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Thyroid-Stimulating Hormone Predicts Total Cholesterol and Low-Density Lipoprotein Cholesterol Reduction during the
Massimo Raffaele Mannarino1, Vanessa Bianconi1, Elena Cosentini1
1Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy.
Insights
Lower thyroid-stimulating hormone (TSH) levels in COVID-19 patients correlate with reduced lipid levels, including total cholesterol (TC) and LDL-cholesterol (LDL-C), prior to hospitalization. This suggests a link between thyroid function and lipid metabolism changes during the pandemic.
Area of Science:
- Endocrinology
- Infectious Diseases
- Metabolic Disorders
Background:
- COVID-19 is associated with complex lipid metabolism dysregulation, including reduced cholesterol levels.
- Thyroid function is also affected in COVID-19, often presenting with decreased thyroid-stimulating hormone (TSH).
Purpose of the Study:
- To investigate the association between TSH levels during COVID-19 and the preceding variation (Δ) in lipid profile parameters.
- To explore the relationship between TSH and lipid changes in the period from 1 month to 1 year before hospitalization.
Main Methods:
- Retrospective analysis of clinical data from 324 COVID-19 patients hospitalized between March 2020 and March 2022.
- Univariable and multivariable analyses were used to assess the association between TSH levels and Δ-TC, Δ-LDL-C, and Δ-HDL-C.
- Adjustments were made for confounders including C-reactive protein (CRP) and COVID-19 severity.
Main Results:
- 14% of patients had TSH levels below the lower reference limit.
- Significant reductions in plasma TC, LDL-C, and HDL-C were observed.
- TSH was directly associated with Δ-TC, Δ-LDL-C, and Δ-HDL-C, and inversely associated with CRP and COVID-19 severity.
- Independent associations were found between TSH and Δ-TC/Δ-LDL-C after adjusting for confounders.
Conclusions:
- Lower TSH levels may contribute to the reduction in total cholesterol and LDL-cholesterol observed during the acute phase of COVID-19.
- The findings highlight a potential link between thyroid dysfunction and lipid alterations in COVID-19 patients.
Abstract:
A complex dysregulation of lipid metabolism occurs in COVID-19, leading to reduced total cholesterol (TC), LDL-cholesterol (LDL-C), and HDL-cholesterol (HDL-C) levels, along with a derangement of thyroid function, leading to reduced thyroid-stimulating hormone (TSH) levels. This study aimed to explore the association between TSH levels during COVID-19 and the variation (Δ) of lipid profile parameters in the period preceding (from 1 month up to 1 year) hospital admission due to COVID-19. Clinical data of 324 patients (mean age 76 ± 15 years, 54% males) hospitalized due to COVID-19 between March 2020 and March 2022 were retrospectively analyzed. The association between TSH levels at hospital admission and either Δ-TC, Δ-LDL-C, or Δ-HDL-C over the selected time frame was assessed through univariable and multivariable analyses. TSH levels were below the lower reference limit of 0.340 μUI/mL in 14% of COVID-19 patients. A significant reduction of plasma TC, LDL-C, and HDL-C was recorded between the two time points (p < 0.001 for all the comparisons). TSH was directly associated with Δ-TC (rho = 0.193, p = 0.001), Δ-LDL-C (rho = 0.201, p = 0.001), and Δ-HDL-C (rho = 0.160, p = 0.008), and inversely associated with C-reactive protein (CRP) (rho = −0.175, p = 0.004). Moreover, TSH decreased with increasing COVID-19 severity (p < 0.001). CRP and COVID-19 severity were inversely associated with Δ-TC, Δ-LDL-C, and Δ-HDL-C (p < 0.05 for all associations). A significant independent association was found between TSH and either Δ-TC (β = 0.125, p = 0.044) or Δ-LDL-C (β = 0.131, p = 0.036) after adjusting for multiple confounders including CRP and COVID-19 severity. In conclusion, lower levels of TSH may contribute to explain TC and LDL-C reduction in the acute phase of COVID-19.
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