Outcome of Sars-COV-2-related thyrotoxicosis in survivors of Covid-19: a prospective study

Abstract

Purpose To evaluate the post-coronavirus disease-19 (COVID-19) outcome of thyroid function in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related thyrotoxicosis. Methods This was a single-center prospective study involving 29 patients (11 females, 18 males; median age 64 years, range: 43-85) with thyrotoxicosis diagnosed after hospitalization for COVID-19 and then followed-up for a median period of 90 days (range: 30-120) after hospital discharge. At follow-up, patients were evaluated for serum thyrotropin (TSH), freethyroxine (FT4), free-triiodiothyronine (FT3), TSH receptor antibodies (TRAb), thyroglobulin antibodies (TgAb), thyroperoxidase antibodies (TPOAb) and ultrasonographic thyroid structure. Results After recovery of COVID-19, serum TSH values significantly increased (P < 0.001) and FT4 values significantly decreased (P = 0.001), without significant change in serum FT3 (P = 0.572). At follow-up, 28 subjects (96.6%) became euthyroid whereas overt hypothyroidism developed in one case. At the ultrasound evaluation of thyroid gland, hypoecogenicity was found in 10 patients (34.5%) and in these cases serum TSH values tended to be higher than those without thyroid hypoecogenity (P = 0.066). All subjects resulted to be negative for TgAb, TPOAb and TRAb. Conclusion In a short-term follow-up, thyroid function spontaneously normalized in most subjects with SARS-CoV-2-related thyrotoxicosis. However, thyroid hypoecogenicity was found in a remarkable number of them and future longer-term studies are needed to clarify whether this ultrasonographic alteration may predispose to develop late-onset thyroid dysfunction.

Low testosterone predicts hypoxemic respiratory insufficiency and mortality in patients with COVID-19 disease: another piece in the COVID puzzle

“…These studies are poorly comparable, due to the different thresholds applied to identify low T subjects and the heterogeneity of the populations involved (e.g., ICU vs asymptomatic subjects). The high prevalence observed in our cohort suggests a specific association between SARS-CoV-2 infection and gonadal failure, possibly involving the whole hypothalamic-pituitary–gonadal (HPG) axis, in association with a higher degree of systemic inflammation, as similarly described for other endocrine glands [ 28 , 42 ].…”

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

“…Pizzocaro et al recruited 58 patients with COVID-19 associated thyrotoxicosis where 23 (39.7%) of the patients died. Among the rest of the patients, 29 patients were enrolled to the prospective study [18]. The authors reported that all but one subject with COVID-19 related thyrotoxicosis became euthyroid after a median of 90 days while one-third of the patients revealed hypoechogenicity on ultrasound evaluation associated with higher TSH values at follow-up.…”

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

“…Indeed, this rate is also similar to the background rate of abnormal thyroid ultrasonographic echogenicity reported in population studies (around 10%) [ 31 ]. Existing studies have focused on the ultrasonographic features of COVID-19 survivors who had symptomatic SARS-CoV-2-related thyroiditis in acute illness [ 7 ]. In contrast, our study attempted to identify any subclinical ultrasonographic suggestion of thyroid parenchymal damage, as these abnormalities could predict subsequent thyroid dysfunction [ 32 ].…”

“…However, thyroid USG has been mainly performed in patients who had clinically overt thyroid dysfunction in acute COVID-19 [ 6 , 7 ]. Little is known in a broader sense on how the infection may affect the subsequent ultrasonographic features and thyroid volumes for COVID-19 survivors.…”