Management of endocrine surgical disorders during COVID-19 pandemic: expert opinion for non-surgical options

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Authors: Orhan Agcaoglu ; Atakan Sezer ; Ozer Makay ; Murat Faik Erdogan ; Fahri Bayram ; Sibel Guldiken ; Marco Raffaelli ; Yusuf Alper Sonmez ; Yong-Sang Lee ; Kyriakos Vamvakidis ; Radu Mihai ; Quan-Yang Duh ; Baris Akinci ; Faruk Alagol ; Martin Almquist ; Marcin Barczynski ; Taner Bayraktaroglu ; Eren Berber ; Yusuf Bukey ; Guldeniz Karadeniz Cakmak ; Nuh Zafer Canturk ; Zeynep Canturk ; Mehmet Celik ; Ozlem Celik ; Banu Ozturk Ceyhan ; Sergii Cherenko ; Thomas Clerici ; David Scott Coombes ; Orhan Demircan ; Oguzhan Deyneli ; Gianlorenzo Dionigi ; Ali Ugur Emre ; Yesim Erbil ; Ali Ilker Filiz ; Hulya Ilıksu Gozu ; Sibel Ozkan Gurdal ; Gunay Gurleyik ; Mehmet Haciyanli ; Abut Kebudi ; Seokmo Kim ; Giannis Koutelidakis ; Bekir Kuru ; Meral Mert ; Guzide Gonca Oruk ; Serdar Ozbas ; Fausto Palazzo ; Rumen Pandev ; Phillip Riss ; Tevfik Sabuncu ; Ibrahim Sahin ; Gurhan Sakman ; Fusun Saygili ; Yasemin Giles Senyurek ; Ilya Sleptsov ; Sam Van Slycke ; Serkan Teksoz ; Tarik Terzioglu ; Serdar Tezelman ; Fatih Tunca ; Mustafa Umit Ugurlu ; Mehmet Uludag ; Jesus Villar-Del-Moral ; Menno Vriens ; Dilek Yazici

MeSH: COVID-19* ; Consensus ; Expert Testimony ; Humans ; Pandemics* ; SARS-CoV-2

Keywords: Consensus ; Endocrine disease ; Expert opinion ; Pandemic ; Qualtrics ; Survey

Abstract: Purpose: The COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic.

Methods: We used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire.

Results: Overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole ± β-blocker combination for Graves' disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3-4 cytological results and papillary microcarcinoma.

Conclusion: This survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible.