Background Data on the association between coronavirus disease 2019 (COVID-19) and thyroid have been reported, including overt thyrotoxicosis and suppression of thyroid function. We aimed to evaluate the thyroid hormone profile and its association with the prognosis of COVID-19 in Korean patients.
Methods The clinical data of 119 patients with COVID-19, admitted in the Myongji Hospital, Goyang, South Korea, were retrospectively evaluated. The thyroid hormone profiles were analyzed and compared based on disease severity (non-severe disease vs. severe to critical disease). Clinical outcomes were analyzed according to the tertiles of thyroid hormones.
Results Of the 119 patients, 76 (63.9%) were euthyroid, and none presented with overt thyroid dysfunction. Non-thyroidal illness syndrome was the most common manifestation (18.5%), followed by subclinical thyrotoxicosis (14.3%) among patients with thyroid dysfunction. Thyroid stimulating hormone (TSH) and triiodothyronine (T3) levels were significantly lower in patients with severe to critical disease than in those with non-severe disease (P<0.05). Patients in the lowest T3 tertile (<0.77 ng/mL) had higher rates of mechanical ventilation, intensive care unit admission, and death than those in the middle and highest (>1.00 ng/mL) T3 tertiles (P<0.05). COVID-19 patients in the lowest T3 tertile were independently associated with mortality (hazard ratio, 5.27; 95% confidence interval, 1.09 to 25.32; P=0.038) compared with those in the highest T3 tertile.
Conclusion Thyroid dysfunction is common in COVID-19 patients. Changes in serum TSH and T3 levels may be important markers of disease severity in COVID-19. Decreased T3 levels may have a prognostic significance in COVID-19 related outcome.
Citations
Citations to this article as recorded by
The prevalence of thyroid disorders in COVID-19 patients: a systematic review and meta-analysis Sadra Ashrafi, Hossein Hatami, Razieh Bidhendi-Yarandi, Mohammad Hossein Panahi BMC Endocrine Disorders.2024;[Epub] CrossRef
Thyroid Stimulating Hormone as a Possible Additional COVID-19 Outcome Marker Anamarija Zrilic Vrkljan, Ana Majic Tengg, Tanja Palaversa, Srecko Marusic, Lana Ruzic, Ines Bilic-Curcic, Maja Cigrovski Berkovic Medicina.2024; 60(2): 314. CrossRef
Effect of Hypothalamic Adrenal Axis and Thyroid Function Alterations on Prognosis of Critically Ill COVID-19 Patients Muhammet KORKUSUZ, Sulbiye KARABURGU, Tayfun ET, Rafet YARIMOĞLU, Nuh KUMRU Namık Kemal Tıp Dergisi.2024; 12(1): 17. CrossRef
Thyroxine changes in COVID-19 pandemic: A systematic review and meta-analysis Ziqi Li, Pengwei Hou, Shuwen Mu, Renzhi Wang, Hui Miao, Ming Feng, He Wang, Wentai Zhang, Yihao Chen, Tianshun Feng, Shousen Wang, Yi Fang Frontiers in Endocrinology.2023;[Epub] CrossRef
The Influence of SARS-CoV-2 Infection on the Thyroid Gland Aleksandra Piekarska, Marta Góral, Marta Kozula, Aleksandra Jawiarczyk-Przybyłowska, Katarzyna Zawadzka, Marek Bolanowski Biomedicines.2023; 11(2): 614. CrossRef
Thyroid Function Abnormalities and Outcomes in Hospitalized Patients
with COVID-19 Infection: A Cross-Sectional Study Deepika Patel, Dukhabandhu Naik, Sadishkumar Kamalanathan, Kadhiravan Tamilarasu, Jayaprakash Sahoo, Ayan Roy, Chandhana Merugu, Varun Suryadevara Hormone and Metabolic Research.2023; 55(03): 169. CrossRef
The Spectrum of Thyroid Function Tests and Autoantibodies During Hospitalization and After Six Months of Discharge in COVID-19 Patients: Does COVID-19 Trigger Autoimmunity? Ziynet Alphan Uc, Pinar Yagcı, Zelal Adibelli, Cevdet Duran Endocrine Research.2023; 48(2-3): 44. CrossRef
Transient low T3 syndrome in patients with COVID-19: a new window for prediction of disease severity Mingyao Zhong, Yue Gao, Hongling Hu, Xuan Zhu, Lulu Gan, Ling Li, Cheng Xiang, Yimin Yan, Zhe Dai Frontiers in Endocrinology.2023;[Epub] CrossRef
