Potential Interaction Between SARS-CoV-2 and Thyroid: A Review

Chen, Wenjie; Tian, Yang; Li, Zhihui; Zhu, Jingqiang; Wei, Tao; Lei, Jianyong

doi:10.1210/endocr/bqab004

Cited by 96 publications

(154 citation statements)

References 80 publications

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“…in more than ¾ and thyroid function tests suggesting hyperthyroid etiology in 100% of the cases. It has also been hypothesized that drugs used in COVID-19, especially glucocorticoids and low molecular weight heparin, may also damage the gland and affect thyroid function [43]. While this mechanism might play a role in thyroid abnormalities, there is not enough evidence to support it in our review because not all patients described here received steroids and heparin for COVID-19 infection.…”

Section: Discussionmentioning

confidence: 90%

The Association of Subacute Thyroiditis with COVID-19: a Systematic Review

Rehman

Farooq

Ali³

et al. 2021

SN Compr. Clin. Med.

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The multisystem effects of SARS-CoV-2 encompass the thyroid gland as well. Emerging evidence suggests that SARS-CoV-2 can act as a trigger for subacute thyroiditis (SAT). We conducted a systematic literature search using PubMed/Medline and Google Scholar to identify cases of subacute thyroiditis associated with COVID-19 and evaluated patient-level demographics, major clinical features, laboratory findings and outcomes. In the 21 cases that we reviewed, the mean age of patients was 40.0 ± 11.3 years with a greater female preponderance (71.4%). Mean number days between the start of COVID-19 illness and the appearance of SAT symptoms were 25.2 ± 10.1. Five patients were confirmed to have ongoing COVID-19, whereas the infection had resolved in 16 patients before onset of SAT symptoms. Fever and neck pain were the most common presenting complaints (81%). Ninety-four percent of patients reported some type of hyperthyroid symptoms, while the labs in all 21 patients (100%) confirmed this with low TSH and high T3 or T4. Inflammatory markers were elevated in all cases that reported ESR and CRP. All 21 cases (100%) had ultrasound findings suggestive of SAT. Steroids and anti-inflammatory drugs were the mainstay of treatment, and all patients reported resolution of symptoms; however, 5 patients (23.8%) were reported to have a hypothyroid illness on follow-up. Large-scale studies are needed for a better understanding of the underlying pathogenic mechanisms, but current evidence suggests that clinicians need to recognize the possibility of SAT both in ongoing and resolved COVID-19 infection to optimize patient care.

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Section: Discussionmentioning

confidence: 90%

The Association of Subacute Thyroiditis with COVID-19: a Systematic Review

Rehman

Farooq

Ali³

et al. 2021

SN Compr. Clin. Med.

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“…Serum TSH is usually normal, and tends to reduce only in the most severe chronic conditions. Nevertheless, since the alterations of olfaction and taste typical of COVID-19 are in keeping with a SARS-CoV-2 neuro-tropism, the possibility of a hypothalamic-pituitary involvement should not be discarded, as it was previously suggested during SARS-CoV-1 outbreak (3,18,19).…”

Section: Introductionmentioning

confidence: 99%

“…An alteration in thyroid function tests (TFT), mainly characterized by the reduction of TSH levels has been recorded during SARS-CoV-2 infection as associated to either a destructive thyroiditis or a non-thyroidal illness (NTI). Indeed, cases of destructive thyrotoxicosis (3)(4)(5)(6)(7)(8)(9) or subacute thyroiditis (3,4; 8-14) have been reported in patients with COVID-19 infection. On the other hand, SARS-CoV-2 coronavirus can cause immune response hyperactivity leading to the release of proinflammatory cytokines which may cause a cytokine storm (17).…”

Section: Introductionmentioning

confidence: 99%

The spectrum of thyroid function tests during hospitalization for SARS COV-2 infection

