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. 2020 Oct;183(4):381-387.
doi: 10.1530/EJE-20-0335.

Thyrotoxicosis in patients with COVID-19: the THYRCOV study

Andrea Lania  1   2 , Maria Teresa Sandri  3 , Miriam Cellini  1 , Marco Mirani  1 , Elisabetta Lavezzi  1 , Gherardo Mazziotti  1   2
Affiliations

Thyrotoxicosis in patients with COVID-19: the THYRCOV study

Andrea Lania et al. Eur J Endocrinol. 2020 Oct.

Abstract

Objective: This study assessed thyroid function in patients affected by the coronavirus disease-19 (COVID-19), based on the hypothesis that the cytokine storm associated with COVID-19 may influence thyroid function and/or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may directly act on thyroid cells, such as previously demonstrated for SARS-CoV-1 infection.

Design and methods: This single-center study was retrospective and consisted in evaluating thyroid function tests and serum interleukin-6 (IL-6) values in 287 consecutive patients (193 males, median age: 66 years, range: 27-92) hospitalized for COVID-19 in non-intensive care units.

Results: Fifty-eight patients (20.2%) were found with thyrotoxicosis (overt in 31 cases), 15 (5.2%) with hypothyroidism (overt in only 2 cases), and 214 (74.6%) with normal thyroid function. Serum thyrotropin (TSH) values were inversely correlated with age of patients (rho -0.27; P < 0.001) and IL-6 (rho -0.41; P < 0.001). In the multivariate analysis, thyrotoxicosis resulted to be significantly associated with higher IL-6 (odds ratio: 3.25, 95% confidence interval: 1.97-5.36; P < 0.001), whereas the association with age of patients was lost (P = 0.09).

Conclusions: This study provides first evidence that COVID-19 may be associated with high risk of thyrotoxicosis in relationship with systemic immune activation induced by the SARS-CoV-2 infection.

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Figures

Figure 1
Figure 1
Individual outcomes of serum-free thyroxine (FT4) values in seven patients with overt thyrotoxicosis in the course of COVID-19 who were sequentially evaluated for thyroid function. Two patients (dashed line) were treated with thiamazole, whereas the other five patients (solid line) were not treated with thyroid-targeting drugs.
Figure 2
Figure 2
Scatter plot of age in COVID-19 patients stratified for serum thyrotropin (TSH) values. The solid lines identified the median values in each group. Comparisons were performed by Kruskal–Wallis'; and Mann–Whitney's tests.
Figure 3
Figure 3
Scatter plot of serum interleukin-6 (IL-6) values expressed in log-scale in COVID-19 patients stratified for serum thyrotropin (TSH) values. The solid lines identified the median values in each group. Comparisons were performed by Kruskal–Wallis' and Mann–Whitney's tests.
Figure 4
Figure 4
In-hospital mortality rate in COVID-19 patients stratified for serum thyrotropin (TSH) values. *P < 0.05 vs the other groups.
Figure 5
Figure 5
Scatter plot of hospitalization length in COVID-19 patients stratified for serum thyrotropin (TSH) values. The solid lines identified the median values in each group. Comparisons were performed by Kruskal–Wallis' and Mann–Whitney's tests.
See this image and copyright information in PMC

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