The Association Between COVID-19 and Thyroxine Levels: A Meta-Analysis Yiru Chen, Xiuneng Li, Yu Dai, Jingjing Zhang Frontiers in Endocrinology.2022;[Epub] CrossRef
The New Entity of Subacute Thyroiditis amid the COVID-19 Pandemic: From Infection to Vaccine Mihaela Popescu, Adina Ghemigian, Corina Maria Vasile, Andrei Costache, Mara Carsote, Alice Elena Ghenea Diagnostics.2022; 12(4): 960. CrossRef
Potential of Endogenous Oxytocin in Endocrine Treatment and Prevention of COVID-19 Stephani C. Wang, Fengmin Zhang, Hui Zhu, Haipeng Yang, Yang Liu, Ping Wang, Vladimir Parpura, Yu-Feng Wang Frontiers in Endocrinology.2022;[Epub] CrossRef
The Association Between FT3 With the Outcome and Inflammation/Coagulopathy/Fibrinolysis of COVID-19 Jiayi Deng, Siye Zhang, Fei Peng, Quan Zhang, Yi Li, Yanjun Zhong Frontiers in Endocrinology.2022;[Epub] CrossRef
Primary hypothyroidism with an episode of ventricular tachycardia in a patient with COVID-19 Pin-Hsu Liao, Yu-Cheng Cheng, Po-Yu Liu, I-Te Lee Medicine.2022; 101(25): e29243. CrossRef
Low triiodothyronine syndrome is associated with stroke‐associated pneumonia Huijun Chen, Minjie Xu, Yezhi Huang, Jincai He, Wenwei Ren European Journal of Clinical Investigation.2022;[Epub] CrossRef
Association of thyroid dysfunction and COVID-19: A systematic review and meta-analysis Mohammad Darvishi, Mohammad Reza Nazer, Hamze Shahali, Majid Nouri Frontiers in Endocrinology.2022;[Epub] CrossRef
The prognostic utility of serum thyrotropin in hospitalized Covid-19 patients: statistical and machine learning approaches E. Pappa, P. Gourna, G. Galatas, M. Manti, A. Romiou, L. Panagiotou, R. Chatzikyriakou, N. Trakas, G. Feretzakis, C. Christopoulos Endocrine.2022; 80(1): 86. CrossRef
Thyrotropin Levels in Patients with Coronavirus Disease 2019: Assessment during Hospitalization and in the Medium Term after Discharge Abdallah Al-Salameh, Noémie Scherman, Imane Adda, Juliette André, Yoann Zerbib, Julien Maizel, Jean-Daniel Lalau, Etienne Brochot, Claire Andrejak, Rachel Desailloud Life.2022; 12(12): 2014. CrossRef
COVID-19 and thyroid function: What do we know so far? Camila Lüdke Rossetti, Juliana Cazarin, Fabio Hecht, Fabyan Esberard de Lima Beltrão, Andrea Cláudia Freitas Ferreira, Rodrigo Soares Fortunato, Helton Estrela Ramos, Denise Pires de Carvalho Frontiers in Endocrinology.2022;[Epub] CrossRef
Background Whether hyperthyroidism is an independent risk factor for cardiovascular events remains controversial. We aimed to evaluate the association of overt and subclinical hyperthyroidism with the risk of ischemic heart disease (IHD), stroke, heart failure, and cardiovascular mortality.
Methods Studies regarding the association between hyperthyroidism and cardiovascular events were searched on PubMed and Embase databases. The cardiovascular disease (CVD) risk was classified as high and low, based on pre-existing diseases, including history of coronary, cerebral, or peripheral artery disease; heart failure; atrial fibrillation; diabetes mellitus; or chronic kidney disease.
Results Thirty-seven cohort studies were included in this meta-analysis. The pooled hazard ratio for subjects with overt hyperthyroidism compared with the control group was 1.11 (95% confidence interval [CI], 1.03 to 1.19) for IHD, 1.35 (95% CI, 1.03 to 1.75) for stroke, and 1.20 (95% CI, 1.00 to 1.46) for cardiovascular mortality. For subjects with subclinical hyperthyroidism, the pooled hazard ratio was 1.24 (95% CI, 1.07 to 1.45) for IHD, when compared with the control group. Subgroup analysis by CVD risk showed that the risk of stroke in overt hyperthyroidism was increased in the low CVD risk group; however, these association was not observed in the high CVD risk group. Similarly, the risk of IHD in subjects with subclinical hyperthyroidism was significantly increased in the low CVD risk group.
