Thyroid dysfunction is associated with poor COVID-19 outcomes

Year 2023, Volume: 1 Issue: 3, 85 - 90, 10.09.2023

Ahmet Hüsrev Tekeli

Abstract

Aim: We aimed to investigate the effects of the thyroid hormone level on the hospitalization rate and prognosis of COVID-19 patients.
Methods: Patients with a positive PCR test result and having their TSH, fT3, and fT4 values tested. The patients were classified according to their thyroids' functional status. The hospital and intensive care unit hospitalization rates and the mortality rate were evaluated.
Results: A total of 708 patients were included in the study. 225 (31.8%) patients were euthyroid. The rates of hospitalization to the intensive care unit (p < 0.001) and the clinic (p < 0.001) and the mortality rate (0.012) were lower. 483 (68.2%) were classified as euthyroid sick syndrome. In 305 (43.1%) patients, only the fT3 level was low, whereas in 47 (6.6%), both fT3 and fT4 were low, and in 131 (18.5%) patients, the fT3, fT4, and TSH levels were low. BUN, creatinine, D-dimer, neutrophil %, troponin T, CRP, procalcitonin, and LDH were higher in patients with thyroid dysfunction, and the aPTT was longer. In contrast, the leukocyte count and percentage were lower.
Conclusions: The intensive care hospitalization rate, the duration of hospitalization in the clinic, and the mortality rate were lower in euthyroid patients. ICU hospitalization and mortality rates were higher in patients with low fT3 and fT4 levels. Thyroid dysfunction is common in COVID-19 patients. The variations in serum TSH and T3 levels may significantly indicate disease severity in COVID-19.
Keywords: COVID-19; intensive care; euthyroid sick syndrome

Keywords

COVID-19;, intensive care;, euthyroid sick syndrome

References

• Lui DTW, Lee CH, Chow WS, Fong CHY, Woo YC, Lam KSL, et al. A territory-wide study on the impact of COVID-19 on diabetes-related acute care. J Diabetes Investig. 2020;11(5):1303-6.
• Scappaticcio L, Pitoia F, Esposito K, Piccardo A, Trimboli P. Impact of COVID-19 on the thyroid gland: an update. Rev Endocr Metab Disord. 2020.
• Fliers E, Bianco AC, Langouche L, Boelen A. Thyroid function in critically ill patients. Lancet Diabetes Endocrinol. 2015;3(10):816-25.
• Van den Berghe G. Non-thyroidal illness in the ICU: a syndrome with different faces. Thyroid. 2014;24(10):1456-65.
• Muller I, Cannavaro D, Dazzi D, Covelli D, Mantovani G, Muscatello A, et al. SARS-CoV-2-related atypical thyroiditis. Lancet Diabetes Endocrinol. 2020;8(9):739-41.
• Chen M, Zhou W, Xu W. Thyroid Function Analysis in 50 Patients with COVID-19: A Retrospective Study. Thyroid. 2021;31(1):8-11.
• Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091.
• Zhang Y, Lin F, Tu W, Zhang J, Choudhry AA, Ahmed O, et al. Thyroid dysfunction may be associated with poor outcomes in patients with COVID-19. Mol Cell Endocrinol. 2021;521:111097.
• Rothwell PM, Lawler PG. Prediction of outcome in intensive care patients using endocrine parameters. Crit Care Med. 1995;23(1):78-83.
• Rothwell PM, Udwadia ZF, Lawler PG. Thyrotropin concentration predicts outcome in critical illness. Anaesthesia. 1993;48(5):373-6.
• Salvatore D., Cohen R., Peter A. Kopp and P. Reed Larsen Williams Textbook of Endocrinology, 11, 332-63.
• Gao W, Guo W, Guo Y, Shi M, Dong G, Wang G, et al. Thyroid hormone concentrations in severely or critically ill patients with COVID-19. J Endocrinol Invest. 2021;44(5):1031-40.
• Monig H, Arendt T, Meyer M, Kloehn S, Bewig B. Activation of the hypothalamo-pituitary-adrenal axis in response to septic or non-septic diseases--implications for the euthyroid sick syndrome. Intensive Care Med. 1999;25(12):1402-6.
• Wajner SM, Goemann IM, Bueno AL, Larsen PR, Maia AL. IL-6 promotes non-thyroidal illness syndrome by blocking thyroxine activation while promoting thyroid hormone inactivation in human cells. J Clin Invest. 2011;121(5):1834-45.
• McGonagle D, Sharif K, O'Regan A, Bridgewood C. The Role of Cytokines including Interleukin-6 in 16. COVID-19 induced Pneumonia and Macrophage Activation Syndrome-Like Disease. Autoimmun Rev. 2020;19(6):102537.
• Khoo B, Tan T, Clarke SA, Mills EG, Patel B, Modi M, et al. Thyroid Function Before, During, and After COVID-19. J Clin Endocrinol Metab. 2021;106(2):e803-e11.