Thyroid function abnormalities in COVID-19 patients

Abstract

Background: The novel coronavirus COVID-19, has caused a worldwide pandemic, impairing several human organs and systems. Whether COVID-19 affects human thyroid function remains unknown. Methods: 84 hospitalized COVID-19 patients in the First Affiliated Hospital, Zhejiang University School of Medicine (Hangzhou, China) were respectively enrolled in this study. In addition, 91 other patients with pneumonia and 807 healthy subjects were included as controls. Findings: We found that the levels of TT3 and TSH were lower in COVID-19 patients than control groups (p<0.001). Within the group of COVID-19 patients, 61.9% patients (52/84) presented with thyroid function abnormalities. We found a larger proportion of patients in severe condition exhibited thyroid dysfunction than mild/moderate cases (74.6% vs. 23.8%, p < 0.001). Patients with thyroid dysfunction tended to have increased interval time for negative conversion of viral nucleic acid (14.1 ± 9.4 vs. 10.6 ± 8.3 days, p = 0.088). To note, thyroid dysfunction was also associated with decreased lymphocytes (p < 0.001) and increased CRP (p = 0.002). In 7 patients with dynamic changes of thyroid function, we observed the levels of TT3 and TSH gradually increased and reached normal range without thyroid hormone replacement at Day 30 post-admission. The correlation between TT3 and TSH level seemed to be positive rather than negative in the early stage, and gradually turned to be negatively related over time. Interpretations: Thyroid function abnormalities are common in COVID-19 patients, especially in severe cases. This might be caused by virus attack and damage to the thyroid-pituitary axis. Therefore, more attention should be paid to thyroid function during treatment of COVID-19, and close follow-up is also needed after discharge.

Evaluation of Thyroid Status in Hospitalized Patients with COVID-19.

“…The few available retrospective studies suggest that admitted patients with COVID-19 exhibit thyroid hormone changes similar to those observed in NTI [3][4][5][6].…”

Extrapulmonary Clinical Manifestations in COVID-19 Patients

“…A study has been showed that 52 (61.9%) of 84 COVID hospitalized patients presented thyroid function abnormalities. 112 Another study with 658 hospitalized COVID‐19 patients confirmed that 42 (6.4%) of 658 patients manifested ketosis on admission with no obvious fever or diarrhea. 113 This report suggests that SARS-CoV-2 infection can cause ketosis per se in nondiabetic persons and may increase the risk of ketoacidosis in patients with diabetes.…”

Endocrine involvement in COVID-19: Mechanisms, clinical features, and implications for care

“…In COVID-19, two studies have shown low normal TSH, tri-iodothyronine (T3), thyroxine (T4) suggesting a possible central mechanism related to cytokines. [ 8 17 ] In another report, levels of LH were found to be elevated in patients with SARS CoV-2 infections. [ 18 19 ] Long term follow-up of patients recovering from COVID-19 is needed to estimate any long-term morbidity.…”

“…[ 49 ] Another study reported low T3 and TSH in COVID-19 patients compared to controls. [ 8 ] Post COVID-19 subacute thyroiditis was first reported from Italy. [ 50 ] Another report described thyrotoxicosis in a patient during the hospital stay.…”

“…[ 6 7 ] Few reports of endocrine involvement exist. [ 6 7 8 ] Since endocrine and immunological responses are closely related, interactions are expected in COVID-19. [ 9 10 11 ] In this mini-review, we aim to summarise the endocrine manifestations reported so far in COVID-19 and explore mechanisms to decipher how SARS CoV-2 may affect various endocrine organs.…”