COVID-19 Alter Thyroid Function Tests During the Acute Phase

Abstract

Objective: This study aims to evaluate thyroid function tests in patients diagnosed with COVID-19, previously normal thyroid function. Materials and Methods: This research was conducted using the data of patients who visited COVID-19 outpatient clinics for the first time and had normal thyroid function in their medical history. All patients were divided into two groups based on their age and gender. Group I consisted of patients whose PCR test was positive for the first time, while Group II (control group) consisted of patients whose test was negative. The study examined the TSH (thyroid-stimulating hormone), fT3 (free tri-iodothyronine), fT4 (free thyroxine), albumin, and total protein (TP) test parameters of all patients in both groups and compared the results. Statistical significance was assessed using SPSS 20.0, and a p-value of less than 0.05 was considered significant. Results: The study included 1360 patients, with 356 in Group I and 1004 in Group II. In Group I, TSH levels were low, but fT3 and fT4 levels were significantly high. Additionally, albumin and TP values were significantly lower in Group I. A moderate positive correlation was found between albumin and fT3 levels, as well as between albumin and TP levels, in Group I. There was no statistically significant difference in age or gender distribution between the groups Conclusions: There is a significant increase in thyroid function tests when COVID-19 infection is first diagnosed. However, detailed pathophysiological studies are needed to reveal the underlying reasons for this increase.

Keywords

• Albumin
• COVID-19
• thyroid-stimulating hormone
• thyroxine
• triiodothyronine

Covıd-19 Akut Dönemde Tiroid Fonksiyon Testlerini Bozuyor

Öz

Amaç: Bu çalışmada, geçmişte tiroid fonksiyonu normal olan COVID-19 tanısı almış hastalarda tiroid fonksiyon testlerinin değerlendirilmesi amaçlanmıştır. Materyal ve Metot: Bu araştırma, COVID-19 polikliniklerine ilk kez başvuran ve tıbbi geçmişinde normal tiroid fonksiyonu olan hastaların verileri kullanılarak yürütülmüştür. Tüm hastalar yaş ve cinsiyetlerine göre iki gruba ayrılmıştır. Grup I, PCR testi ilk kez pozitif çıkan hastalardan oluşurken, Grup II (kontrol grubu) testi negatif çıkan hastalardan oluşmuştur. Çalışmada, her iki gruptaki tüm hastaların TSH (tiroid uyarıcı hormon), sT3 (serbest tri-iyodotironin), sT4 (serbest tiroksin), albumin ve toplam protein (TP) test parametreleri incelenmiş ve sonuçlar aralarında karşılaştırılmıştır. İstatistiksel anlamlılık SPSS 20.0 kullanılarak değerlendirilmiş ve 0,05'ten küçük p değeri anlamlı kabul edilmiştir. Bulgular: Çalışmaya 1360 hasta dahil edilmiş olup, Grup I'de 356 ve Grup II'de 1004 hasta yer almıştır. Grup I'de TSH düzeyleri düşüktü, ancak sT3 ve sT4 düzeyleri anlamlı derecede yüksekti. Ek olarak, albümin ve TP değerleri Grup I'de anlamlı derecede düşüktü. Grup I'de albümin ve sT3 düzeyleri arasında ve albümin ve TP düzeyleri arasında orta düzeyde pozitif korelasyon bulundu. Gruplar arasında yaş veya cinsiyet dağılımında istatistiksel olarak anlamlı bir fark yoktu. Sonuç: COVID-19 enfeksiyonu ilk teşhis edildiğinde tiroid fonksiyon testlerinde anlamlı bir artış vardır. Ancak, bu artışın altında yatan nedenleri ortaya çıkarmak için ayrıntılı patofizyolojik çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Albümin
• COVID-19
• tiroid stimüle edici hormon
• tiroksin
• triiyodotironin

References

1. Yazar H, Kayacan Y, Ozdin M. De Ritis ratio and biochemical parameters in COVID-19 patients. Arch Physiol Biochem. 2022;128(6):1676-1680. doi:10.1080/13813455.2020.1788604
2. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506. doi:10.1016/S0140-6736(20)30183-5
3. Yuan Y, Jiao B, Qu L, Yang D, Liu R. The development of COVID-19 treatment. Front Immunol. 2023;14:1125246. doi:10.3389/fimmu.2023.1125246
4. Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol. 2023;21(3):133-146. doi:10.1038/s41579-022-00846-2
5. Fallahi P, Elia G, Ragusa F, et al. Thyroid autoimmunity and SARS-CoV-2 infection. J Clin Med. 2023;5;12(19):6365. doi:10.3390/jcm12196365
6. De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet. 2016;27;388(10047):906-918. doi:10.1016/S0140-6736(16)00278-6
7. Ross DS, Burch HB, Cooper DS, et al. American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016;26(10):1343–1421. doi:10.1089/thy.2016.0229
8. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-62. doi:10.1016/S0140-6736(20)30566-3

9. Gorini F, Bianchi F, Iervasi G. COVID-19 and thyroid: Progress and prospects. Int J Environ Res Public Health. 2020;11;17(18):6630. doi:10.3390/ijerph17186630
10. Durgun C, Durgun M. Evaluation of thyroid function tests in patients with COVID-19. Cureus. 2023;19;15(6):e40628. doi:10.7759/cureus.40628
11. Wei W, Yi-xiu Y, Hao Y, et al. Evaluation and observation of serum thyroid hormone and parathyroid hormone in patients with severe acute respiratory syndrome. J Chin Antituberculous Assoc. 2003;25:232–234. doi:10.1016/j.humpath.2006.06.011
12. Wei L, Sun S, Xu CH, et al. Pathology of the thyroid in severe acute respiratory syndrome. Hum Pathol. 2007;38(1):95-102. doi:10.1016/j.humpath.2006.06.011
13. Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091. doi:10.1136/bmj.m1091
14. Chen M, Zhou W, Xu W. Thyroid function analysis in 50 patients with COVID-19: a retrospective study. Thyroid 2021;31: 8–11. doi: 10.1089/thy.2020.0363.
15. Speer G, Somogyi P. Thyroid complications of SARS and coronavirus disease 2019 (COVID-19). Endocrine Journal. 2021;68 (2), 129-136. doi:10.1507/endocrj.EJ20-0443
16. Gorini F, Bustaffa E, Coi A, Iervasi G, Bianchi F. Bisphenols as environmental triggers of thyroid dysfunction: Clues and evidence. Int J Environ Res Public Health. 2020;17,2654. doi:10.3390/ijerph17082654
17. Lippi G, Plebani M, Laboratory abnormalities in patients with COVID-2019 infection, Clinical Chemistry and Laboratory Medicine, 2020;58(7):1131-1134. doi:10.1515/cclm-2020-0198
18. Soraya G, Ulhaq Z. Crucial laboratory parameters in COVID-19 diagnosis and prognosis: An updated meta-analysis. Med Clin (Barc). 2020;155(4):143-151. doi:10.1016/j.medcli.2020.05.017
19. Kalabin A, Mani VR, Valdivieso SC, Donaldson B. Does C-reactive protein/ albumin ratio have prognostic value in patients with COVID-19? J Infect Dev Ctries. 2021;1(8):1086-93. doi:10.3855/jidc.14826