Reply to Reply: The clinical outcome of COVID‐19 infection in patients with a history of thyroid cancer: A nationwide study

We would like to thank Dr. Abobaker and Dr. Darrat for their interest in our recent article.1, 2 We think our results are not contradictory to those of the studies mentioned by the authors.3-6 The type of cancer, stage, treatment modalities and comorbidities effect the prognosis and mortality of COVID-19 disease in all these studies, while increased COVID-19 mortality in patients with thyroid cancer was not reported in any of them. One of these studies reported one death in eight cases of head and neck cancer, which does not clearly mention if any of them was thyroid cancer.3 Two other studies did not mention any mortality in patients with thyroid cancer.4, 5 A recent report mentioned an increased risk of COVID-19 infection but not mortality in patients recently diagnosed with common cancers.6 Still, thyroid cancer had the smallest association to the risk of infection when compared to other cancers.6

We also appreciate the authors' comments about potential bias regarding the discordant hospitalization rates between the groups in our article. To clarify the uncertainty, we compared the mortality rates of all the hospitalized patients with and without thyroid cancer (Table 1). Then, we made the comparisons after performing propensity score matching for the hospitalization status in addition to age, gender and comorbidities (Table 2). None of these analyses yielded increased death rates in patients previously diagnosed with thyroid cancer. We believe that these additional analyses now increased the robustness of our findings which indicate that the diagnosis of thyroid cancer did not increase the COVID-19 mortality.

Table 1. Comparison of outcomes in hospitalized patient groups with and without thyroid cancer Thyroid ca (+) *Hospitalized* N = 208 Thyroid ca (−) *hospitalized* N = 63,717 p Value Death, n (%) 15 (7.2) 4324 (6.8) .808 Table 2. Comparison of outcomes in age, gender, T2DM, HT, CKD, hospitalization matched patient groups with and without thyroid cancer Thyroid ca (+) N = 151 Thyroid ca (-) N = 151 p Value Age, median (IQR) 55 (19) 54 (19) .970 Gender (female), n (%) 119 (78.8) 119 (78.8) 1.000 T2DM, n (%) 85 (56.3) 85 (56.3) 1.000 HT, n (%) 108 (71.5) 108 (71.5) 1.000 CKD, n (%) 14 (9.3) 14 (9.3) 1.000 Hospitalization, n (%) 106 (70.2) 106 (70.2) 1.000 Death, n (%) 6 (4.0) 4 (2.6) .520

The authors declare that there are no conflict of interests.

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