Management of Graves’ hyperthyroidism and orbitopathy in time of COVID-19 pandemic

Bartalena, Luigi; Chiovato, Luca; Marcocci, Claudio; Vitti, Paolo; Piantanida, Eliana; Tanda, Maria Laura

doi:10.1007/s40618-020-01293-7

Cited by 26 publications

(41 citation statements)

References 16 publications

(19 reference statements)

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“…Currently, there is no clear evidence that the SARS-CoV-2 has direct impact on any form of thyroid disease [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

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Thyroid surgery during coronavirus-19 pandemic phases I, II and III: lessons learned in China, South Korea, Iran and Italy

Zhang

Zhou

et al. 2020

J Endocrinol Invest

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Objective We compared demographic and clinic-pathological variables related to the number of surgeries for thyroid conditions or for cancer, morbidity, and fine needle aspiration (FNA) practices among Covid19 pandemic phases I, II, III and the same seasonal periods in 2019. Methods The prospective database of the Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, China was used for this study. Covid19 emergency levels were stratified according to the World Health Organization: phase I (January 25–February 25, 2020), phase II (February 26–March 19), phase III (March 20–April 20). Results There were fewer outpatient FNAs and surgeries in 2020 than in 2019. There were no thyroid surgeries during phase I. There were also fewer surgeries for cancer with a significant reduction of advanced stage cancer treatments, mainly stage T1b N1a in phase II and T3bN1b in phase III. Operative times and postoperative stays were significantly shorter during the pandemic compared to our institutional baseline. In phase III, vocal cord paralysis (VCP) increased to 4.3% of our baseline numbers ( P = 0.001). There were no cases of Covid19-related complications during the perioperative period. No patients required re-admission to the hospital. Conclusion The Covid19 outbreak reduced thyroid surgery patient volumes. The decrease of Covid19 emergency plans contributed to unexpected outcomes (reduction of early stage cancer treatment, decreased operative times and hospital stays, increased VCP rate). Electronic supplementary material The online version of this article (10.1007/s40618-020-01407-1) contains supplementary material, which is available to authorized users.

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“…Currently, there is no clear evidence that the SARS-CoV-2 has direct impact on any form of thyroid disease [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…The impact of the SARS-CoV-2 endemic on thyroid surgery, is yet to be investigated [ 16 ]. The objectives of the current report were: Compare thyroid surgery patient volumes, operations for cancer, morbidity, and trends for fine needle aspiration (FNA) practices, between the Covid19 outbreak and the same seasonal period during 2019.…”

Section: Introductionmentioning

confidence: 99%

Thyroid surgery during coronavirus-19 pandemic phases I, II and III: lessons learned in China, South Korea, Iran and Italy

Zhang

Zhou

et al. 2020

J Endocrinol Invest

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“…Routine assessment of thyroid function during hospitalization for COVID-19 is not recommended by the World Health Organization clinical management guidelines [1]. However, worsening of pre-existing thyroid dysfunction or de novo occurrence of thyroid disease, possibly caused by infection itself, should not be missed, to avoid misleading work-up, unnecessary medicalization, and its potential negative prognostic impact [2].…”

mentioning

confidence: 99%

SARS-CoV-2: a potential trigger for subacute thyroiditis? Insights from a case report

Ippolito

Dentali

Tanda

2020

J Endocrinol Invest

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159

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“…In a recent study, AI was observed in patients taking prednisolone 5 mg per day, with a mortality increase following treatment interruption [27]. Nonetheless, the risk of AI post COVID-19 infection in patients treated with high-dose GCs (as those with Graves' orbitopathy [28]) is not yet reported. Nonetheless, the pulse immunosuppressive GC treatment for ophthalmopathy does not increase the risk of secondary AI [29,30].…”

Section: Risk Of Adrenal Insufficiency In Patients With Covid-19mentioning

confidence: 99%

What we have to know about corticosteroids use during Sars-Cov-2 infection

Ferraú

Ceccato

Cannavò

et al. 2020

J Endocrinol Invest

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Purpose Glucocorticoids (GCs), alone or associated to other drugs, were widely used in the management of patients affected by severe acute respiratory syndrome caused by SARS-CoV-2 infection, during the recent COVID-19 outbreak. This review summarizes the available data on HPA axis impairment in GC-treated SARS-CoV-2 patients, focusing on the risk of adrenal insufficiency and on potential drug interactions during concomitant treatments. Methods Literature on the impact of GCs therapy on HPA axis and on the consequences of coadministration of GCs and other drugs in SARS-CoV-2 patients has been reviewed. Results GC treatment can cause symptoms of hypercortisolism, especially in patients with individual hypersensibility, or hypoadrenalism after drug withdrawal, due to hypothalamic-pituitary-adrenal (HPA) axis suppression, with consequences in terms of increased morbidity and mortality risk. On the other hand, in SARS-CoV-2-infected patient's cortisol secretion could be insufficient also due to critical illness-related corticosteroid insufficiency (CIRCI). In addition, in this clinical context, the co-administration of antiretroviral drugs and corticosteroids may trigger drug-drug interaction and enhance the exposure to the latter ones, metabolized through the CYP450 CYP3A pathway, severely impacting on HPA axis. Conclusion Physicians involved in the management of patients affected by COVID-19 should be aware of the need of an appropriate GC dose tapering, and of potential interaction of GCs with antiviral therapy and drugs used to treat associated co-morbidities.

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Management of Graves’ hyperthyroidism and orbitopathy in time of COVID-19 pandemic

Cited by 26 publications

References 16 publications

Thyroid surgery during coronavirus-19 pandemic phases I, II and III: lessons learned in China, South Korea, Iran and Italy

Thyroid surgery during coronavirus-19 pandemic phases I, II and III: lessons learned in China, South Korea, Iran and Italy

SARS-CoV-2: a potential trigger for subacute thyroiditis? Insights from a case report

What we have to know about corticosteroids use during Sars-Cov-2 infection

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