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Abnormal TSH Level as a Predictor of Severe Outcomes Among Patients Hospitalized With COVID-19
Pinak A Shah1, Kartika Shetty1, Faraz Rahman1
1Mountain View Hospital, Sunrise GME, Las Vegas, NV, USA.
Insights
Low thyroid-stimulating hormone (TSH) levels in hospitalized COVID-19 patients indicate a poor prognosis. This finding suggests TSH may be a valuable indicator for severe outcomes in SARS-CoV-2 infection.
Area of Science:
- Endocrinology
- Infectious Diseases
- Critical Care Medicine
Background:
- Thyroid dysfunction is increasingly recognized as a potential complication in severe infections.
- The prognostic significance of thyroid function tests in patients with COVID-19 remains an area of active investigation.
Purpose of the Study:
- To investigate the association between thyroid dysfunction and mortality in hospitalized patients diagnosed with COVID-19.
- To evaluate the prognostic value of thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels in predicting severe COVID-19 outcomes.
Main Methods:
- A retrospective, multi-center study included 10,933 patients hospitalized with COVID-19.
- Patients with pre-existing thyroid disease or treatment were excluded.
- Thyroid function tests (TSH, fT4) and clinical outcomes (mortality, ICU admission, ventilation, length of stay) were analyzed.
Main Results:
- Patients with low TSH and low fT4 had significantly higher odds of mortality (OR 10.07).
- Low TSH, irrespective of fT4 levels, was associated with increased odds of mortality (OR 1.46 for low TSH/normal fT4; OR 1.38 for low TSH/high fT4).
- Low TSH levels were also linked to higher odds of ICU admission and mechanical ventilation.
Conclusions:
- Low TSH levels, regardless of fT4, are indicative of a poor prognosis in hospitalized COVID-19 patients.
- TSH levels may serve as a valuable prognostic marker for severe outcomes in SARS-CoV-2 infection.
- Further research is warranted to elucidate the mechanisms underlying thyroid dysfunction in severe COVID-19.
Objective:
To assess the association between thyroid dysfunction and mortality among patients hospitalized with COVID-19. Design: This is a retrospective multi-center study, which examined all patients admitted with Covid-19 diagnoses, and thyroid function results in absence of known thyroid disease.
Results:
10,933 hospitalized COVID-19 positive patients were included in the study. These patients were without prior diagnosis or treatment of thyroid disease. Outcomes assessed were mortality, ICU admission, Ventilator use, length of stay, readmission and complications during hospital stay. Patients with low TSH and Low free T4 had odds of mortality of 10.07(95% CI [7.44-13.6]) compared to patients with Normal TSH and any free T4 levels. Patients with Low TSH and High free T4 also had odds of mortality of 1.38 (95% CI [1.19-1.59]) compared to patients with Normal TSH and Any free T4 level. Patients with Low TSH and Normal free T4 levels also had an Odds of mortality of 1.46 (95% CI [1.31-1.62]) compared to patients with Normal TSH and any free T4 level. Patients with Low TSH also had higher odds of ICU admission and Ventilator use when compared to patients with normal TSH.
Conclusions:
This study shows that patients with low TSH, regardless of free T4 level, indicates poor prognosis for hospitalized patients with SARS-CoV-2 infection and offers further insights into possible prognostic value of TSH levels for severe COVID-19 outcomes.
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