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

Abstract

BackgroundSome studies have indicated that interferon (IFN) may be valuable in COVID-19. We aimed to evaluate the impact of short-term IFN on incident thyroid dysfunction and autoimmunity among COVID-19 survivors.MethodsWe included consecutive adults without known thyroid disorder admitted to Queen Mary Hospital for COVID-19 from July 2020 to January 2021 who had thyroid function tests (TFTs) and anti-thyroid antibodies measured both on admission and at three months.Results226 patients were included (median age 55.0 years; 49.6% men): 135 were IFN-treated. There tended to be more abnormal TFTs upon reassessment in IFN-treated patients (8.1% vs 2.2%, p=0.080). 179 patients (65.4% IFN-treated) had a complete reassessment of anti-thyroid antibodies. There were significant increases in titres of both anti-thyroid peroxidase antibodies (anti-TPO: baseline 29.21 units [IQR: 14.97 – 67.14] vs reassessment 34.30 units [IQR: 18.82 – 94.65], p<0.001) and anti-thyroglobulin antibodies (anti-Tg: baseline 8.23 units [IQR: 5.40 – 18.44] vs reassessment 9.14 units [IQR: 6.83 – 17.17], p=0.001) in the IFN-treated group but not IFN-naïve group. IFN treatment (standardised beta 0.245, p=0.001) was independently associated with changes in anti-TPO titre. Of the 143 patients negative for anti-TPO at baseline, 8 became anti-TPO positive upon reassessment (seven IFN-treated; one IFN-naïve). Incident anti-TPO positivity was more likely to be associated with abnormal TFTs upon reassessment (phi 0.188, p=0.025).ConclusionIFN for COVID-19 was associated with modest increases in anti-thyroid antibody titres, and a trend of more incident anti-TPO positivity and abnormal TFTs during convalescence. Our findings suggest that clinicians monitor the thyroid function and anti-thyroid antibodies among IFN-treated COVID-19 survivors, and call for further follow-up studies regarding the clinical significance of these changes.

Causal associations between COVID-19 and diseases of seven organs: A proteome-wide Mendelian randomization study

“…The thyroid disorders caused by COVID-19 has been widely demonstrated. 36,37 HTCBSA is one of the major subtypes of hypothyroidism. Some previous studies have provided evidence of COVID-19-related hypothyroidism.…”

A prospective follow-up on thyroid function, thyroid autoimmunity and long COVID among 250 COVID-19 survivors

“…While the large multicentre trial coordinated by the World Health Organization (WHO) failed to demonstrate clinical benefits with interferon treatment in hospitalized COVID-19 patients [ 37 ], it could be explained by the delayed treatment. Hence, it is clinically relevant to evaluate the safety of interferon treatment, including thyroid-specific outcomes, which inform the potential need for surveillance, as our previous 3-month follow-up study demonstrated a modest increase in anti-thyroid antibody titres among interferon-treated patients [ 9 ]. Interferon-beta has also been used in multiple sclerosis as chronic maintenance therapy and reported to be associated with incident thyroid dysfunction and autoimmunity, mainly during the first year of treatment [ 38 ].…”

“…Dexamethasone [ 25 ] and subcutaneous low-molecular-weight heparin [ 26 ] were added at physicians’ discretion as clinically indicated. Interferon beta-1b was given once daily subcutaneously at a dose of 16 million IU [ 9 ]. The decision to use interferon beta-1b was not influenced by the baseline thyroid function and antibody levels.…”

“…Interferons are one of the immunotherapies in COVID-19, showing benefits in reducing clinical severity and hastening viral clearance in randomised controlled trials (RCT) [ 7 ], particularly when initiated during the early stage of viraemia [ 8 ]. Our group previously showed that interferon beta-1b therapy in acute COVID-19 was associated with a modest increase in anti-thyroid antibody titres upon a 3-month follow-up [ 9 ]. Further follow-up is warranted to delineate whether this change is transient and to identify any subsequent thyroid dysfunction as the occurrence of anti-TPO can precede thyroid dysfunction [ 10 ].…”