Thyroid Function, Inflammatory Response, and Glucocorticoids in COVID-19

Abstract

The ongoing COVID-19 pandemic calls for extensive research on various medical topics. Since the beginning of the pandemic, multiple studies investigated the impact of SARS CoV-2 on thyroid function. However, crucial data, such as trend progression over time or influence of commonly used drugs, might still be missing. We checked the thyroid function in 174 patients with PCR-confirmed COVID-19. Our research covered three separate time points of hospitalization (days 1, 4, and 10). We did not exclude patients treated with glucocorticoids but, instead, compared them with patients not treated with steroids. We correlated the results of thyroid function tests with markers of systemic inflammation. We checked if abnormal thyroid function can predict unfavorable outcomes defined as combined primary endpoint and/or secondary endpoints; the combined primary endpoint was the occurrence of death, mechanical ventilation, non-invasive ventilation, vasopressor infusion, or prolonged hospital stay, and the secondary endpoint was any of the listed events. In general, 80.46% of evaluated patients displayed abnormalities in thyroid function tests over at least one time point throughout the observation. We noticed a high prevalence of features typical for thyroid dysfunction in non-thyroidal illness (NTI). Free triiodothyronine (fT3) concentration was significantly lower in the group requiring glucocorticoids. Patients displaying abnormal thyroid function were statistically more likely to meet the predefined combined primary endpoint. We found that fT3 measured at admission could be perceived as an independent predictor of endpoint completion for all analyzed groups. Thyroid involvement is common in COVID-19. Our study supports the idea of thyroid function abnormalities being important clinical tools and allowing early recognition of possible detrimental outcomes of the disease.

Thyrotropin Levels in Patients with Coronavirus Disease 2019: Assessment during Hospitalization and in the Medium Term after Discharge

“…However, some studies found a difference in TSH levels between moderate and severe/critical COVID-19 even if the number of patients was low [21,25,[30][31][32][33][34] whereas others did not find a difference in TSH levels despite the higher number of patients [35]. It is also possible that factors other than systemic inflammation markers (i.e., CRP levels) participate in thyroid dysfunction in patients with COVID-19 such as: treatment with corticosteroids [28], use of iodinated contrast media, the background population iodine intake and the existence of iodine deficiency. Finally, in agreement with the reported data [25,31,33,36] levels of fT3 and fT4 were lowers in patients with critical COVID-19 as compared with those with non-critical form.…”

“…Interestingly, Świ ątkowska-Stodulska et al assessed thyroid function tests in patients admitted to the hospital for COVID-19 at three different time points. They found that abnormal thyroid function tests were present in 57.5% of the patients on day 1, 63.1% on day 4, and 76.6% on day 10 [28].…”

Thyroglobulin levels in COVID-19-positive patients: Correlations with thyroid function tests, inflammatory markers, and glucocorticoid use

“…proved that abnormal thyroid function in COVID-19 is common and up to 64% of patients display abnormal TFTs ( 3 ). Our recent study on thyroid function in patients hospitalized for COVID-19 supported these findings: up to 80% of recruited individuals showed abnormal TFTs at least once during the observation period ( 27 ). In particular, NTI appeared to be common in patients with COVID-19 ( 27 , 28 ).…”

“…Our recent study on thyroid function in patients hospitalized for COVID-19 supported these findings: up to 80% of recruited individuals showed abnormal TFTs at least once during the observation period ( 27 ). In particular, NTI appeared to be common in patients with COVID-19 ( 27 , 28 ). NTI features tended to fade over time in patients recovering from COVID-19, but remained prominent in patients who succumbed to their illness ( 29 ).…”

“…NTI features tended to fade over time in patients recovering from COVID-19, but remained prominent in patients who succumbed to their illness ( 29 ). A positive correlation was observed between abnormal TFTs and high inflammatory markers, and abnormal TFTs could herald an unfavorable clinical course of the disease and a prolonged hospital stay ( 27 , 30 ).…”