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. 2024 Oct 27;22(3):e146857.
doi: 10.5812/ijem-146857. eCollection 2024 Jul.

Thyroid Function in the Time of COVID-19: A Systematic Review of Disease Progression and Vaccination Effect

Maryam Zarkesh #  1 , Maryam Sanoie #  1 , Shabnam Heydarzadeh  1 , Raziyeh Abooshahab  2   1 , Afsoon Daneshafrooz  1 , Farhad Hosseinpanah  3 , Mehdi Hedayati  1
Affiliations

Thyroid Function in the Time of COVID-19: A Systematic Review of Disease Progression and Vaccination Effect

Maryam Zarkesh et al. Int J Endocrinol Metab. .

Abstract

Objectives: This systematic review sought to address three key questions: (1) what differences in abnormal thyroid function test results are observed between COVID-19 patients and healthy individuals? (2) How does the severity of COVID-19 infection influence the development of thyroid dysfunction? (3) What impact do COVID-19 vaccines have on thyroid function and autoimmune processes?

Methods: A literature search was conducted in PubMed, Web of Science, and Scopus from December 2019 to April 2023 to identify studies on thyroid dysfunction in COVID-19 patients without pre-existing thyroid conditions. The search focused on observational and case-control studies.

Results: The literature search yielded 329 reports, from which duplicates and unrelated publications were excluded. Ultimately, 21 studies met the inclusion criteria and were selected for review. A second literature search yielded 605 reports, from which 5 studies were selected for inclusion in the systematic review.

Conclusions: The findings suggest that SARS-CoV-2 infection can induce transient and reversible thyroid dysfunction, possibly through direct viral effects on the thyroid gland or via indirect immune-mediated mechanisms. Clinicians should be mindful of the potential, albeit rare, thyroid-related adverse effects of COVID-19 vaccines and monitor thyroid function, particularly in high-risk individuals.

Keywords: SARS-CoV-2 Virus; Thyroid Diseases; Thyroid Hormones; Vaccines.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.. The impact of COVID-19 and vaccine on thyroid function, SARS-CoV-2 can cause hormonal changes by directly affecting the pituitary axis. On the other hand, this virus can interfere with the function of these cells by binding to the angiotensin-converting enzyme 2 (ACE2) in thyroid cells. Changes in the levels of thyroid hormones based on the direct and indirect effect of viral infection can cause various systemic changes such as the activation of various pro-inflammatory cytokines, as a result, the cytokine storm with the combined effect on the hypothalamic-pituitary axis (HPT) leads to a decrease in the level of hormones. Covid-19 vaccines destroy thyroid follicular cells by binding spike protein to angiotensin-converting enzyme II (ACE-2) receptors, leading to thyroid dysfunction and hormonal changes. Also, some homologies between the amino acid sequences of the virus with human tissue proteins such as thyroid peroxidase (TPO) leads to cross-react.
Figure 2.
Figure 2.. Flow chart showing the selection process for the systematic review of eligible studies on thyroid dysfunction in COVID-19 patients.
Figure 3.
Figure 3.. Flow chart showing the selection process for the systematic review of eligible studies on thyroid dysfunction with COVID-19 vaccine.
See this image and copyright information in PMC

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