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

Abstract

Introduction : During the COVID-19 pandemic thyroid gland alteration/dysfunction has been emerged as a possible endocrine complication. The present review is focused on inflammatory and autoimmune thyroid complications triggered by SARS-CoV-2 infection by searching through databases like MEDLINE and Scopus up to April 2021. Areas covered : Beside the occurrence of ‘non-thyroidal illness’ in severe clinical conditions, alterations of thyroid function and structure may occur during COVID-19 as a consequence of either direct or indirect effects of SARS-CoV-2 infection on the gland. On the one hand, SARS-CoV-2 uses ACE2 as a receptor to infect the host cells and ACE2 is highly expressed by follicular thyroid cells. On the other hand, COVID-19 is associated with a systemic inflammatory and immune response, involving Th1/Th17/Th2 lymphocytes and proinflammatory cytokines, which resembles the immune activation that occurs in immune-mediated thyroid diseases. COVID-19-related thyroid disorders include destructive thyroiditis and onset or relapse of autoimmune thyroid disorders, leading to a broad spectrum of thyroid dysfunction ranging from thyrotoxicosis to hypothyroidism, that may worsen COVID-19 clinical course and affect prognosis. Expert opinion : Physicians should be aware of the possible occurrence of thyroid dysfunction during and after SARS-CoV-2 infection. Further longitudinal studies are warranted to evaluate potential long-term sequelae.

COVID-19-Associated Subacute Thyroiditis: Evidence-Based Data From a Systematic Review

“…It could be thus hypothesized that SAT would be a typical complication of less severe forms of COVID-19 occurring in communitydwelling, young female subjects that are less frequently included in clinical studies, while hospitalized patients would more often experience non-thyroidal illness syndrome due to the hyperinflammatory state typical of severe COVID-19 (55)(56)(57). In this context, a systematic review by Ruggeri et al (58) provided a comprehensive review of all COVID-19-related inflammatory disorders. This paper highlighted, from a slightly different point of view, that thyroid dysfunction is frequently observed in COVID-19 patients, regardless of the underlying thyroid disease, and physicians should be aware of its possible occurrence.…”

The Impact of Interferon Beta-1b Therapy on Thyroid Function and Autoimmunity Among COVID-19 Survivors

“…Studying the patterns of thyroid function and autoimmunity in the interferon-naïve group could facilitate our understanding of the potential of SARS-CoV-2 in triggering autoimmunity (28). In our cohort, we did not observe significant increases in anti-TPO and anti-Tg titres among the interferon-naïve group.…”

SARS-CoV-2: Emerging Role in the Pathogenesis of Various Thyroid Diseases

“… 32 , 38–40 Interestingly, these immune factors were shown to be associated with various autoimmune endocrine diseases, including autoimmune thyroid disorders. 41 , 42 …”