Management of thyroid disorders during the COVID-19 outbreak: a position statement from the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM)

Martins, João Roberto Maciel; Villagelin, Danilo; Carvalho, Gisah Amaral de; Vaisman, Fernanda; Teixeira, Patrícia de Fátima dos Santos; Scheffel, Rafael Selbach; Sgarbi, José Augusto

doi:10.20945/2359-3997000000352

Cited by 17 publications

(19 citation statements)

References 61 publications

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“…Rather, NTIS is more likely to be seen as an adaptive mechanism to critical illnesses. 10,14,15 As we could expect, NTIS has been frequently observed in COVID-19 patients, with the same pattern as in other critical conditions. 16,17,18 Literature regarding the association between COVID-19 and previous hypothyroidism is still controversial, results may be biased by the inclusion of NTIS patients, and more studies with larger sample sizes and comparison with non-hypothyroidism patients are still needed.…”

Section: Introductionsupporting

confidence: 79%

Section: Introductionsupporting

confidence: 66%

“…Other studies have found that previous diagnosis of hypothyroidism or other thyroid diseases were not a risk factor for COVID-19 infection and were not associated with poorer outcomes of the disease. 10,11,12,13 It is well known that critically ill patients with no previous history of thyroid dysfunction usually present alterations in thyroid hormones levels, a situation known as non-thyroidal illness syndrome (NTIS). 14 Patients with NTIS typically present with decreased concentrations of plasma triiodothyronine (T3), low thyroxine (T4), and usually slightly decreased thyroid-stimulating hormone (TSH), which may be variable depending on the phase of the disease.…”

Section: Introductionmentioning

confidence: 99%

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Hypothyroidism does not lead to worse prognosis in COVID-19: findings from the Brazilian COVID-19 registry

Pereira

Silveira

Guimarães

et al. 2021

Preprint

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BackgroundIt is not clear whether previous thyroid diseases influence the course and outcomes of COVID-19. The study aims to compare clinical characteristics and outcomes of COVID-19 patients with and without hypothyroidism.MethodsThe study is a part of a multicentric cohort of patients with confirmed COVID-19 diagnosis, including data collected from 37 hospitals. Matching for age, sex, number of comorbidities and hospital was performed to select the patients without hypothyroidism for the paired analysis.ResultsFrom 7,762 COVID-19 patients, 526 had previously diagnosed hypothyroidism (50%) and 526 were selected as matched controls. The median age was 70 (interquartile range 59.0-80.0) years-old and 68.3% were females. The prevalence of underlying comorbidities were similar between groups, except for coronary and chronic kidney diseases, that had a higher prevalence in the hypothyroidism group (9.7% vs. 5.7%, p=0.015 and 9.9% vs. 4.8%, p=0.001, respectively). At hospital presentation, patients with hypothyroidism had a lower frequency of respiratory rate > 24 breaths per minute (36.1% vs 42.0%; p=0.050) and need of mechanical ventilation (4.0% vs 7.4%; p=0.016). D-dimer levels were slightly lower in hypothyroid patients (2.3 times higher than the reference value vs 2.9 times higher; p=0.037). In-hospital management was similar between groups, but hospital length-of-stay (8 vs 9 days; p=0.029) and mechanical ventilation requirement (25.4% vs. 33.1%; p=0.006) were lower for patients with hypothyroidism. There was a trend of lower in-hospital mortality in patients with hypothyroidism (22.1% vs. 27.0%; p=0.062).ConclusionIn this large Brazilian COVID-19 Registry, patients with hypothyroidism had a lower requirement of mechanical ventilation, and showed a trend of lower in-hospital mortality. Therefore, hypothyroidism does not seem to be associated with a worse prognosis, and should not be considered among the comorbidities that indicate a risk factor for COVID-19 severity.

