Thyrotoxicosis in patients with COVID-19: the THYRCOV study

Abstract

<jats:p>Objective. This study assessed thyroid function in patients affected by the coronavirus disease-19 (COVID-19), based on the hypothesis that the cytokine storm associated with COVID-19 may influence thyroid function and/or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may directly act on thyroid cells, such as previously demonstrated for SARS-CoV-1 infection. </jats:p> <jats:p>Design and Methods. This single-center study was retrospective and consisted in evaluating thyroid function tests and serum interleukin-6 (IL-6) values in 287 consecutive patients (193 males, mean age 64.3±14.0 years, range: 27-92), hospitalized for COVID-19 in non-intensive care units. </jats:p> <jats:p>Results. Fifty-eight patients (20.2%) were found with thyrotoxicosis (overt in 31 cases), 15 (5.2%) with hypothyroidism (overt in only 2 cases), 214 (74.6%) with normal thyroid function. Serum thyrotropin (TSH) values were inversely correlated with age of patients (rho -0.27; p&lt;0.001) and IL-6 (rho -0.41; p&lt;0.001). In the multivariate logistic regression analysis, thyrotoxicosis resulted to be significantly associated with higher IL-6 (odds ratio 3.25, 95% confidence interval 1.97-5.36; p&lt;0.001), whereas the association with age of patients was lost (p=0.09). </jats:p> <jats:p>Conclusions. This study provides a first evidence that COVID-19 may be associated with high risk of thyrotoxicosis in relationship with systemic immune activation induced by the SARS-CoV-2 infection. </jats:p>

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

“…Thyroid function of patients with COVID-19 can be manifested as thyrotoxicosis or hypothyroidism. The mortality rate of patients with normal TSH was lower than that of patients with abnormal TSH [ 18 ]. The results of another Chinese study showed that TT3 and TSH levels decreased with the severity of COVID-19 [ 19 ].…”

A case of postpartum thyroiditis following SARS-CoV-2 infection

“…Prednisone is used for treatment of SAT, but PPT can be observed. Recently, Lania, et al reported that 20.2% of patients with COVID-19 infection developed thyrotoxicosis possibly based on systemic immune activation induced by the SARS-CoV-2 infection [17].…”

Impact of COVID-19 on the thyroid gland: an update

“…Since ORs are co-expressed with the key mediators of SARS-CoV-2 cell entry (i.e.ACE2, TMPRSS2, cathepsin L) it has been postulated that their damage could be involved in sequelae of COVID-19 from other peripheral organs, not excluding the thyroid [54]. Moreover, SARS-CoV-2 could also indirectly affect the thyroid gland, since "hyperactivity of Th1/Th17 immune responses" and "cytokine storm" associated to COVID-19 may trigger and perpetuate the thyroid gland inflammation [42].…”

“…Most of the published studies were a collection of expert opinions and recommendations on the new strategies of care of thyroid patients in the face of COVID-19 transmission risk and health care surge capacity [8,[28][29][30][31][32][33][34]. Instead, only 13 articles explored thyroid function and/or reported new-onset thyroid diseases in patients contracting COVID-19 [7,[35][36][37][38][39][40][41][42][43][44][45][46]. Only two studies investigated the histopathological characteristics of the thyroid gland and viral thyroid tropism from patients who died of severe COVID-19 [47,48].…”