Low FT3 is an independent marker of disease severity in patients hospitalized for COVID-19

Dutta, Amitabh; Jevalikar, Ganesh; Sharma, Rutuja; Farooqui, Khalid; Mahendru, Shama; Dewan, Arun; Bhudiraja, Sandeep; Mithal, Ambrish

doi:10.1530/ec-21-0362

Cited by 11 publications

(15 citation statements)

References 20 publications

(71 reference statements)

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“…It is suggested that COVID-19 could lead to severe inflammation. The results of the present study showed the relevant inflammation biomarkers with corresponding changes at early stages on admission (T0-T1), including the significant increase in WBC, CRP, PCT, and ESR, with the significant decrease in Lys, consistent with previous studies (3,5,13,14,22). Furthermore, we found that the changes were even more dramatic in the ESS group compared to the non-ESS group; the inflammatory responses seemed to be stronger.…”

Section: Discussionsupporting

confidence: 91%

“…As stated similarly by a recent study, serum FT3 can predict COVID-19 mortality using the area under the receiver operating characteristic (ROC) curve, and ESS was associated with a 7.05 OR of mortality (15). Moreover, FT3 was thought to be an independent marker of the severity in patients with COVID-19 (14). Meanwhile, the non-survival patients had a lower level of serum TSH compared to the survival patients.…”

Section: Discussionmentioning

confidence: 76%

“…However, the determination of the causal relationship of thyroid diseases and virus infection, if any, still requires extensive clinical research. Particularly, previous studies hint that low serum levels of free T3 (FT3) might be of a practical predictive value in prognosis (3,(13)(14)(15). The primary purpose of our research was to further clarify the predictive value of FT3 in COVID-19 outcome and the potential mechanisms with regard to the dynamic process of inflammation/ coagulopathy/fibrinolysis during COVID-19 infection.…”

Section: Introductionmentioning

confidence: 98%

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The Association Between FT3 With the Outcome and Inflammation/Coagulopathy/Fibrinolysis of COVID-19

et al. 2022

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BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has caused substantial threats to people’s physical health and lives, claiming the lives of over 5 million people worldwide. It is imperative to identify the disease severity and intervene with effective therapy as early as possible. Previous studies have shown that low free triiodothyronine (FT3) may possess the predictive value on COVID-19 prognosis.MethodsIn this retrospective cohort study, 15-day clinical and laboratory data of 186 hospitalized patients of COVID-19 after admission were analyzed. Groups were based on the disease severity of COVID-19, survival or non-survival, and presence or absence of euthyroid sick syndrome (ESS). Categorical variables were compared with the chi-square test or Fisher’s exact test. Continuous variables were tested by Wilcoxon rank-sum test for the non-normal distribution. Spearman correlations were used to assess the correlations between FT3 with clinic parameters of multiple time points.ResultsThe non-survival patients had significant lower levels of FT3 (3.24 ± 0.42 vs. 4.19 ± 0.08 pmol/L, p < 0.05) and thyroid-stimulating hormone (TSH) (0.69 ± 0.19 vs. 2.32 ± 0.2 uIU/ml, p < 0.05), and the FT3 of severe patients was significantly lower than that of non-severe patients (3.67 ± 0.14 vs. 4.33 ± 0.09 pmol/L, p < 0.05). Fifty-nine cases of COVID-19 patients were diagnosed with ESS. Compared with non-ESS patients, those with ESS were older and had higher proportions of fever, shortness of breath, hypertension, diabetes, severe disease, and mortality. In addition, the correlation analysis between FT3 and clinical parameters showed that FT3 were positively related to the lymphocyte count and albumin and negatively correlated with C-reactive protein, erythrocyte sedimentation rate, and D-dimer at all time points in the first 15 days after admission.ConclusionLow FT3 had a significant predictive value on the prognosis of COVID-19 patients, and FT3 was significantly related with clinic parameters of inflammation/coagulopathy/fibrinolysis.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 98%

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The Association Between FT3 With the Outcome and Inflammation/Coagulopathy/Fibrinolysis of COVID-19

et al. 2022

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“…In a retrospective study including 236 patients, low FT3 on admission independently correlated with the severity of COVID-19 [62]. Similar conclusions were reached by the studies of Gao et al [63] and Schwartz et al [64].…”