Campi

Bulgarelli

Dubini

et al. 2021

European Journal of Endocrinology

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Objective Alterations in thyroid function tests (TFTs) have been recorded during SARS-CoV-2 infection as associated to either a destructive thyroiditis or a non-thyroidal illness. Methods We studied 144 consecutive COVID-19 patients admitted to a single Center, in intensive or subintensive care Units. Those with previous thyroid dysfunctions or taking interfering drugs were excluded. Differently from previous reports, TSH, FT3, FT4, thyroglobulin (Tg), anti-Tg autoantibodies (TgAb) were measured at baseline and every 3-7 days. C-reacting protein (CRP), cortisol and IL-6 were also assayed. Results The majority of patients had a normal TSH at admission, usually with normal FT4 and FT3. Low TSH levels were found either at admission or during hospitalization in 39% of patients, associated with low FT3 in half of the cases. FT4 and Tg levels were normal, and TgAb negative. TSH and FT3 were invariably restored at discharge in survivors, whereas were permanently low in most deceased cases, but only FT3 levels were predictors of mortality. Cortisol, CRP and IL-6 levels were higher in patients with low TSH and FT3 levels. Conclusions: Almost half of our COVID-19 patients without interfering drugs had normal TFTs both at admission and during follow up. In this series, the transient finding of low TSH with normal FT4 and low FT3 levels, inversely correlated with CRP, cortisol and IL-6 and associated with normal Tg levels, is likely due to the cytokine storm induced by SARS-Cov-2 with a direct or mediated impact on TSH secretion and deiodinase activity, and not to a destructive thyroiditis.

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“…Chen [15] To review the potential interaction between COVID-19 and the thyroid gland, including thyroid pathology, function and diseases. To explore the potential harmful effects of COVID-19 drugs on the thyroid SAT caused by SARS-CoV-2 has been reported.…”

Section: Discussionmentioning

confidence: 99%

“…By the search strategy, a number of 247 records was initially found. Among these, according to the above criteria, 238 studies were excluded since they were not review articles, and nine reviews were finally included [7,[11][12][13][14][15][16][17][18] (Fig. 1).…”

Section: Reviews Retrievedmentioning

confidence: 99%

Thyroid sequelae of COVID-19: a systematic review of reviews

Trimboli

Camponovo

Scappaticcio

et al. 2021

Rev Endocr Metab Disord

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The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has the potential to cause multi-organ effects including endocrine disorders. The impact of COVID-19 on the thyroid gland has been described but several aspects have to be clarified. The systematic review was conceived to achieve more solid information about: 1) which thyroid disease or dysfunction should be expected in COVID-19 patients; 2) whether thyroid patients have a higher risk of SARS-CoV-2 infection; 3) whether the management has to be adapted in thyroid patient when infected. The literature was searched by two authors independently. A 5-step search strategy was a priori adopted. Only reviews focused on the relationship between thyroid and COVID-19 were included. The last search was performed on February 21st 2021. Two-hundred-forty-seven records was initially found and nine reviews were finally included. The reviews identified several potential thyroid consequences in COVID-19 patients, such as thyrotoxicosis, low-T3 syndrome and subacute thyroiditis, while no relevant data were found regarding the potential impact of COVID-19 on the management of patients on thyroid treatment. The present systematic review of reviews found that: 1) patients diagnosed with COVID-19 can develop thyroid dysfunction, frequently non-thyroidal illness syndrome when hospitalized in intensive care unit, 2) having a thyroid disease does not increase the risk for SARS-CoV-2 infection, 3) thyroid patients do not need a COVID-19-adapted follow-up. Anyway, several factors, such as critical illness and medications, could affect thyroid laboratory tests.

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Potential Interaction Between SARS-CoV-2 and Thyroid: A Review

Cited by 96 publications

References 80 publications

The Association of Subacute Thyroiditis with COVID-19: a Systematic Review

The Association of Subacute Thyroiditis with COVID-19: a Systematic Review

The spectrum of thyroid function tests during hospitalization for SARS COV-2 infection

Thyroid sequelae of COVID-19: a systematic review of reviews

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