Thyroid Function Abnormalities in COVID-19 Patients

Abstract

PurposeThe novel coronavirus COVID-19, has caused a worldwide pandemic, impairing several human organs and systems. Whether COVID-19 affects human thyroid function remains unknown.MethodsEighty-four hospitalized COVID-19 patients in the First Affiliated Hospital, Zhejiang University School of Medicine (Hangzhou, China) were retrospectively enrolled in this study, among which 22 cases had complete records of thyroid hormones. In addition, 91 other patients with pneumonia and 807 healthy subjects were included as controls.ResultsWe found that levels of total triiodothyronine (TT3) and thyroid stimulating hormone (TSH) were lower in COVID-19 patients than healthy group (p < 0.001). Besides, TSH level in COVID-19 patients was obviously lower than non-COVID-19 patients (p < 0.001). Within the group of COVID-19, 61.9% (52/84) patients presented with thyroid function abnormalities and the proportion of thyroid dysfunction was higher in severe cases than mild/moderate cases (74.6 vs. 23.8%, p < 0.001). Patients with thyroid dysfunction tended to have longer viral nucleic acid cleaning time (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). 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.ConclusionThyroid function abnormalities are common in COVID-19 patients, especially in severe cases. This might be partially explained by nonthyroidal illness syndrome.

Physiological Role and Use of Thyroid Hormone Metabolites - Potential Utility in COVID-19 Patients

“…It was further reported that decreases in T3 levels were more pronounced in the COVID-19 patients than in other critically ill patients. Lower TSH and total T3 levels in COVID-19 patients compared to patients hospitalized for non-COVID-19 pneumonia were also reported in two other studies (49,51). Decreases in total T3 and TSH levels were correlated to increases in pro-inflammatory cytokines, such as interleukin (IL)-2, IL-6, IL-7, interferon (INF)-g, and tumor necrosis factor (TNF)-a. T3 predicted all-cause mortality and IL-6 and C-reactive protein (CRP) were negatively correlated with fT3 levels.…”

“…This theory is supported by the observation that number and intensity of the staining with anti-TSH antibody was decreased in pituitary glands of deceased COVID-19 patients. Decreased TSH levels may result from direct virus attack on TSH-producing cells in the pituitary gland or by action of cytokines (49).…”

The Association of Subacute Thyroiditis with COVID-19: a Systematic Review

“…Cytokine storm syndrome-a term used to describe the detrimental effects of hypercytokinemia on human cells-has been well described in the literature as the cause of thyroid problems [30]. While it is well documented that this storm is the cause of nonthyroidal illness syndrome seen in COVID-19 patients, at present there is little evidence to suggest the direct thyroid cytotoxic effect of cytokines, at least in humans [30,31]. Immunemediated post-viral inflammatory reaction, involving both the adaptive and innate immune systems, has also been described in the literature as a cause of thyroid problems [32,33].…”

Correlation Between Inflammatory Parameters and Thyroid Axis in Patients With COVID-19

“…Some studies have analyzed the thyroid function in COVID-19 patients and found patterns suggestive of NTIS [14][15][16]20], but very few have reported an association with markers of in ammation. Lui et al found that higher CRP level was independently associated with low FT3.…”