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

Abstract

Objective: We have previously observed thyroid dysfunction, i.e. atypical thyroiditis (painless thyrotoxicosis associated to non-thyroidal illness syndrome), in patients with severe-acute-respiratory-syndrome-coronavirus-2 disease (Covid-19). This study aimed to analyse the evolution of thyroid dysfunction over time. Methods: 183 consecutive patients hospitalised for severe Covid-19 without known thyroid history were studied at hospital admission (baseline). Survivors were offered 12-month longitudinal follow-up including assessment of thyroid function, autoantibodies and ultrasound scan (US). Patients showing US focal hypoechoic areas suggestive of thyroiditis (focal-hypoechogenicity) also underwent thyroid 99mTc or 123I uptake scan. Results: At baseline, after excluding from TSH analysis 63 out of 183 (34%) Covid-19 patients commenced on steroids before hospitalisation, 12 (10%) showed atypical thyroiditis. Follow-up of 75 patients showed normalisation of thyroid function and inflammatory markers, and no increased prevalence of detectable thyroid autoantibodies. Baseline US (available in 65 patients) showed focal-hypoechogenicity in 28% patients, of whom 82% had reduced thyroid 99mTc/123I uptake. The presence of focal-hypoechogenicity was associated with baseline low TSH (p=0.034), high FT4 (p=0.018) and high IL-6 (p=0.016). Focal-hypoechogenicity persisted after 6 and 12 months in 87% and 50% patients, respectively, but reduced in size. After 9 months thyroid 99mTc/123I uptake partially recovered from baseline (+28%), but was still reduced in 67% patients. Conclusions: Severe Covid-19 induces mild transient thyroid dysfunction correlating with disease severity. Focal-hypoechogenicity, associated with baseline high FT4, IL-6 and low TSH, does not seem to be related to thyroid autoimmunity and may persist after one year although decreasing in size. Long-term consequences seem unlikely.

Development of SARS-CoV-2 atypical thyroiditis in a patient with severe COVID-19

“…Согласно немногочисленным исследованиям, атипичным SARS-CoV-2-ассоциированный тиреоидит назван в связи с рядом особенностей течения: тиреотоксикоз, развивающийся строго в остром периоде болезни [21][3] [22] и всегда ассоциированный с высокими уровнями провоспалительных цитокинов в крови [2]. Кроме того, существует ряд морфологических особенностей, отличающих атипичный тиреоидит от подострого: последний характеризуется деструкцией фолликулярных клеток и фолликулов, потере фолликулами коллоида, а также патогномоничной инфильтрацией полинуклеарными лейкоцитами, лимфоцитами, в результате чего образуются гранулемы, которые содержат гигантские многоядерные клетки.…”

“…При контрольном исследовании показатели ТТГ, Т4св, Т3св находились в референсном диапазоне, что не потребовало проведения дальнейших диагностических исследований и лечения. Согласно большинству исследований, изменения в тиреоидном статусе при заболевании COVID-19 чаще носят транзиторный, преходящий характер, что было показано на примере вышеописанного пациента [2] [10] [33].…”

COVID-19 associated thyroid dysfunction and other comorbidities and its management using phytochemical-based therapeutics: a natural way

“…Thyroid 99m Tc/ 123 I uptake was reduced in 67% of patients after 9 months but partially recovered from baseline (+28%). These results suggest that COVID-19 causes modest, temporary thyroid impairment [ 154 ]. It does not appear that thyroid autoimmunity is related to focal hypoechogenicity, which may continue after a year while shrinking in size and is associated with baseline high FT4, IL6, and low TSH.…”