Development of a prediction score (ThyroCOVID) for identifying abnormal thyroid function in COVID-19 patients

Abstract

Purpose Thyroid dysfunction in COVID-19 carries clinical and prognostic implications. In this study, we developed a prediction score (ThyroCOVID) for abnormal thyroid function (TFT) on admission amongst COVID-19 patients. Methods Consecutive COVID-19 patients admitted to Queen Mary Hospital were prospectively recruited during July 2020–May 2021. Thyroid-stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) were measured on admission. Multivariable logistic regression analysis was performed to identify independent determinants of abnormal TFTs. ThyroCOVID was developed based on a clinical model with the lowest Akaike information criteria. Results Five hundred and forty six COVID-19 patients were recruited (median age 50 years, 45.4% men, 72.9% mild disease on admission). 84 patients (15.4%) had abnormal TFTs on admission. Patients with abnormal TFTs were more likely to be older, have more comorbidities, symptomatic, have worse COVID-19 severity, higher SARS-CoV-2 viral loads and more adverse profile of acute-phase reactants, haematological and biochemical parameters. ThyroCOVID consisted of five parameters: symptoms (malaise), comorbidities (ischaemic heart disease/congestive heart failure) and laboratory parameters (lymphocyte count, C-reactive protein, and SARS-CoV-2 cycle threshold values). It was able to identify abnormal TFT on admission with an AUROC of 0.73 (95% CI 0.67–0.79). The optimal cut-off of 0.15 had a sensitivity of 75.0%, specificity of 65.2%, negative predictive value of 93.5% and positive predictive value of 28.1% in identifying abnormal TFTs on admission amongst COVID-19 patients. Conclusion ThyroCOVID, a prediction score to identify COVID-19 patients at risk of having abnormal TFT on admission, was developed based on a cohort of predominantly non-severe COVID-19 patients.

Association of thyroid dysfunction and COVID-19: A systematic review and meta-analysis

“…But what is apparent is that thyroid dysfunction is accompanied with more severe form of COVID thus monitoring TFT seems to be beneficial specially in some populations including patients with preexisting thyroid condition, in severe form of infection, and in patients with manifestation of viral thyroiditis (neck pain). Likewise, regarding to the new published article inventing a scoring system for thyroid dysfunction in COVID patient with five parameters including symptoms, presence of ischemic heart disease/congestive heart failure and abnormal laboratory finding (lymphocyte count, C-reactive protein, and SARS-CoV-2 cycle threshold values) should be considered for TFT evaluation ( 63 ).…”

Transient low T3 syndrome in patients with COVID-19: a new window for prediction of disease severity

“…Our analysis of the low T3 group demonstrated that the level of T3 was lower in non-survivors and in those with more severe disease, and our ROC analysis demonstrated that the FT3 level was a acceptable predictor of critical COVID-19. Recent studies of COVID-19 patients also demonstrated an association between lymphopenia and thyroid function ( 32 ), indicating a potential interaction between the hypothalamic-pituitary-thyroid axis and the immune system ( 33 ). The levels of lymphocytes and D-dimer affect the relationship between COVID-19 and the thyroid, because a strong inflammatory response and coagulation dysfunction predict worse clinical outcome.…”

SARS-CoV-2 infection and thyroid dysfunction in children

“…The key marker of ESS is a predominantly low T3 level, and decreased thyroxine (T4) or thyroid-stimulating hormone (TSH), also called thyrotropin, can be revealed. At the same time, reports underlined the increased frequency of subacute thyroiditis and thyrotoxicosis [4,5].…”

“…Recent studies underlined the association between low thyroid hormones levels, especially FT3, and critical disease as well as increased mortality related to SARS-CoV-2 infection [7]. Despite the presence of much research on adults [5,8], it remains unclear in the pediatric population. A routine thyroid panel study is not indicated for asymptomatic patients with COVID-19.…”