Impact of COVID-19 on the thyroid gland: an update

Abstract

Coronavirus disease 2019 (COVID-19) is the pandemic of the new millennium. COVID-19 can cause both pulmonary and systemic inflammation, potentially determining multi-organ dysfunction. Data on the relationship between COVID-19 and thyroid have been emerging, and rapidly increasing since March 2020. The thyroid gland and the virus infection with its associated inflammatory-immune responses are known to be engaged in complex interplay. SARS-CoV-2 uses ACE2 combined with the transmembrane protease serine 2 (TMPRSS2) as the key molecular complex to infect the host cells. Interestingly, ACE2 and TMPRSS2 expression levels are high in the thyroid gland and more than in the lungs. Our literature search provided greater evidence that the thyroid gland and the entire hypothalamic–pituitary–thyroid (HPT) axis could be relevant targets of damage by SARS-CoV-2. Specifically, COVID-19-related thyroid disorders include thyrotoxicosis, hypothyroidism, as well as nonthyroidal illness syndrome. Moreover, we noticed that treatment plans for thyroid cancer are considerably changing in the direction of more teleconsultations and less diagnostic and therapeutical procedures. The current review includes findings that could be changed soon by new results on the topic, considering the rapidity of worldwide research on COVID-19.

Management of hyponatraemia and hypernatraemia during the Covid-19 pandemic: a consensus statement of the Spanish Society for Endocrinology (Acqua Neuroendocrinology Group)

“…2 ). Among those etiologies, endocrinological assessment should include free thyroxine and thyroid stimulating hormone measurement, as COVID-19 can be associated with thyroid dysfunction [ 24 ], as well as diagnostic tests for adrenal insufficiency (9 am cortisol and/or synacthen test). Adrenal failure might be elicited by direct SARS-COV2 infiltration of adrenal cells or by dexamethasone-induced adrenal suprression [ 18 , 25 ].…”

Thyroid sequelae of COVID-19: a systematic review of reviews

“…In patients severely affected by COVID-19, changes in thyroid function may relate to a ‘sick euthyroid’ syndrome, but there may be specific thyroid-related damage which requires further investigation Gorini [ 12 ] To summarize the main findings on thyroid and COVID-19 and define research lines aimed at patient care and effective public health measures Thyroid disease is not a risk factor for the development of COVID-19, and a higher prevalence of thyroid disease has not been found in patients with COVID-19. Questioning patients about the presence of thyroid disease at the time of hospitalization with subsequent follow-up might be useful in patients with multiple diseases to avoid thyrotoxicosis first and hypothyroidism later resulting from SAT Caron [ 13 ] To discuss the diagnosis and the management of patients presenting with thyrotoxicosis, thyroid-associated orbitopathy and hypothyroidism in the context of SARS-CoV-2 infection Routine assessment of thyroid function in the acute phase for COVID-19 patients requiring intensive care is useful, as they frequently present thyrotoxicosis related to SARS-CoV-2, and during convalescence to diagnose and adapt levothyroxine replacement treatment in patients with primary or central hypothyroidism Scappaticcio [ 7 ] To explore the impact of COVID-19 on the thyroid gland SAT mainly occurs during or soon after mild COVID-19. Thyrotoxicosis without neck pain (possibly in the context of the nonthyroidal illness syndrome) could characterize more severe and critical cases of COVID-19 pneumonia.…”

Post-Coronavirus Disease 2019 De Quervain’s Thyroiditis – A Case Report and Literature Review

“…Due to the increased expression of angiotensin-converting enzyme 2 and transmembrane protease serine 2 levels in the thyroid gland than in the lungs, these act as the key routes for virus entry into host cells in susceptible patients. Abnormal immunological response and cytokine storm due to COVID-19 may also provoke thyroiditis [10].…”