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Endocrinologists Navigate Deferments, Telehealth Amid COVID-19

What your doctor is reading on Medscape.com:

MAY 07, 2020 — James V. Hennessey, MD, has been working from home, like so many others, since the lockdowns went into effect. The director of clinical endocrinology at Beth Israel Deaconess Medical Center in Boston, Massachusetts, has felt surprisingly heartened by his experience.

“So far, these [video-based] discussions have been reassuring,” he told Medscape Medical News. “The images generating the referral have been available for review, and we’ve been able to reassure the patients that there are no danger signs in their histories.” 

Hennessey noted that for patients who agree to thyroid nodule consultations via video consult, the arrangement has allowed for the assessment of difficulty swallowing and other obvious difficulties.

While Hennessey has not yet encountered anything serious during his virtual consults, such as a rapidly growing anaplastic thyroid cancer, “it will only take some time before we hear of one, I’m sure,” he observed.

Surprisingly Productive

During the COVID-19 pandemic, many physicians have been forced to innovate and turn aspects of their practices virtual. Use of telehealth services has increased by 50% in the United States since the start of the pandemic, according to research by Frost and Sullivan consultants. Three endocrinologists report that telehealth, although not always ideal, may provide more information than expected.

Recent recommendations say physicians should defer biopsies of asymptomatic thyroid nodules until the risk for COVID-19 has passed. As a result, some patients may experience increased anxiety because of such delays.

But cases determined to require more urgent care should not be delayed, says the guidance.

Trevor Angell, MD, concurred that it’s possible to safely defer thyroid nodule assessment.

“I would agree that with appropriate risk stratification by symptom assessment, ultrasound, and lab testing, thyroid nodules can be safely triaged for delayed evaluation,” said Angell, an assistant professor of clinical medicine and associate medical director of the Thyroid Center at the Keck School of Medicine of the University of Southern California, in Los Angeles.

“I have found that patients with thyroid nodules that are not highly suspicious are reasonably reassured that the delay in obtaining FNA [fine needle aspiration] is very unlikely to have an impact on the ultimate outcome,” he told Medscape Medical News.

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