A LOOK AT THYROID FUNCTIONS AS A PREDICTOR ON PROGNOSIS OF CRITICALLY ILL PATIENTS IN INTENSIVE CARE UNITS FROM THE PERSPECTIVE OF COVID-19 Yoğun Bakım Ünitesindeki Kritik Hastaların Prognozunun Belirleyicisi Olarak Tiroid Fonksiyonlarına Covid-19 Perspektifinden Bir Bakış

Yıl 2024, Cilt: 14 Sayı: 2, 113 - 119, 14.06.2024

Murat Tümer , Nihal Deniz Bulut Yüksel , Banu Kılıçaslan , Seda Banu Akıncı

Öz

ABSTRACT
Objective: Thyroid gland can be affected both by cytokine storm and through angiotensin-converting
enzyme 2 receptors. A worse prognosis has been described in patients with low fT3 levels. The aim of
this study is to evaluate the prognostic significance of thyroid function during COVID-ICU hospitalization.
Material and Methods: After ethical approval, 100 COVID-19 patients followed in the ICU between March
2020 and April 2021 was admitted to study. Patients with previous thyroid disease were excluded from
study. Free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) levels at ICU
admission were evaluated. Clinical, demographic, laboratory, treatment, and outcome data were obtained
from the patient's electronic hospital records. Mann Whitney U, Spearman correlation, binary logistic, and
linear regression tests were used for statistical analysis.
Results: TSH was in 31 patients, fT3 was in 37 patients, and fT4 was in 54 patients, which were outside the
normal ranges. fT3 were lower in non-survivors than the survivors (p=0.036). However, the fT3 level was not
the independent factor for mortality rate in linear regression analysis (p=0.652). APACHE II and procalcitonin
levels as independent predictors of mortality (p=0.017). fT3 remained an independent factor for the length
of ICU stay (p=0.024) and the length of hospital stay (p=0.031).
Conclusion: fT3 is a prognostic indicator that can predict hospital and ICU length of stay in critically ill patients
with Covid-19. In the future, a broader panel of validated biochemical markers, including fT3 levels,
may become a simple tool for stratified management of patients with severe COVID-19.

Anahtar Kelimeler

A LOOK AT THYROID FUNCTIONS AS A PREDICTOR ON PROGNOSIS OF CRITICALLY ILL PATIENTS IN INTENSIVE CARE UNITS FROM THE PERSPECTIVE OF COVID-19, Yoğun Bakım Ünitesindeki Kritik Hastaların Prognozunun Belirleyicisi Olarak Tiroid Fonksiyonlarına Covid-19, Perspektifinden Bir Bakış

Kaynakça

• 1. 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; 21:1–13.
• 2. Li MY, Li L, Zhang Y, Wang XS. Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infect Dis Poverty. 2020; 9(1):45
• 3. Ippolito S, Dentali F. Tanda ML. SARS-CoV-2: a potential trigger for subacute thyroiditis? Insights from a case report. J Endocrinol Invest. 2020; 43 (8):1171–2.
• 4. Wei L, Sun S, Xu CH, Zhang J, Xu Y, Zhu H, et al. Pathology of the thyroid in severe acute respiratory syndrome. Hum Pathol. 2007; 38(1): 95–102.
• 5. Lui DTW, Lee CH, Chow WS, Lee ACH, Tam AR, Fong CHY, et al. Thyroid dysfunction in relation to immune profile, disease status, and outcome in 191 patients with COVID-19. J Clin Endocrinol Metab. 2021;106(2): e926–e935.
• 6. Lisco G, De Tullio A, Stragapede A, Solimando AG, Albanese F, Capobianco M, et al. COVID-19 and the endocrine system: a comprehensive review on the theme. J Clin Med 2021, 10(13):2920.
• 7. Llamas M, Garo ML, Giovanella L. Low free-T3 serum levels and prognosis of COVID-19: systematic review and meta-analysis. Clin Chem Lab Med 2021; 59(12): 1906–13
• 8. Campi I, Bulgarelli I, Dubini A, Perego GB, Tortorici E, Torlasco C, et al. The spectrum of thyroid function tests during hospitalization for SARS COV-2 infection. Eur J Endocrinol 2021; 184(5):699–709.
• 9. Gao W, Guo W, Guo Y, Shi M, Dong G, Wang G, et al. Thyroid hormone concen- trations in severely or critically ill patients with COVID-19. J Endocrinol Invest 2021; 44(5):1031–40.
• 10. Schwarz Y, Percik R, Oberman B, Yaffe D, Zimlichman E, Tirosh A. Sick euthyroid syndrome on presentation of patients with COVID-19: a potential marker for disease severity. Endocr Pract 2021; 27 (2):101–9.