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Published on: November 5, 2021
Thyroid complications of SARS and coronavirus disease 2019 (COVID-19)
1Department of Endocrinology, Municipal Clinic Biatorbágy, H-2051, Biatorbágy, Hungary.
Insights
COVID-19 and SARS patients exhibit thyroid abnormalities, including decreased thyroid hormone levels and hypothyroidism. Monitoring thyroid function is crucial in COVID-19 patients due to potential thyroid injury and its impact on critical illness outcomes.
Area of Science:
- Endocrinology
- Infectious Diseases
- Virology
Background:
- Previous coronavirus outbreaks, such as SARS, demonstrated thyroid abnormalities in patients.
- COVID-19 (coronavirus disease 2019) shares similarities with SARS, suggesting potential overlapping effects on the thyroid.
- Thyroid hormone dysfunction is linked to poorer outcomes in critical illnesses like ARDS (acute respiratory distress syndrome).
Purpose of the Study:
- To review and synthesize existing literature on thyroid diseases in the context of COVID-19.
- To explore the potential mechanisms linking SARS-CoV-2 infection to thyroid dysfunction.
- To emphasize the importance of monitoring thyroid hormones in COVID-19 patients.
Main Methods:
- Literature review of studies on thyroid diseases and coronavirus infections (SARS and COVID-19).
- Analysis of reported thyroid function tests (T3, T4, TSH) in patients.
- Examination of evidence for direct thyroid injury and associated complications.
Main Results:
- Both SARS and COVID-19 patients present with thyroid abnormalities.
- Observed decreases in serum T3, T4, and TSH levels in SARS patients.
- Thyroiditis (subacute, autoimmune, atypical) identified as a complication of COVID-19.
- SARS-CoV-2 utilizes ACE2, which is expressed in the thyroid, suggesting a potential direct viral impact.
- Thyroid dysfunction can exacerbate critical illness outcomes.
Conclusions:
- Thyroid dysfunction is a significant concern in COVID-19 patients.
- Direct thyroid injury may contribute to thyroid disorders in COVID-19.
- Monitoring thyroid hormone levels in COVID-19 patients is recommended for better management and outcome prediction.
Abstract:
We have reviewed the available literature on thyroid diseases and coronavirus disease 2019 (COVID-19), and data from the previous coronavirus pandemic, the severe acute respiratory syndrome (SARS) epidemic. We learned that both SARS and COVID-19 patients had thyroid abnormalities. In the limited number of SARS cases, where it was examined, decreased serum T3, T4 and TSH levels were detected. In a study of survivors of SARS approximately 7% of the patients had hypothyroidism. In the previous evaluation evidence was found that pituitary function was also affected in SARS. Others suggested a hypothalamic-pituitary-adrenal axis dysfunction. One result published recently indicates that a primary injury to the thyroid gland itself may play a key role in the pathogenesis of thyroid disorders in COVID-19 patients, too. Subacute thyroiditis, autoimmune thyroiditis and an atypical form of thyroiditis are complications of COVID-19. Thyroid hormone dysfunction affects the outcome by increasing mortality in critical illnesses like acute respiratory distress syndrome, which is a leading complication in COVID-19. Angiotensin-converting enzyme 2 is a membrane-bound enzyme, which is also expressed in the thyroid gland and the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) uses it for docking, entering as well as replication. Based on the available results obtained in the SARS-CoV-2 pandemic, beside others, we suggest that it is necessary to monitor thyroid hormones in COVID-19.
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