Clinical presentation and prognosis of COVID-19 in older adults with hypothyroidism: data from the GeroCovid observational study

Abstract

Background The prevalence of hypothyroidism among older patients hospitalized for COVID-19 and its association with mortality is unclear. This study aims to investigate the prevalence of hypothyroidism in older COVID-19 inpatients and verify if this comorbidity is associated with a specific pattern of onset symptoms and a worse prognosis. Methods COVID-19 inpatients aged ≥ 60 years, participating in the GeroCovid acute wards cohort, were included. The history of hypothyroidism was derived from medical records and the use of thyroid hormones. Sociodemographic data, comorbidities, symptoms/signs at the disease onset and inflammatory markers at ward admission were compared between people with vs without history of hypothyroidism. The association between hypothyroidism and in-hospital mortality was tested through Cox regression. Results Of the 1245 patients included, 8.5% had a history of hypothyroidism. These patients were more likely to present arterial hypertension and obesity compared with those without an history of hypothyroidism. Concerning COVID-19 clinical presentation, patients with hypothyroidism had less frequently low oxygen saturation and anorexia but reported muscle pain and loss of smell more commonly than those without hypothyroidism. Among the inflammatory markers, patients with hypothyroidism had higher lymphocytes values. At Cox regression, hypothyroidism was associated with reduced in-hospital mortality only in the univariable model (HR = 0.66, 95% CI 0.45–0.96, p = 0.03); conversely, no significant result were observed after adjusting for potential confounders (HR = 0.69, 95% CI 0.47–1.03, p = 0.07). Conclusions Hypothyroidism does not seem to substantially influence the prognosis of COVID-19 in older people, although it may be associated with peculiar clinical and biochemical features at the disease onset. Supplementary Information The online version contains supplementary material available at 10.1007/s40618-023-02048-w.

Effects of SARS-CoV-2 infection on hypothyroidism and subclinical hypothyroidism: a meta-analysis

“…In this meta-analysis, we systematically examined the effects of SARS-CoV-2 infection on thyroid function. Our overall findings showed that TSH, TT3, and TT4 levels were not significantly affected by SARS-CoV-2 infection, thus aligning with the current popular hypothesis that SARS-CoV-2 infection does not directly induce significant changes in thyroid function (15). However, our findings indicate several relevant effects when we investigated the impact of the severity of COVID-19.…”

“…In addition, there are studies suggesting that COVD-19 may trigger an inflammatory response in the thyroid gland, leading to transient hypothyroidism (13). Nevertheless, these studies do not always converge on a shared conclusion (10)(11)(12)(13)(14)(15)(16). The inconsistency may be due to a variety of factors, such as the differences in biochemical detection methods used, the population characteristics of the subjects, the geographical environment, and the specific genotypes or variants of SARS-CoV-2 involved.…”