fernández
- Endocrine Surgery Unit, Department of Surgery, National Institute for Medical Sciences and Nutrition, Mexico City, Mexico
| | | | - Levent Yücel
- Department of Otorhinolaryngology, University of Health Sciences, Gülhane Research and Training Hospital, Ankara, Turkey
| | - Erwin Danil Yulian
- Division of Surgical Oncology, Department of Surgery, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Petra Zahradnikova
- Department of Paediatric Surgery, Medical Faculty of Comenius University, National Institute of Children's Diseases, Bratislava, Slovakia
| | - Paul Zarogoulidis
- Third Surgery Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evgeniia Ziablitskaia
- Central Research Laboratory, Clinical Medical Multidisciplinary Center of St Luke VI Vernadsky Crimean Federal University, Simferopol, Russia
| | - Anna Zolotoukho
- Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
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