tetano
Editor, Senior Moderator
Eur Thyroid J
. 2023 Jan 1;ETJ-22-0200.
doi: 10.1530/ETJ-22-0200. Online ahead of print.
Long-term outcome of thyroid abnormalities in patients with severe Covid-19
Ilaria Muller[SUP] 1 [/SUP], Anita Daturi[SUP] 2 [/SUP], Matteo Varallo[SUP] 3 [/SUP], Tiziana E Re[SUP] 4 [/SUP], Davide Dazzi[SUP] 5 [/SUP], Sara Maioli[SUP] 6 [/SUP], Erica Crivicich[SUP] 7 [/SUP], Francesco Di Marco[SUP] 8 [/SUP], Virgilio Longari[SUP] 9 [/SUP], Beatrice Dazzi[SUP] 10 [/SUP], Massimo Castellani[SUP] 11 [/SUP], Giovanna Mantovani[SUP] 12 [/SUP], Maura Arosio[SUP] 13 [/SUP], Mario Salvi[SUP] 14 [/SUP]
Affiliations
Abstract
Objective: We have previously observed thyroid dysfunction, i.e. atypical thyroiditis (painless thyrotoxicosis associated to non-thyroidal illness syndrome), in patients with severe-acute-respiratory-syndrome-coronavirus-2 disease (Covid-19). This study aimed to analyse the evolution of thyroid dysfunction over time.
Methods: 183 consecutive patients hospitalised for severe Covid-19 without known thyroid history were studied at hospital admission (baseline). Survivors were offered 12-month longitudinal follow-up including assessment of thyroid function, autoantibodies and ultrasound scan (US). Patients showing US focal hypoechoic areas suggestive of thyroiditis (focal-hypoechogenicity) also underwent thyroid 99mTc or 123I uptake scan.
Results: At baseline, after excluding from TSH analysis 63 out of 183 (34%) Covid-19 patients commenced on steroids before hospitalisation, 12 (10%) showed atypical thyroiditis. Follow-up of 75 patients showed normalisation of thyroid function and inflammatory markers, and no increased prevalence of detectable thyroid autoantibodies. Baseline US (available in 65 patients) showed focal-hypoechogenicity in 28% patients, of whom 82% had reduced thyroid 99mTc/123I uptake. The presence of focal-hypoechogenicity was associated with baseline low TSH (p=0.034), high FT4 (p=0.018) and high IL-6 (p=0.016). Focal-hypoechogenicity persisted after 6 and 12 months in 87% and 50% patients, respectively, but reduced in size. After 9 months thyroid 99mTc/123I uptake partially recovered from baseline (+28%), but was still reduced in 67% patients.
Conclusions: Severe Covid-19 induces mild transient thyroid dysfunction correlating with disease severity. Focal-hypoechogenicity, associated with baseline high FT4, IL-6 and low TSH, does not seem to be related to thyroid autoimmunity and may persist after one year although decreasing in size. Long-term consequences seem unlikely.
. 2023 Jan 1;ETJ-22-0200.
doi: 10.1530/ETJ-22-0200. Online ahead of print.
Long-term outcome of thyroid abnormalities in patients with severe Covid-19
Ilaria Muller[SUP] 1 [/SUP], Anita Daturi[SUP] 2 [/SUP], Matteo Varallo[SUP] 3 [/SUP], Tiziana E Re[SUP] 4 [/SUP], Davide Dazzi[SUP] 5 [/SUP], Sara Maioli[SUP] 6 [/SUP], Erica Crivicich[SUP] 7 [/SUP], Francesco Di Marco[SUP] 8 [/SUP], Virgilio Longari[SUP] 9 [/SUP], Beatrice Dazzi[SUP] 10 [/SUP], Massimo Castellani[SUP] 11 [/SUP], Giovanna Mantovani[SUP] 12 [/SUP], Maura Arosio[SUP] 13 [/SUP], Mario Salvi[SUP] 14 [/SUP]
Affiliations
- PMID: 36715690
- DOI: 10.1530/ETJ-22-0200
Abstract
Objective: We have previously observed thyroid dysfunction, i.e. atypical thyroiditis (painless thyrotoxicosis associated to non-thyroidal illness syndrome), in patients with severe-acute-respiratory-syndrome-coronavirus-2 disease (Covid-19). This study aimed to analyse the evolution of thyroid dysfunction over time.
Methods: 183 consecutive patients hospitalised for severe Covid-19 without known thyroid history were studied at hospital admission (baseline). Survivors were offered 12-month longitudinal follow-up including assessment of thyroid function, autoantibodies and ultrasound scan (US). Patients showing US focal hypoechoic areas suggestive of thyroiditis (focal-hypoechogenicity) also underwent thyroid 99mTc or 123I uptake scan.
Results: At baseline, after excluding from TSH analysis 63 out of 183 (34%) Covid-19 patients commenced on steroids before hospitalisation, 12 (10%) showed atypical thyroiditis. Follow-up of 75 patients showed normalisation of thyroid function and inflammatory markers, and no increased prevalence of detectable thyroid autoantibodies. Baseline US (available in 65 patients) showed focal-hypoechogenicity in 28% patients, of whom 82% had reduced thyroid 99mTc/123I uptake. The presence of focal-hypoechogenicity was associated with baseline low TSH (p=0.034), high FT4 (p=0.018) and high IL-6 (p=0.016). Focal-hypoechogenicity persisted after 6 and 12 months in 87% and 50% patients, respectively, but reduced in size. After 9 months thyroid 99mTc/123I uptake partially recovered from baseline (+28%), but was still reduced in 67% patients.
Conclusions: Severe Covid-19 induces mild transient thyroid dysfunction correlating with disease severity. Focal-hypoechogenicity, associated with baseline high FT4, IL-6 and low TSH, does not seem to be related to thyroid autoimmunity and may persist after one year although decreasing in size. Long-term consequences seem unlikely.