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With the emergence and rise of the COVID-19 pandemic in 2020, many health services were interrupted and reallocated due to system overload. Tuberculosis (TB) care was one of the affected services during this period, especially in regions with greater social vulnerabilities. Thus, this study aimed to describe the distribution of TB cases before and during the COVID-19 pandemic on an island in the Brazilian Amazon. This quantitative descriptive retrospective study evaluated the distribution of 797 new confirmed and notified cases of TB in residents of the sixteen municipalities in the region of Marajó Island (Pará, Brazil), from 2017 to 2022. The data were obtained from the Development and Administration Company of the Metropolitan Area of Belém and Google Earth, using the ArcGIS and TerraView software for georeferencing notification points in each municipality of the archipelago. The Kernel density estimator and scan statistics were used to analyze the point patterns. Almost all municipalities in the archipelago showed variations during the study years. The scan statistics showed a greater number of cases in the pre-pandemic years of 2017-2019. These data indicated that the factors related to the increase and decrease in the number of cases must be analyzed, as the decrease may be related to the underreporting of patients due to the lack of access to health resources in more isolated areas.