No Impact of COVID-19 Pandemic on Early Mortality for Thyroid Cancer in the US. Comment on Lee et al. Impact of the COVID-19 Pandemic on Thyroid Cancer Surgery. Curr. Oncol. 2024, 31, 3579–3590

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The comment presents a clear and succinct argument regarding thyroid malignancy as a contrast to often times exaggerated tales of increased mortality due to COVID-19 lockdowns. The statistics used are adequate, I have no concerns regarding internal or external validity and the format of the comment is excellent for highlighting the argument. 

Author Response

The comment presents a clear and succinct argument regarding thyroid malignancy as a contrast to often times exaggerated tales of increased mortality due to COVID-19 lockdowns. The statistics used are adequate, I have no concerns regarding internal or external validity and the format of the comment is excellent for highlighting the argument. 

• We are thankful for these valuable comments on our work. No action required.

Reviewer 2 Report

Comments and Suggestions for Authors

The paper presents the results of a single parameter analysis - thyroid cancer mortality before and during the pandemic. The results are consistent with previous studies and show that COVID 19 had no effect on thyroid cancer mortality nor on the medical care given to these patients.

Given that the format for the presentation is a comment, there is not enough room for some introductory data showing the possible influence of SARS-CoV 2 on thyroid cancer cells. This would be the major influence of COVID on the mortality of these patients - accelerating the course of the disease or making it more aggressive. Otherwise, it is obvious that the mortality was pretty much the same as in the general population exposed to COVID. Maybe the presence of pulmonary metastases in some of these patients influenced the results, but that should be the subject of a different trial.

I suggest adding a sentence about possible mechanisms influencing the outcome of thyroid cancer patients exposed to SARS-CoV2 infection, if possible.

As there are several papers written on this topic, please add some more references.

Author Response

The paper presents the results of a single parameter analysis - thyroid cancer mortality before and during the pandemic. The results are consistent with previous studies and show that COVID 19 had no effect on thyroid cancer mortality nor on the medical care given to these patients. Given that the format for the presentation is a comment, there is not enough room for some introductory data showing the possible influence of SARS-CoV 2 on thyroid cancer cells. This would be the major influence of COVID on the mortality of these patients - accelerating the course of the disease or making it more aggressive. Otherwise, it is obvious that the mortality was pretty much the same as in the general population exposed to COVID. Maybe the presence of pulmonary metastases in some of these patients influenced the results, but that should be the subject of a different trial.

• We are thankful for these valuable comments on our work. We will do our best to improve the manuscript according the suggestions.

I suggest adding a sentence about possible mechanisms influencing the outcome of thyroid cancer patients exposed to SARS-CoV2 infection, if possible.

• ANSWER: Thanks for this comment. Done, as follows: “Nonetheless, it is worth noting that COVID-19 may still have implications for thyroid cancer patients as it can affect their outcomes through various mechanisms [5,6], such as cytokine storm, which can negatively impact multiple organs, including the thyroid; immune system dysregulation, immunosuppression and the resulting enhancement of tumor immune evasion, which can be caused by the virus or induced by cancer or COVID-19 treatments (e.g., chemotherapy, steroids); autoimmunity, as some cancer patients are known to develop anti-thyroid antibodies after COVID-19, as well as anxiety and stress, which may influence cancer progression via neuroendocrine and immunological mechanisms”

As there are several papers written on this topic, please add some more references.

• ANSWER: Thanks for this comment. Done. We have included two representative ones, with the corresponding references, as follows: “This evidence is consistent with other previous reports, such as that of Kathuria-Prakash et al. [3], who found that initial disease burden and extent, therapy and its response showed no significant association with the severity of COVID-19, or the report of Sahin et al [4], that showed that COVID-19 disease does not cause an enhanced risk of death in patients with a history of thyroid cancer [4]”. The two new references have now been included in the list.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have addressed properly my comments. Possible mechanisms influencing the outcome of thyroid cancer patients exposed to SARS-CoV2 infection were added, and the reference section was enhanced.

I consider the paper can be published in the current form.