Thyroid function before, during and after COVID-19
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Context: The effects of COVID-19 on the thyroid axis remain uncertain. Recent evidence has been conflicting, with both thyrotoxicosis and suppression of thyroid function reported.
Objective: We aimed to detail the acute effects of COVID-19 on thyroid function and determine if these effects persisted upon recovery from COVID-19.
Design: Cohort observational study.
Participants and setting: Adult patients admitted to Imperial College Healthcare National Health Service Trust, London, UK with suspected COVID-19 between March 9 to April 22, 2020 were included, excluding those with pre-existing thyroid disease and those missing either free thyroxine (FT4) or TSH measurements. Of 456 patients, 334 had COVID-19 and 122 did not.
Main Outcome Measures: TSH and FT4 measurements at admission, and where available, those taken in 2019 and at COVID-19 follow-up.
Results: Most patients (86·6%) presenting with COVID-19 were euthyroid, with none presenting with overt thyrotoxicosis. Patients with COVID-19 had a lower admission TSH and FT4 compared to those without COVID-19. In the COVID-19 patients with matching baseline thyroid function tests from 2019 (n=185 for TSH and 104 for FT4), both TSH and FT4 were reduced at admission compared to baseline. In a complete cases analysis of COVID-19 patients with TSH measurements at follow-up, admission and baseline (n=55), TSH was seen to recover to baseline at follow-up.
Conclusions: Most patients with COVID-19 present with euthyroidism. We observed mild reductions in TSH and FT4 in keeping with a non-thyroidal illness syndrome. Furthermore, in survivors of COVID-19, thyroid function tests at follow-up returned to baseline.
Objective: We aimed to detail the acute effects of COVID-19 on thyroid function and determine if these effects persisted upon recovery from COVID-19.
Design: Cohort observational study.
Participants and setting: Adult patients admitted to Imperial College Healthcare National Health Service Trust, London, UK with suspected COVID-19 between March 9 to April 22, 2020 were included, excluding those with pre-existing thyroid disease and those missing either free thyroxine (FT4) or TSH measurements. Of 456 patients, 334 had COVID-19 and 122 did not.
Main Outcome Measures: TSH and FT4 measurements at admission, and where available, those taken in 2019 and at COVID-19 follow-up.
Results: Most patients (86·6%) presenting with COVID-19 were euthyroid, with none presenting with overt thyrotoxicosis. Patients with COVID-19 had a lower admission TSH and FT4 compared to those without COVID-19. In the COVID-19 patients with matching baseline thyroid function tests from 2019 (n=185 for TSH and 104 for FT4), both TSH and FT4 were reduced at admission compared to baseline. In a complete cases analysis of COVID-19 patients with TSH measurements at follow-up, admission and baseline (n=55), TSH was seen to recover to baseline at follow-up.
Conclusions: Most patients with COVID-19 present with euthyroidism. We observed mild reductions in TSH and FT4 in keeping with a non-thyroidal illness syndrome. Furthermore, in survivors of COVID-19, thyroid function tests at follow-up returned to baseline.
Date Issued
2021-02
Date Acceptance
2020-11-04
Citation
Journal of Clinical Endocrinology and Metabolism, 2021, 106 (2), pp.e803-e811
ISSN
0021-972X
Publisher
Endocrine Society
Start Page
e803
End Page
e811
Journal / Book Title
Journal of Clinical Endocrinology and Metabolism
Volume
106
Issue
2
Copyright Statement
© The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Sponsor
Medical Research Council
Medical Research Council (MRC)
Identifier
https://academic.oup.com/jcem/article/106/2/e803/5979483
Grant Number
MR/T006242/1
MR/T006242/1
Subjects
COVID-19
SARS-CoV-2
thyroid function
thyroid gland
Adult
Aged
Aged, 80 and over
COVID-19
Cohort Studies
Comorbidity
Female
Follow-Up Studies
Humans
Male
Middle Aged
Risk Factors
SARS-CoV-2
Thyroid Diseases
Thyroid Function Tests
Thyroid Gland
Thyrotropin
Thyroxine
Time Factors
Triiodothyronine
Thyroid Gland
Humans
Thyroid Diseases
Thyrotropin
Triiodothyronine
Thyroxine
Thyroid Function Tests
Risk Factors
Cohort Studies
Follow-Up Studies
Comorbidity
Time Factors
Adult
Aged
Aged, 80 and over
Middle Aged
Female
Male
COVID-19
SARS-CoV-2
Endocrinology & Metabolism
1103 Clinical Sciences
1114 Paediatrics and Reproductive Medicine
Publication Status
Published
Date Publish Online
2020-11-12