Role of non‐thyroidal illness syndrome in predicting adverse outcomes in COVID‐19 patients predominantly of mild‐to‐moderate severity

Abstract

Objective: Existing studies reported the potential prognostic role of non-thyroidal illness syndrome (NTIS), characterized by low triiodothyronine (T3) with normal/low thyroidstimulating hormone (TSH), mainly in severe COVID-19. None considered the significant impact of SARS-CoV-2 viral load on adverse outcomes. We aimed to clarify the prognostic role of NTIS among predominantly mild-to-moderate COVID-19 patients. Design: A prospective study of COVID-19 patients. Patients and Measurements: Consecutive adults admitted to Queen Mary Hospital for confirmed COVID-19 from July to December 2020 were prospectively recruited. SARS-CoV-2 viral load was represented by cycle threshold (Ct) values from real-time reverse transcription-polymerase chain reaction of the respiratory specimen on admission. Serum TSH, free thyroxine and free T3 were measured on admission. The outcome was deterioration in clinical severity, defined as worsening in ≥1 category of clinical severity according to the Chinese National Health Commission guideline.Results: We recruited 367 patients. At baseline, 75.2% had mild disease, and 27 patients (7.4%) had NTIS. Fifty-three patients (14.4%) had clinical deterioration. Patients with NTIS were older, had more comorbidities, worse symptomatology, higher SARS-CoV-2 viral loads and worse profiles of inflammatory and tissue injury markers. They were more likely to have clinical deterioration (p < .001). In multivariable stepwise logistic regression analysis, NTIS independently predicted clinical deterioration (adjusted odds ratio 3.19, p = .017), in addition to Ct value <25 (p < .001), elevated C-reactive protein (p = .004), age >50 years (p = .011) and elevated creatine kinase (p = .017).Conclusions: Non-thyroidal illness syndrome was not uncommon even in mild-tomoderate COVID-19 patients. NTIS on admission could predict clinical deterioration in COVID-19, independent of SARS-CoV-2 viral load, age and markers of inflammation and tissue injury. K E Y W O R D S COVID-19, euthyroid sick syndromes, prognosis, SARS-CoV-2, thyroid function tests, thyroid gland How to cite this article: Lui DTW, Lee CH, Chow WS, et al. Role of non-thyroidal illness syndrome in predicting adverse outcomes in COVID-19 patients predominantly of mild-tomoderate severity.

Thyroid Hormone Profile and Its Prognostic Impact on the Coronavirus Disease 2019 in Korean Patients

“…In our study, NTIS was more commonly observed in patients with severe to critical disease (23%) than in those with non-severe disease (6.3%). The frequency of NTIS in our cohort is comparable to those reported in the recent studies, which were 20% to 30% among patients with severe COVID-19 [ 11 , 12 ] and higher than that among patients with mild to moderate baseline severity [ 24 ]. These findings suggested that alterations in thyroid function at COVID-19 presentation were more similar to an NTIS pattern than to a classic subacute thyroiditis, especially in the patients with more severe COVID-19 disease.…”

Non-thyroidal illness syndrome and SARS-CoV-2-associated multisystem inflammatory syndrome in children

“…Patients frequently develop NTIS when hospitalized in intensive care units. NTIS with its overlapping symptoms and elevated inflammatory markers represents an independent risk factor for COVID-19 severity [20]. NTIS has also been reported in mild-to-moderate COVID-19 patients; in these subjects, NTIS at admission could be useful in predicting clinical deterioration independent of viral load, age, markers of inflammation and tissue injury [20].…”

The Impact of Interferon Beta-1b Therapy on Thyroid Function and Autoimmunity Among COVID-19 Survivors

“…The public health ordinance in Hong Kong required all patients tested positive for COVID-19 to be admitted to the hospital, including those detected on contact tracing and the Universal Community Testing Programme, regardless of symptoms ( 7 ). Our institution is one of the major centres in Hong Kong receiving confirmed COVID-19 patients.…”

“…Consecutive adult patients (aged ≥18 years) admitted to our institution for COVID-19 between 21 July 2020 and 20 January 2021 were prospectively recruited. The presence of SARS-CoV-2 was confirmed in all patients by reverse transcription-polymerase chain reaction (RT-PCR) from the nasopharyngeal swab (NPS) or deep throat saliva (DTS), using the LightMix SarbecoV E-gene assay (TIB Molbiol, Berlin, Germany), which targeted the envelope protein (E) gene of SARS-CoV-2 ( 7 , 8 ). Exclusion criteria were (i) history of thyroid, hypothalamic or pituitary disorders; (ii) use of anti-thyroid drugs or thyroid hormone replacement; and (iii) use of medications with potential impact on thyroid function, including systemic steroid, amiodarone, heparin and dopamine, before admission.…”