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Published on: July 5, 2022
Elevated Risk of New-Onset Thyroid Disease Associated With SARS-CoV-2 Infection: A 4.5-Year Observational Study
Shiv Mehrotra-Varma1, Roham Hadidchi1, Sonya Henry1
1Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, NY 10461, USA.
Context:
Thyroid disease has been reported as a complication associated with acute SARS-CoV-2 infection.
Objective:
This study evaluated the long-term risk of incident thyroid dysfunction after COVID-19 in patients without preexisting thyroid disease.
Methods:
Patients without prior thyroid disease were grouped into 15 372 individuals hospitalized with COVID-19, 41 757 nonhospitalized individuals with COVID-19, 343 348 contemporary COVID-negative controls (March 1, 2020-August 17, 2024), and 171 141 historical controls (January 1, 2016-December 31, 2019) within the Montefiore Health System. Outcomes included new-onset thyroid disease, hypothyroidism, hyperthyroidism, and other/unspecified thyroid disease, and thyrotropin (TSH), free 3,5,3'-triiodothyronine (FT3), and free thyroxine (FT4) levels. The primary analysis used Cox regression with inverse probability weighting (IPW). Sensitivity analyses included multivariate adjustment, 1:1 propensity score matching, and comparisons with historical controls.
Results:
Compared to contemporary COVID-negative controls, patients hospitalized for COVID-19 had significantly higher risk of all thyroid disease (IPW-adjusted hazard ratio (HR) = 2.11 [2.03-2.19]), hypothyroidism (HR = 2.02 [1.92-2.12]), hyperthyroidism (HR = 2.31 [2.13-2.50]), and other/unspecified thyroid disease (HR = 2.27 [2.12-2.43]). Nonhospitalized COVID-positive patients also had increased risk of all thyroid disease (HR = 1.40 [1.35-1.46]), hypothyroidism (HR = 1.37 [1.31-1.43]), hyperthyroidism (HR = 1.56 [1.45-1.68]), and other/unspecified thyroid disease (HR = 1.42 [1.34-1.51]). Sensitivity analyses were consistent with the main findings. Estimates of risks were attenuated in the nonhospitalized cohort when compared to historical controls.
Conclusion:
SARS-CoV-2 infection is associated with an increased risk of all forms of new-onset thyroid disease investigated both in hospitalized and nonhospitalized patients. These findings suggest that enhanced screening for thyroid dysfunction may be warranted among individuals recovering from COVID-19.
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