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A Review of Thyroid Dysfunction Due to COVID-19
1Department of Endocrinology, Farhikhtegan Hospital, Faculty of Medicine, Tehran Medical Sciences Islamic Azad University, Tehran, Iran.
Abstract:
Coronavirus disease 2019 (COVID-19) affects thyroid function. These changes are due to the direct impact of the virus on thyroid cells via angiotensin-converting-enzyme 2 (ACE2) receptors, inflammatory reaction, apoptosis in thyroid follicular cells, suppression of hypothalamus-pituitarythyroid axis, an increase in activity of adrenocortical axis, and excess cortisol release due to cytokine storm of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Euthyroid sick syndrome (ESS), thyroiditis, clinical and subclinical hypothyroidism, central hypothyroidism, exacerbation of underlying autoimmune thyroid disease, and clinical and subclinical hyperthyroidism can be associated with coronavirus. Adjuvants in coronavirus vaccines induce autoimmune/inflammatory syndrome known as vaccine adjuvants (ASIA) syndrome. Thyroiditis and Graves' disease have been reported to be associated with ASIA syndrome after some coronavirus vaccinations. Some coronavirus medications, such as hydroxychloroquine, monoclonal antibodies, lopinavir/ritonavir, remdesivir, naproxen, anticoagulants, and glucocorticoids can also affect thyroid tests, and correct diagnosis of thyroid disorders will be more difficult. Changes in thyroid tests may be one of the most important manifestations of COVID-19. These changes can be confusing for clinicians and can lead to inappropriate diagnoses and decisions. Prospective studies should be conducted in the future to increase epidemiological and clinical data and optimize the management of thyroid dysfunctions in patients with COVID-19.
Insights
COVID-19 significantly impacts thyroid function through direct viral effects and immune responses, leading to various thyroid disorders. Understanding these changes is crucial for accurate diagnosis and management of thyroid dysfunction during the pandemic.
Area of Science:
- Endocrinology
- Virology
- Immunology
Background:
- Coronavirus disease 2019 (COVID-19) impacts thyroid function through direct viral effects on thyroid cells expressing ACE2 receptors.
- SARS-CoV-2 infection triggers inflammatory responses, apoptosis, and axis suppression, leading to diverse thyroid dysfunctions.
Approach:
- This review synthesizes current knowledge on COVID-19's effects on the thyroid.
- It examines mechanisms including viral entry, cytokine storm, and axis dysregulation.
- The impact of COVID-19 medications and vaccines on thyroid function is also considered.
Key Points:
- COVID-19 is associated with Euthyroid Sick Syndrome, thyroiditis, hypothyroidism, and hyperthyroidism.
- Vaccine adjuvants can induce autoimmune/inflammatory syndromes (ASIA), including thyroiditis and Graves' disease.
- Medications used for COVID-19 can alter thyroid test results, complicating diagnosis.
Conclusions:
- Thyroid test abnormalities are significant manifestations of COVID-19, potentially confusing clinicians.
- Further prospective studies are needed to gather more data and optimize thyroid dysfunction management in COVID-19 patients.
- Accurate diagnosis and management of thyroid disorders in COVID-19 require careful consideration of viral, inflammatory, and iatrogenic factors.
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