To the Editor Although recent evidence suggests that COVID-19 can affect practically all organs, data on the impact of SARS-CoV-2 on the thyroid gland are very scarce. Two patients with Graves' disease (GD) and COVID-19 have been recently published [1], and we would like to provide more evidence with two more cases. Patient 1 was a 45-year-old woman with a 12-year medical history of GD. She had 2 previous episodes of hyperthyroidism that were treated with antithyroid drugs (ATD), first in 2008 after diagnosis (ATD for 22 months) and then at a relapse in 2015 (ATD for 25 months). She also had Graves' ophthalmopathy that was treated with corticosteroids for 3 months in 2018. At the beginning of March 2020, her thyroid function was normal, with free thyroxine levels (FT4) of 1.36 ng/dL (normal range, 0.93-1.7 ng/dL) and serum thyroid-stimulating hormone levels (TSH) of 0.75 µIU/ mL (normal range, 0.27-4.2 µIU/mL), although anti-TSH receptor antibodies (anti-TSHR-Ab) were slightly elevated (1.9 mIU/mL; normal range < 1.5 mIU/mL). In May 2020, she developed bilateral pneumonia and was diagnosed with SARS-CoV-2 infection. This patient also presented palpitations and nervousness. Her blood test results showed a TSH of < 0.005 µIU/mL, a FT4 of > 7.7 ng/dL and an anti-TSHR-Ab of 28.7 mIU/mL. Thyroid ultrasound showed hypervascularization. She started methimazole (MMI) at a daily dose of 40 mg, which resulted in a rapid normalization of her thyroid function. No deterioration of her ophthalmopathy was observed. The MMI dosage of 40 mg/day was reduced to 5 mg/day during follow-up and she shows improvement in her condition after 3 months of treatment.

Introduction A small percentage of patients will develop a severe form of COVID-19 caused by SARS-CoV-2 infection. Thus, it is important to predict the potential outcomes identifying early markers of poor prognosis. In this context, we evaluated the association of SARS-CoV-2 infection with lipid abnormalities and their role in prognosis. Methods Single-center, retrospective, observational study of COVID-19 patients admitted from March to October 2020. Clinical and laboratory data, comorbidities, and treatments for COVID-19 were evaluated. Main outcomes including intensive care unit (ICU) admission and mortality were analyzed with a multivariable Cox proportional hazards regression model. Results We selected 1489 from a total of 2038 consecutive patients with confirmed COVID-19, who had a complete lipid profile before ICU admission. During the follow-up performed in 1109 patients, we observed a decrease in T-c, HDL-c, and LDL-c in 28.6%, 42.9%, and 30.4% of patients, respectively, and an increase in TG in 76.8%. The decrease of both T-c and HDL- c was correlated with a decrease in albumin levels (r = 0.39 and r = 0.37, respectively). Kaplan–Meier survival curves found an increased ICU admission in patients with lower T-c (HR 0.55, CI 0.36–0.86), HDL-c (HR 0.61, CI 0.45–0.84), and LDL-c (HR 0.85, CI 0.74–0.97). Higher values of T-c (HR 0.45, CI 0.36–0.57), HDL-c (HR 0.66, CI 0.54–0.81), and LDL-c (HR 0.86, CI 0.78–0.94) showed a protective effect on mortality. Conclusions Abnormalities in lipid profile are a frequent complication of SARS-CoV-2 infection and might be related to morbidity and mortality. Funding Proyectos de Investigación en Salud (FIS) and cofinanced by FEDER.

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