Thyroid hormone concentrations in severely or critically ill patients with COVID-19

Abstract

Objective COVID-19 is a new coronavirus infectious disease. We aimed to study the characteristics of thyroid hormone levels in patients with COVID-19 and to explore whether thyroid hormone predicts all-cause mortality of severely or critically ill patients. Methods The clinical data of 100 patients with COVID-19, who were admitted to Wuhan Tongji Hospital from February 8 to March 8, 2020, were analyzed in this retrospective study. The patients were followed up for 6–41 days. Patients were grouped into non-severe illness and severe or critical illness, which included survivors and non-survivors. Multivariate Cox proportional hazards analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality in association with continuous and the lower two quartiles of thyroid hormone concentrations in severely or critically ill patients. Results The means of free T3 (FT3) were 4.40, 3.73 and 2.76 pmol/L in non-severely ill patients, survivors and non-survivors, respectively. The lower (versus upper) two quartiles of FT3 was associated with all-cause mortality HR (95% CI) of 9.23 (2.01, 42.28). The HR (95% CI) for all-cause mortality in association with continuous FT3 concentration was 0.41 (0.21, 0.81). In the multivariate-adjusted models, free T4 (FT4), TSH and FT3/FT4 were not significantly related to all-cause mortality. Patients with FT3 less than 3.10 pmol/L had increased all-cause mortality. Conclusion FT3 concentration was significantly lower in patients with severe COVID-19 than in non-severely ill patients. Reduced FT3 independently predicted all-cause mortality of patients with severe COVID-19.

Relationship between betacoronaviruses and the endocrine system: a new key to understand the COVID-19 pandemic—A comprehensive review

“…This correlation was confirmed by further studies [84,85], in particular Gao et al grouped 100 patients into non-severely ill patients, survivors and non-survivors displaying mean FT3 values of 4.40, 3.73 and 2.76 pmol/L, respectively. Hence, FT3 levels were significantly lower in patients with severe COVID-19 disease and FT3 levels lower than 3.10 pmol/L predicted morality independently from all other causes [84]. Moreover, a study was performed in 40 COVID-19 patients with non-severe symptoms, matched to 54 healthy subjects by age and gender; serum samples were collected at 1st, 4th, 7th and 10th day of hospitalization and, compared to controls.…”

“…In all these patients, mortality correlated with the severity of thyroid hormone changes, while pre-existent thyroid diseases were not recorded [83]. This correlation was confirmed by further studies [84,85], in particular Gao et al grouped 100 patients into non-severely ill patients, survivors and non-survivors displaying mean FT3 values of 4.40, 3.73 and 2.76 pmol/L, respectively. Hence, FT3 levels were significantly lower in patients with severe COVID-19 disease and FT3 levels lower than 3.10 pmol/L predicted morality independently from all other causes [84].…”

The cytokine storm and thyroid hormone changes in COVID-19

“…In further study by Gao et al [ 116 ], thyroid function parameters were evaluated in a cohort of 100 COVID-19 patients from Wuhan, and findings were compared between critical and non-critical patients. Results showed that TSH and FT3 levels, but not FT4 levels, were significantly lower in critically ill patients when compared with the non-critically ill ones.…”

Prevalence of thyroid dysfunction in patients with COVID-19: a systematic review

“…Among these records, 141 were excluded (114 because outside the field of interest, 13 as reviews/editorials/letters, 14 as case reports or small case series). Eight original articles were selected and retrieved in full-text version [6][7][8][9][10][11][12][13]. One article was excluded after reading the full text [6].…”