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IMPORTANCE: There is epidemiologic evidence that the increasing incidence of thyroid cancer is associated with subclinical disease detection. Evidence for a true increase in thyroid cancer incidence has also been identified. However, a true increase in disease would likely be heralded by an increased incidence of thyroid-referable symptoms in patients presenting with disease. OBJECTIVES: To evaluate whether modes of detection (MODs) used to identify thyroid nodules for surgical removal have changed compared with historic data and to determine if MODs vary by geographic location. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective analysis of pathology and medical records of 1328 patients who underwent thyroid-directed surgery in 16 centers in 4 countries: 4 centers in Canada, 1 in Denmark, 1 in South Africa, and 12 in the US. The participants were the first 100 patients (or the largest number available) at each center who had thyroid surgery in 2019. The MOD of the thyroid finding that required surgery was classified using an updated version of a previously validated tool as endocrine condition, symptomatic thyroid, surveillance, or without thyroid-referable symptoms (asymptomatic). If asymptomatic, the MOD was further classified as clinician screening examination, patient-requested screening, radiologic serendipity, or diagnostic cascade. MAIN OUTCOMES AND MEASURES: The MOD of thyroid nodules that were surgically removed, by geographic variation; and the proportion and size of thyroid cancers discovered in patients without thyroid-referable symptoms compared with symptomatic detection. Data analyses were performed from April 2021 to February 2022. RESULTS: Of the 1328 patients (mean [SD] age, 52 [15] years; 993 [75%] women; race/ethnicity data were not collected) who underwent thyroid surgery that met inclusion criteria, 34% (448) of the surgeries were for patients with thyroid-related symptoms, 41% (542) for thyroid findings discovered without thyroid-referable symptoms, 14% (184) for endocrine conditions, and 12% (154) for nodules with original MOD unknown (under surveillance). Cancer was detected in 613 (46%) patients; of these, 30% (183 patients) were symptomatic and 51% (310 patients) had no thyroid-referable symptoms. The mean (SD) size of the cancers identified in the symptomatic group was 3.2 (2.1) cm (median [range] cm, 2.6 [0.2-10.5]; 95% CI, 2.91-3.52) and in the asymptomatic group, 2.1 (1.4) cm (median [range] cm, 1.7 [0.05-8.8]; 95% CI, 1.92-2.23). The MOD patterns were significantly different among all participating countries. CONCLUSIONS AND RELEVANCE: This retrospective analysis found that most thyroid cancers were discovered in patients who had no thyroid-referable symptoms; on average, these cancers were smaller than symptomatic thyroid cancers. Still, some asymptomatic cancers were large, consistent with historic data. The substantial difference in MOD patterns among the 4 countries suggests extensive variations in practice.

Subacute thyroiditis is a granulomatous inflammatory disorder often triggered by a preceding viral infection. Patients typically present with complaints of anterior neck pain associated with a tender enlarged thyroid gland. The coronaviruses have never before been implicated in the aetiology of subacute thyroiditis. It is postulated that the pathogenesis related to thyroid disease in Coronavirus disease 2019 (COVID-19) is multifactorial. Contributory factors include effects of the virus-related cytokine storm and direct action of the virus on SARS-CoV-2 receptors in the thyroid. This article further reviews the association between thyroiditis and COVID-19. The clinical characteristics, diagnostic workup and management of a patient who presented with subacute thyroiditis following COVID-19 are discussed. Furthermore, complications are entertained and suggestions for the management of thyroiditis following COVID-19 are provided.

Metastasis of a neuroendocrine tumour (NET) to the orbit is a rare occurrence, with published data limited to a few case reports. Orbital involvement usually presents with proptosis and decreased ocular mobility. Timing, in relation to the presentation of the primary tumour (PT), varies. The authors report a case of a 58-year-old female whose clinical presentation of orbital metastases preceded clinical suspicion of a midgut NET. Her presentation was with severe headaches and bilateral ptosis, histologically proven to be due to orbital muscle infiltration. The PT location was determined from the histopathological markers on orbital muscle biopsy, which suggested a gastrointestinal origin. Abdominal computed tomography (CT) was in keeping with a midgut NET with features characteristic of a desmoplastic reaction. Additional CT findings were widespread metastases, corroborated by nuclear imaging. The patient developed carcinoid syndrome and subsequently underwent surgical resection of the PT due to acute bowel obstruction. Her carcinoid symptoms and ocular findings improved on continued somatostatin receptor analogue therapy, but she sadly died within one month following surgery.