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      Thyroid dysfunction in COVID-19 patients

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          Abstract

          Purpose

          “Non thyroidal illness syndrome” (NTIS) or “euthyroid sick syndrome” (ESS) is a possible biochemical finding in euthyroid patients with severe diseases. It is characterized by a reduction of serum T 3 (fT3), sometimes followed by reduction of serum T 4 (fT4). The relationship between thyroid hormones levels and mortality is well known and different studies showed a direct association between NTIS and mortality. The sudden spread of the 2019 novel coronavirus (SARS-CoV 2) infection (COVID-19) and its high mortality become a world healthcare problem. Our aim in this paper was to investigate if patients affected by COVID-19 presented NTIS and the relationship between thyroid function and severity of this infection.

          Methods

          We evaluated the thyroid function in two different groups of consecutive patients affected by COVID-19 with respect to a control group of euthyroid patients. Group A included patients hospitalized for COVID-19 pneumonia while patients requiring intensive care unit (ICU) for acute respiratory syndrome formed the group B. Group C identified the control group of euthyroid patients.

          Results

          Patients from group A and group B showed a statistically significant reduction in fT3 and TSH compared to group C. In group B, compared to group A, a further statistically significant reduction of fT3 and TSH was found.

          Conclusions

          COVID-19 in-patients can present NTIS. FT3 and TSH serum levels are lower in patients with more severe symptoms.

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          The cytokine storm and COVID‐19

          Biying Hu, Shaoying Huang, Lianghong Yin (2020)
          Abstract Coronavirus disease 2019 (COVID‐19), which began in Wuhan, China in December 2019 has caused a large global pandemic and poses a serious threat to public health. More than four million cases of COVID‐19, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), have been confirmed as of May 11, 2020. SARS‐CoV‐2 is a highly pathogenic and transmissible coronavirus that primarily spreads through respiratory droplets and close contact. A growing body of clinical data suggests that a cytokine storm is associated with COVID‐19 severity and is also a crucial cause of death from COVID‐19. In the absence of antivirals and vaccines for COVID‐19, there is an urgent need to understand the cytokine storm in COVID‐19. Here, we have reviewed the current understanding of the features of SARS‐CoV‐2 and the pathological features, pathophysiological mechanisms, and treatments of the cytokine storm induced by COVID‐19. Additionally, we suggest that the identification and treatment of the cytokine storm are important components for rescuing patients with severe COVID‐19. This article is protected by copyright. All rights reserved.
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            Thyrotoxicosis in patients with COVID-19: the THYRCOV study

            Andrea Lania, Maria Sandri, Miriam Cellini … (2020)
            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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              Comparison of Hospitalized Patients With ARDS Caused by COVID-19 and H1N1

              Xiao Tang, Ronghui Du, Rui Wang … (2020)
              Background Since the outbreak of coronavirus disease 2019 (COVID-19) in China in December 2019, considerable attention has been focused on its elucidation. However, it is also important for clinicians and epidemiologists to differentiate COVID-19 from other respiratory infectious diseases such as influenza viruses. Research question The aim of this study was to explore the different clinical presentations between COVID-19 and influenza A (H1N1) pneumonia in patients with ARDS. Study Design and Methods This analysis was a retrospective case-control study. Two independent cohorts of patients with ARDS infected with either COVID-19 (n = 73) or H1N1 (n = 75) were compared. Their clinical manifestations, imaging characteristics, treatments, and prognosis were analyzed and compared. Results The median age of patients with COVID-19 was higher than that of patients with H1N1, and there was a higher proportion of male subjects among the COVID-19 cohort (P < .05). Patients with COVID-19 exhibited higher proportions of nonproductive coughs, fatigue, and GI symptoms than those of patients with H1N1 (P < .05). Patients with H1N1 had higher Sequential Organ Failure Assessment (SOFA) scores than patients with COVID-19 (P < .05). The Pao 2/Fio 2 of 198.2 mm Hg in the COVID-19 cohort was significantly higher than the Pao 2/Fio 2 of 107.0 mm Hg in the H1N1 cohort (P < .001). Ground-glass opacities was more common in patients with COVID-19 than in patients with H1N1 (P < .001). There was a greater variety of antiviral therapies administered to COVID-19 patients than to H1N1 patients. The in-hospital mortality of patients with COVID-19 was 28.8%, whereas that of patients with H1N1 was 34.7% (P = .483). SOFA score-adjusted mortality of H1N1 patients was significantly higher than that of COVID-19 patients, with a rate ratio of 2.009 (95% CI, 1.563-2.583; P < .001). Interpretation There were many differences in clinical presentations between patients with ARDS infected with either COVID-19 or H1N1. Compared with H1N1 patients, patients with COVID-19-induced ARDS had lower severity of illness scores at presentation and lower SOFA score-adjusted mortality.
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                Author and article information

                Contributors
                M. Franco:
                ORCID: http://orcid.org/0000-0002-5675-7745
                martafranco220@gmail.com
                Journal
                Journal ID (nlm-ta): J Endocrinol Invest
                Journal ID (iso-abbrev): J Endocrinol Invest
                Title: Journal of Endocrinological Investigation
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 0391-4097
                ISSN (Electronic): 1720-8386
                Publication date (Electronic): 8 June 2021
                Pages: 1-5
                Affiliations
                [1 ]Endocrinology Unit, Department of Oncology and Medical Specialities, A.O. San Camillo Forlanini, Rome, Italy
                [2 ]GRID grid.419423.9, ISNI 0000 0004 1760 4142, National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, ; Rome, Italy
                [3 ]Biochemical Clinical Unit, A.O. San Camillo Forlanini, Rome, Italy
                [4 ]GRID grid.417520.5, ISNI 0000 0004 1760 5276, Biostatistical Unit, , IRCCS Regina Elena National Cancer Institute, ; Rome, Italy
                [5 ]GRID grid.417728.f, ISNI 0000 0004 1756 8807, Endocrinology, Diabetology and Andrology Unit, , Humanitas Clinical and Research Center, IRCCS, ; Rozzano, MI Italy
                [6 ]GRID grid.16563.37, ISNI 0000000121663741, SCDU of Endocrinology, Department of Translational Medicine, , University of Piemonte Orientale, ; Novara, Italy
                Author information
                http://orcid.org/0000-0002-5675-7745
                Article
                Publisher ID: 1599
                DOI: 10.1007/s40618-021-01599-0
                PMC ID: 8185485
                PubMed ID: 34101132
                SO-VID: 369b7a42-635a-4165-a0e6-e544fd5df21b
                Copyright © © Italian Society of Endocrinology (SIE) 2021
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 9 January 2021
                Date accepted : 20 May 2021
                Categories
                Subject: Original Article

                Keywords: thyroid function,thyroid hormones,covid-19,sars-cov 2,non-thyroidal illness syndrome,euthyroid sick syndrome
                Data availability:
                Keywords: thyroid function, thyroid hormones, covid-19, sars-cov 2, non-thyroidal illness syndrome, euthyroid sick syndrome

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