Abstract
ContextThe effects of COVID-19 on the thyroid axis remain uncertain. Recent evidence has been conflicting, with both thyrotoxicosis and suppression of thyroid function reported.ObjectiveWe aimed to detail the acute effects of COVID-19 on thyroid function and determine if these effects persisted on recovery from COVID-19.DesignA cohort observational study was conducted.Participants and SettingAdult 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 preexisting thyroid disease and those missing either free thyroxine (FT4) or thyrotropin (TSH) measurements. Of 456 patients, 334 had COVID-19 and 122 did not.Main Outcome MeasuresTSH and FT4 measurements were recorded at admission, and where available, in 2019 and at COVID-19 follow-up.ResultsMost 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), TSH and FT4 both were reduced at admission compared to baseline. In a complete case 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.ConclusionsMost patients with COVID-19 present with euthyroidism. We observed mild reductions in TSH and FT4 in keeping with a nonthyroidal illness syndrome. Furthermore, in survivors of COVID-19, thyroid function tests at follow-up returned to baseline.
Highlights
The COVID-19 pandemic continues to affect the global community, and as understanding of its pathophysiology deepens, so too does interest in the endocrine effects of its causative coronavirus, SARS-CoV-2
Most patients (86·6%) presenting with COVID-19 were euthyroid, with none presenting with overt thyrotoxicosis
In the COVID-19 patients with matching baseline thyroid function tests from 2019 (n=185 for thyroid stimulating hormone (TSH) and 104 for free T4 (FT4)), both TSH and FT4 were reduced at admission compared to baseline
Summary
We aimed to detail the acute effects of COVID-19 on thyroid function and determine if these effects persisted upon recovery from COVID-19. 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
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