Thyroid dysfunction in COVID-19 patients

Abstract

Purpose “Non thyroidal illness syndrome” (NTIS) or “euthyroid sick syndrome” (ESS) is a possible biochemical finding in euthyroid patients with severe diseases. It is characterized by a reduction of serum T 3 (fT3), sometimes followed by reduction of serum T 4 (fT4). The relationship between thyroid hormones levels and mortality is well known and different studies showed a direct association between NTIS and mortality. The sudden spread of the 2019 novel coronavirus (SARS-CoV 2) infection (COVID-19) and its high mortality become a world healthcare problem. Our aim in this paper was to investigate if patients affected by COVID-19 presented NTIS and the relationship between thyroid function and severity of this infection. Methods We evaluated the thyroid function in two different groups of consecutive patients affected by COVID-19 with respect to a control group of euthyroid patients. Group A included patients hospitalized for COVID-19 pneumonia while patients requiring intensive care unit (ICU) for acute respiratory syndrome formed the group B. Group C identified the control group of euthyroid patients. Results Patients from group A and group B showed a statistically significant reduction in fT3 and TSH compared to group C. In group B, compared to group A, a further statistically significant reduction of fT3 and TSH was found. Conclusions COVID-19 in-patients can present NTIS. FT3 and TSH serum levels are lower in patients with more severe symptoms.

Euthyroid sick syndrome as an early surrogate marker of poor outcome in mild SARS-CoV-2 disease

“…Furthermore, a very recent meta-analysis [ 20 ], aimed at verifying the predictive role of low fT3 levels in more severe COVID-19 disease, confirmed the ESS prognostic value in ICU patients [ 20 ]. This meta-analysis considered seven studies, with five reports [ 11 , 12 , 15 , 16 , 18 ] including not-critical patients ( n = 466). As expected, the authors concluded for a higher rate of ESS in ICU patients and in non-survivors (all p < 0.001) [ 20 ].…”

“…Among Eastern studies, we found only few studies reporting the presence of ESS in COVID-19 populations [ 16 , 19 , 40 – 44 ]. In fact, the majority of available European series mostly focused on the role of thyrotoxicosis in the case of severe infections or in critical settings [ 16 , 40 – 43 ]. Regarding ESS, we found two Italian studies showing a high association with a more severe disease [ 16 , 19 ].…”

“…In fact, the majority of available European series mostly focused on the role of thyrotoxicosis in the case of severe infections or in critical settings [ 16 , 40 – 43 ]. Regarding ESS, we found two Italian studies showing a high association with a more severe disease [ 16 , 19 ]. A study from Baldelli et al [ 16 ] in a small Italian population (n = 84) reported a diagnostic rate similar to ours in non-critical and critical patients, up to 43% and 78%, respectively.…”

“…Regarding ESS, we found two Italian studies showing a high association with a more severe disease [ 16 , 19 ]. A study from Baldelli et al [ 16 ] in a small Italian population (n = 84) reported a diagnostic rate similar to ours in non-critical and critical patients, up to 43% and 78%, respectively. Another Italian study by Campi et al [ 19 ] focused on 115 ICU/sub-ICU patients and confirmed the presence of ESS in 18% of cases, but with only half without ongoing interfering drugs (i.e.…”

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

“…8 Current data shows that COVID-19 is associated with a broad spectrum of thyroid dysfunction, ranging from thyrotoxicosis to NTIS and hypothyroidism, that may worsen disease course and affect prognosis. 32,33,34,35,36 This was observed even in mild to moderate COVID-19 cases, independently of SARS-CoV-2 viral load, age and inflammation and tissue injury markers. 37 The cytokine storm and the dysregulated inflammation are believed to affect the thyroid gland, through the proinflammatory cytokines, which resembles the immune activation that occurs in immune-mediated thyroid diseases, causing damage and compromising function.…”