Section: The Role Of Th In Covid-19supporting

confidence: 75%

The Potential of Thyroid Hormone Therapy in Severe COVID-19: Rationale and Preliminary Evidence

Mourouzis

Apostolaki

Trikas

et al. 2022

IJERPH

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Tissue hypoxia is one of the main pathophysiologic mechanisms in sepsis and particularly in COVID-19. Microvascular dysfunction, endothelialitis and alterations in red blood cell hemorheology are all implicated in severe COVID-19 hypoxia and multiorgan dysfunction. Tissue hypoxia results in tissue injury and remodeling with re-emergence of fetal programming via hypoxia-inducible factor-1α (HIF-1a)-dependent and -independent pathways. In this context, thyroid hormone (TH), a critical regulator of organ maturation, may be of relevance in preventing fetal-like hypoxia-induced remodeling in COVID-19 sepsis. Acute triiodothyronine (T3) treatment can prevent cardiac remodeling and improve recovery of function in clinical settings of hypoxic injury as acute myocardial infarction and by-pass cardiac surgery. Furthermore, T3 administration prevents tissue hypoxia in experimental sepsis. On the basis of this evidence, the use of T3 treatment was proposed for ICU (Intensive Care Unit) COVID-19 patients (Thy-Support, NCT04348513). The rationale for T3 therapy in severe COVID-19 and preliminary experimental and clinical evidence are discussed in this review.

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“…The main characteristics of 30 studies from different countries with RT-PCR confirmed the diagnosis of COVID-19.Arabia, South Korea, Turkey, United Kingdom, and the United States(14,25,26,29,31,33,34,37,41,42). All included studies stated that RT-PCR confirmed the diagnosis of COVID-19 through typical COVID-19 symptoms except one study; thus, all studies enrolled symptomatic patients, and only one enrolled asymptomatic COVID-19 patients…”

mentioning

confidence: 89%

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

Darvishi

Nazer²,

Shahali³

et al. 2022

Front. Endocrinol.

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This systematic review and meta-analysis was conducted to evaluate the effect of COVID-19 on thyroid function and the role of thyroid hormones alterations in predicting the severity of COVID-19. Online databases, including Scopus, Medline/PubMed, EMBASE, Google Scholar, and Cochrane were searched up to August 2, 2022. After screening titles, abstracts, and full manuscripts, respectively, 30 reports were enrolled. The risk of bias (ROB) was evaluated using the QUADAS-2 tool. In addition, odds ratio (OR) and hazard ratio (HR) analysis for assessing the OR of abnormal thyroid function tests (TFT) in predicting the COVID-19 severity and poor outcomes. Among 30 enrolled studies, ROB of the current study is estimated low to moderate. The average number of patients in each study was 325 (range: 40-3,703), with an overall mean age of 57.6, and the female proportion of 40.4%. Overall, the pooled analysis showed that the prevalence of thyroid dysfunction among 9,707 COVID-19 cases was 15%. Among mild to moderate COVID-19 patients, 6.2% had abnormal TFT, and among patients who experienced severe to critical COVID-19, 20.8% had abnormal TFT. The pooled OR for abnormal TFT and the severity of COVID-19 obtained from 3,865 COVID-19 patients was 3.77 (2.03, 6.99). The pooled HR of TSH level of COVID-19 mortality was 1.57 (0.91, 2.72). Our results demonstrate a high prevalence of thyroid dysfunction in COVID-19, and that among patients severe cases had a 3.77-fold higher risk of abnormal TFT compared to mild to moderate COVID-19. Further studies are required to evaluate the longer-term prognostic role of thyroid dysfunction in severe COVID-19, and investigate potential therapeutic strategies.

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Low FT3 is an independent marker of disease severity in patients hospitalized for COVID-19

Cited by 11 publications

References 20 publications

The Association Between FT3 With the Outcome and Inflammation/Coagulopathy/Fibrinolysis of COVID-19

The Association Between FT3 With the Outcome and Inflammation/Coagulopathy/Fibrinolysis of COVID-19

The Potential of Thyroid Hormone Therapy in Severe COVID-19: Rationale and Preliminary Evidence

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

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