COVID-19 has changed the way we live and how we do business. While most medical practices remain open, many have quickly adapted to the new requirements to maintain social distancing in order to flatten the curve. As a result, the majority of Dr Gilbert's consultations will be via Telehealth (video) or phone, and for those who it is deemed necessary, a face to face appointment will be offered. Although early efforts with social distancing in Australia were successful in keeping our cases of COVID-19 low and the burden on the health care system manageable, the recent increase in cases is very concerning. Consequently, Dr Gilbert will be continuing with virtual appointments for the immediate future.
Telehealth is Dr Gilbert's preferred method of contact for new patient appointments, while phone consults will typically suffice for reviews. Doxy.me is the method used to connect through Telehealth and all new patient appointments will be provided with a confirmation letter that details how to connect using the link doxy.me/drtrinagilbert. We ask that all patients log in to this address 10 minutes ahead of your appointment and do a "pre-call test" in order to minimize technical issues during consultation time. If you are having difficulty connecting, please contact us as soon as possible to arrange an alternative method.
We understand that this is a stressful and uncertain time. We remain open for business and will do our best to keep you safe and healthy. If you feel there is another way we can accomodate your needs, please feel free to ask.
Am I at risk?
Dr Gilbert has been receiving many phone calls and emails from patients concerned about their risk of catching COVID-19 and having a more severe infection due to their underlying disease. While it is not possible to go through all the endocrine conditions Dr Gilbert manages, below is some information from the American Thyroid Association regarding common thyroid disorders. Please do not hesitate to contact Dr Gilbert to discuss your concerns about the thyroid and other conditions further.
HASHIMOTO’S THYROIDITIS AND HYPOTHYROIDISM
Are people with autoimmune thyroid disease, such as Hashimoto’s thyroiditis or Graves’ disease, at more risk for acquiring COVID-19 or having a more serious COVID-19 infection? The U.S. Centers for Disease Control (CDC) advises that people who are immunocompromised are at higher-risk of severe illness from COVID-19. Immunocompromised people have a weaker immune system and have a harder time fighting infections. However, the immune system is complex, and having autoimmune thyroid disease does not mean that a person is immunocompromised or will be unable to fight off a viral infection. Thus far, there is no indication that patients with autoimmune thyroid disease are at greater risk of getting COVID-19 or of being more severely affected should they acquire the COVID-19 infection.
Are there any shortages of Levothyroxine? Levothyroxine is one of the most widely used medications in Australia, and there are many brand and generic types available. At this time, there are no identified shortages of any types of these thyroid hormone replacement medications.
Does having an overactive thyroid put me at risk for developing COVID-19 or having a more severe reaction? As above, there is no indication that having an autoimmune thyroid disease such as Graves' disease increases the risk of getting the infection or resulting in a more severe course. Hyperthyroidism can put a strain on your body, however, so it is important to take your medication (Carbimazole or PTU) as prescribed and do the scheduled blood tests to ensure you are on the correct dose.
Are there any shortages of Carbimazole? There have been intermittent shortages of Carbimazole over the past few months throughout Australia due to an issue with production. This is expected to continue through to the end of the year. If you are having difficulty obtaining your prescription, please let Dr Gilbert know as she can prescribe another antithyroid medication until the Carbimazole becomes available.
THYROID NODULES AND THYROID CANCER
Is it safe to delay a biopsy of my thyroid nodule? Most thyroid nodules are benign (not cancerous), but some nodules of a certain size that also have suspicious features on ultrasound may be advised to undergo a biopsy. Even if the thyroid nodule is found to be cancerous, there is usually little risk in delaying surgery to have it removed. Thus, it would also be generally safe to delay biopsy of the nodule unless your clinician strongly advises that it be done urgently.
Are people with thyroid cancer at greater risk for COVID-19 infection because they are immunocompromised? The U.S. Centers for Disease Control (CDC) generally states that people who are undergoing cancer treatment meet the definition of being immunocompromised. However, unlike many other types of cancer, the majority of thyroid cancer patients are not receiving chemotherapy or other treatment that would deplete the immune system and cause them to be immunocompromised. Having a previous diagnosis of thyroid cancer and receiving thyroid hormone medication is not a known risk factor for getting COVID-19 or being more severely affected by it. For the rare thyroid cancer patients who are receiving chemotherapy medications for your thyroid cancer treatment, you would be considered at higher risk for severe illness due to COVID-19.
Is it safe to delay thyroid cancer surgery because of the current COVID-19 pandemic? The most common initial treatment for thyroid cancer is surgery to remove the thyroid tumour. Because of the current COVID-19 pandemic, many surgeries that were scheduled for thyroid cancer have had to be delayed, raising concerns about receiving timely care for thyroid cancer. While surgery is necessary, most thyroid cancers are very slow-growing tumours, and the chance of thyroid cancer worsening if surgery is delayed by several months is extremely low. This is true even if there is spread of the thyroid cancer to local lymph nodes in the neck. However, thyroid surgery would be essential and should be performed more urgently for patients with symptoms due to the size of the thyroid tumour, such as difficulty breathing or swallowing, cancers that are invading other parts of the neck, or if the biopsy showed aggressive forms of thyroid cancer, including anaplastic thyroid cancer and medullary thyroid cancer.
Is it safe to delay radioactive iodine treatment because of the current COVID-19 pandemic? Radioactive iodine (RAI) therapy is often used for thyroid cancer patients after having surgery and typically involves several visits to a doctor or healthcare facilities. These treatments are frequently being rescheduled during the current COVID-19 pandemic, causing worry about these delays for patients scheduled to receive RAI.
RAI is often used to eliminate any remaining normal (non-cancerous) thyroid tissue or to decrease the chance of recurrence even when all thyroid cancer appears to have been surgically removed. Delays of six months or even longer do not appear to negatively affect the course of thyroid cancer in patients. Therefore, the short delays expected from waiting until the current COVID-19 pandemic is over are unlikely to lower the effectiveness of the RAI treatment.
In general, treatment with RAI is more urgent for patients who have papillary or follicular thyroid cancer who have distant metastases to the lungs or other body parts, particularly if growth of the metastases have been observed. You will be advised when it is better to delay RAI treatment or when it is better to proceed with treatment despite the current pandemic.