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Section: Introductionsupporting

confidence: 79%

Section: Introductionsupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

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Hypothyroidism does not lead to worse prognosis in COVID-19: findings from the Brazilian COVID-19 registry

Pereira

Silveira

Guimarães

et al. 2021

Preprint

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“…A position statement from the thyroid department of the Brazilian Society of Endocrinology and Metabolism (SBEM) highlighted that most TC cases are at low risk of recurrence, associated with an excellent prognosis, and thus “surgical procedures could and should be postponed safely during the pandemic period”. Additionally, this position statement endorsed the possibility to safely postpone radioiodine (RAI) therapy in case or a pertinent indication [ 76 ]. All COVID-19 guidelines for the management of thyroid tumors with focus on DTC are depicted in Table 3 .…”

Section: The Impact Of Covid-19 On the Oncological Strategy For Dtcmentioning

confidence: 99%

Charting the Unknown Association of COVID-19 with Thyroid Cancer, Focusing on Differentiated Thyroid Cancer: A Call for Caution

Deligiorgi

Siasos

Vakkas

et al. 2021

Cancers

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Background: Conceived of as the “silver lining” of the dark cloud of the coronavirus disease 2019 (COVID-19) pandemic, lessons taught by this catastrophe should be leveraged by medical authorities and policy makers to optimize health care globally. A major lesson is that resilient health systems should absorb sudden shocks incited by overwhelming health emergencies without compromising the continuum of care of chronic diseases, especially of cancer. Methods: The present review dissects the association between COVID-19 and thyroid cancer (TC), especially with differentiated TC (DTC), focusing on available data, knowledge gaps, current challenges, and future perspectives. Results: Obesity has been incriminated in terms of both COVID-19 severity and a rising incidence of TC, especially of DTC. The current conceptualization of the pathophysiological landscape of COVID-19–(D)TC association implicates an interplay between obesity, inflammation, immunity, and oxidative stress. Whether COVID-19 could aggravate the health burden posed by (D)TC or vice versa has yet to be clarified. Improved understanding and harnessing of the pathophysiological landscape of the COVID-19–(D)TC association will empower a mechanism-guided, safe, evidence-based, and risk-stratified management of (D)TC in the COVID-19 era and beyond. Conclusion: A multidisciplinary patient-centered decision-making will ensure high-quality (D)TC care for patients, with or without COVID-19.

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“…In addition, 37 cases of SAT, a rare complication of SARS-CoV-2 infection, have been reported in the literature (Table 1) (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). On the other hand, it is also important to highlight, as declared in a position statement from the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism, well-controlled hypo-and hyperthyroidism are not associated with an increased risk of COVID-19 infection or severity (21).…”

Section: Introductionmentioning

confidence: 99%

Subacute thyroiditis associated with COVID-19 infection: a report of an increasing entity

Hajósi-Kalcakosz¹,

Dénes²,

Góth³

2022

Archives of Endocrinology and Metabolism

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In March 2020, the World Health Organization characterized COVID-19 as a pandemic. By May 2021, 37 cases of subacute thyroiditis (SAT) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had been reported in the literature. We report a patient diagnosed with SAT associated with COVID-19 and review the previously reported cases. A 31-year-old female with no significant previous history developed SAT 5 weeks after SARS-CoV-2 infection. She presented with anterior neck pain and fever. Thyroid function tests revealed hyperthyroidism with slightly increased inflammatory markers. Thyroid ultrasound showed diffuse hypoechoic left lobe and a hypoechoic area in the right lobe. On the fine-needle-aspiration biopsy, large histiocytes, disrupted and normal follicles, and multinucleated giant cells within colloid were seen. Under oral corticosteroid therapy, clinical progression was rapid. Seven weeks later, all thyroid function tests and inflammatory markers normalized. During the recent viral outbreak, clinicians should keep in mind the possibility of SAT after COVID-19, and patients with symptoms of SAT should be tested for SARS-CoV-2.

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Management of thyroid disorders during the COVID-19 outbreak: a position statement from the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM)

Cited by 17 publications

References 61 publications

Hypothyroidism does not lead to worse prognosis in COVID-19: findings from the Brazilian COVID-19 registry

Hypothyroidism does not lead to worse prognosis in COVID-19: findings from the Brazilian COVID-19 registry

Charting the Unknown Association of COVID-19 with Thyroid Cancer, Focusing on Differentiated Thyroid Cancer: A Call for Caution

Subacute thyroiditis associated with COVID-19 infection: a report of an increasing entity

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