Prevalence of thyroid dysfunction in patients with COVID-19: a systematic review

Abstract

Purpose Currently, there is an increasing interest regarding the impact of COVID-19 on the thyroid function. As several recent reports have described the onset of thyroid dysfunction in patients diagnosed with COVID-19, we performed a systematic review to assess the prevalence of thyroid dysfunction in patients with COVID-19 as this information could be clinically relevant for the management of these patients. Methods A comprehensive computer literature search using PubMed/Medline and Cochrane databases was performed until November 14, 2020 to search original articles evaluating thyroid dysfunction in COVID-19 patients. Information about thyroid dysfunction assessed by thyroid function test was retrieved by the eligible articles. Qualitative analysis (systematic review) only was performed whether a significant heterogeneity of data was detected. Results Seven studies including 1237 patients with COVID-19 were included. A significant heterogeneity across the studies was found. Most COVID-19 patients were euthyroid with TSH levels in the normal range (from 44 to 94% of the COVID-19 patients assessed in the included studies). The prevalence of thyroid dysfunction in COVID-19 patients (defined as abnormal thyroid function tests) largely varies among the included studies between 13 and 64% of COVID-19 patients as well as clinical presentation. A positive correlation between thyroid dysfunction and clinical severity of COVID-19 was reported. Conclusion Literature data show that thyroid dysfunction is present in a significant percentage of patients with COVID-19. Assessment of thyroid function may be considered in symptomatic COVID-19 patients to have a baseline before introducing thyroid-interfering drugs and those requiring high-intensity care. Further, well-designed studies are needed to better elucidate the impact of COVID-19 on thyroid function and inform thyroid function testing and thyroid dysfunction management in COVID-19 patients.

SARS-COV-2-related immune-inflammatory thyroid disorders: facts and perspectives

“…These findings are in line with the study by Lania et al [ 60 ], showing an increased risk of cardiac rhythm disturbances and thromboembolic complications in patients with TD compared to those without TD, but are rather different from those emerged from other single-center studies. A more recent review evaluated the prevalence of thyroid dysfunction in patients with COVID-19, including 1237 individual patients with COVID-19 from seven studies [ 98 ]. Most COVID-19 patients assessed in the included studies (from 44 to 94%) were euthyroid with TSH levels in the normal range.…”

“…Low TSH levels were reported in up to 54% of patients with COVID-19, related mainly to a concurrent NTI, and a significant correlation between TD (namely decrease in TSH levels) and clinical severity of COVID-19 was found in four studies [ 60 , 65 , 96 , 99 ]. However, a significant heterogeneity across the studies was found and controversial findings were reported when the correlation between TD and mortality was assessed in patients with COVID-19 [ 98 ]. Thus, at present, there are not enough data to affirm that patients suffering from thyroid diseases are at higher risk of COVID-19, despite a higher prevalence of thyroid disease in patients with COVID-19 has been emerging.…”

The role of estradiol in the immune response against COVID-19

“…Other hormones involved in the functions of the immune system are the thyroid hormones (TH), TSH, T3, and T4 [ 64 ]. It has been reported that patients infected by SARS-CoV-2 present disorders in thyroid function since follicular thyroid cells express ACE2, which renders the organ susceptible to SARS-CoV-2 infection [ 65 ]. This phenomenon was first reported in 2003 during the SARS-CoV-1 outbreak.…”

The association between biochemically confirmed thyroid gland disorder and morbidity and mortality in patients with COVID‐19

“…Interestingly, a systematic review that included seven studies with a total of 1237 patients with COVID‐19 found a positive correlation between biochemically confirmed thyroid dysfunction and disease severity in COVID‐19. 4 …”

“…Interestingly, a systematic review that included seven studies with a total of 1237 patients with COVID-19 found a positive correlation between biochemically confirmed thyroid dysfunction and disease severity in COVID-19. 4 In sum, there is a still need for further studies to determine the risks and severity of COVID-19 infection among patients with a thyroid disorder. Lui et al 5…”