Higher SARS-CoV-2 viral loads correlated with smaller thyroid volumes on ultrasound among male COVID-19 survivors

Abstract

Purpose Thyroid dysfunction, including thyroiditis, is well recognized in COVID-19 patients. We evaluated thyroid ultrasonographic features among COVID-19 survivors, which are less well known. Methods Adult COVID-19 survivors without known thyroid disorders who attended dedicated COVID-19 clinic underwent thyroid ultrasonography and assessment of thyroid function and autoimmunity. Adults admitted for acute non-thyroidal surgical problems and negative for COVID-19 were recruited as control. SARS-CoV-2 viral load (VL) was presented as the inverse of cycle threshold values from the real-time reverse transcription-polymerase chain reaction of the respiratory specimen on admission. Results In total, 79 COVID-19 patients and 44 non-COVID-19 controls were included. All abnormal thyroid function tests during acute COVID-19 recovered upon follow-up. Thyroid ultrasonography was performed at a median of 67 days after acute COVID-19. The median thyroid volume was 9.73 mL (IQR: 7.87–13.70). In multivariable linear regression, SARS-CoV-2 VL on presentation (standardized beta −0.206, p = 0.042) inversely correlated with thyroid volume, in addition to body mass index at the time of ultrasonography ( p < 0.001). Sex-specific analysis revealed similar results among men but not women. Eleven COVID-19 patients (13.9%) had ultrasonographic changes suggestive of thyroiditis, comparable to non-COVID-19 patients ( p = 0.375). None of these 11 patients had isolated low thyroid-stimulating hormone levels suggestive of thyroiditis at initial admission or the time of ultrasonography. Conclusions Higher SARS-CoV-2 VL on presentation were associated with smaller thyroid volumes, especially in men. Further research is suggested to investigate this possible direct viral effect of SARS-CoV-2 on the thyroid gland. There was no increased rate of ultrasonographic features suggestive of thyroiditis in COVID-19 survivors.

The potential impact of COVID-19 on thyroid gland volumes among COVID-19 survivors

“…The mechanisms regarding the effect of COVID-19 on the thyroid gland are not yet fully clear. As we found in our study, the authors did not find any association with systemic inflammation markers such as CRP and the thyroid gland volume [17]. We did not detect any relationship between the inflammatory markers, gender, and severity of disease with thyroid gland volume.…”

“…In a study by Lui et al [17], 79 patients were evaluated for a median of 2 months after the diagnosis of COVID-19. The authors found that thyroid gland volume was lower than in control subjects, although the difference did not reach statistical significance.…”

Is Smaller Thyroid Gland Volume in COVID-19 Survivors Indicative of Chronic Thyroid Dysfunction?

“…Thyroid gland volume was signi cantly lower in patients with a higher viral load and in men. No correlation was found between in ammatory markers during acute COVID-19 infection and thyroid gland volume [22]. We could not evaluate viral load since our study was observational and this is a limitation for this study.…”

Long-term outcome of thyroid abnormalities in patients with severe Covid-19

“…They had a mean (SD) age of 67.5 ± 13.8 years and were predominantly males (N=124, 68%). The NEWS2 score assessed at hospital admission was low in 84 (47%), medium in 60 (33%) and high in 36 (20%) patients and the median (IQR) length of hospitalisation was 20 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) days. Oxygen support was administered low-flow in 40 (22%) patients, while 111 (61%) and 20 (11%) patients required CPAP/HFNC and invasive mechanical ventilation, respectively.…”