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. 2021 Jun;36(3):582-589.
doi: 10.3803/EnM.2021.983. Epub 2021 Jun 8.

Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors

David Tak Wai Lui  1 , Chi Ho Lee  1 , Wing Sun Chow  1 , Alan Chun Hong Lee  1 , Anthony Raymond Tam  1 , Carol Ho Yi Fong  1 , Chun Yiu Law  2 , Eunice Ka Hong Leung  1 , Kelvin Kai Wang To  3 , Kathryn Choon Beng Tan  1 , Yu Cho Woo  1 , Ching Wan Lam  4 , Ivan Fan Ngai Hung  1 , Karen Siu Ling Lam  1
Affiliations

Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors

David Tak Wai Lui et al. Endocrinol Metab (Seoul). 2021 Jun.

Abstract

Background: The occurrence of Graves' disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors.

Methods: We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months.

Results: In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer.

Conclusion: Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.

Keywords: COVID-19; Euthyroid sick syndromes; SARS-CoV-2; Thyroid function tests; Thyroid gland; Thyroiditis.

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Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Changes in thyroid function status in all 122 patients included. fT3, free triiodothyronine; fT4, free thyroxine; TSH, thyroid-stimulating hormone.
See this image and copyright information in PMC

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