Conclusion Overt hyperthyroidism is associated with increased risk of IHD, stroke, and cardiovascular mortality, and subclinical hyperthyroidism is associated with increased risk of IHD. These associations were particularly observed in the low risk CVD group without underlying CVD.
Citations
Citations to this article as recorded by
Trends in Prevalence of Thyroid Dysfunction and its Associations With Mortality Among US Participants, 1988-2012 Xiaowen Zhang, Yong Wang, Hongwei Wang, Xinlin Zhang The Journal of Clinical Endocrinology & Metabolism.2024; 109(2): e657. CrossRef
Adequacy of thyroid hormone replacement for people with hypothyroidism in real‐world settings: A systematic review and meta‐analysis of observational studies Agathoklis Efthymiadis, Matthew Henry, Dimitrios Spinos, Marianthi Bourlaki, Alexandros Tsikopoulos, Angeliki Bourazana, Anastasios Bastounis, Konstantinos Tsikopoulos Clinical Endocrinology.2024; 100(5): 488. CrossRef
Thyroid Disorders and Peripheral Arterial Disease Katica Bajuk Studen, Simona Gaberscek, Katja Zaletel, Ales Blinc, Miso Sabovic, Gerit-Holger Schernthaner, Panagiotis Anagnostis, Pier Luigi Antignani, Mojca Jensterle, Dimitri P Mikhailidis, Pavel Poredos Current Vascular Pharmacology.2024; 22(1): 36. CrossRef
Higher Risk of Incident Hyperthyroidism in Patients With Atrial Fibrillation Pang-Shuo Huang, Jen-Fang Cheng, Jien-Jiun Chen, Yi-Chih Wang, Juey-Jen Hwang, Cho-Kai Wu, Chia-Ti Tsai The Journal of Clinical Endocrinology & Metabolism.2023; 109(1): 92. CrossRef
Eurasian clinical guidelines for the diagnosis and treatment of secondary (symptomatic) forms of arterial hypertension (2022) I. E. Chazova, N. M. Chikhladze, N. V. Blinova, Zh. E. Belaya, N. M. Danilov, E. M. Elfimova, A. Yu. Litvin, L. Ya. Rozhinskaya, N. Yu. Sviridenko, M. Yu. Shvetsov, V. A. Azizov, E. A. Grigorenko, N. P. Mit’kovskaja, I. I. Mustafaev, A. G. Polupanov, A. S Eurasian heart journal.2023; (1): 6. CrossRef
Sympathetic Activation Promotes Cardiomyocyte Apoptosis in a Rabbit Susceptibility Model of Hyperthyroidism-Induced Atrial Fibrillation via the p38 MAPK Signaling Pathway
Jialin Zheng, Shijian Zhao, Qishi Yang, Yantao Wei, Jianmei Li, Tao Guo Critical Reviews in Eukaryotic Gene Expression.2023; 33(5): 17. CrossRef
Cardiovascular outcomes in subclinical thyroid disease: an update Matthew D. Ettleson Current Opinion in Endocrinology, Diabetes & Obesity.2023; 30(5): 218. CrossRef
Lower free triiodothyronine levels are associated with higher all-cause and cardiovascular mortality in people with diabetes-NHANES 2007–2012 Chang Liu, Zhong Xin, Lin Hua Diabetes Research and Clinical Practice.2023; 202: 110811. CrossRef
Hyperthyroidism Sun Y. Lee, Elizabeth N. Pearce JAMA.2023; 330(15): 1472. CrossRef
Is Thyroid Dysfunction Associated with Unruptured Intracranial Aneurysms? A Population-Based, Nested Case–Control Study from Korea Hyeree Park, Sun Wook Cho, Sung Ho Lee, Kangmin Kim, Hyun-Seung Kang, Jeong Eun Kim, Aesun Shin, Won-Sang Cho Thyroid®.2023; 33(12): 1483. CrossRef
Risks of suboptimal and excessive thyroid hormone replacement across ages U. Feldt-Rasmussen, G. Effraimidis, S. Bliddal, M. Klose Journal of Endocrinological Investigation.2023; 47(5): 1083. CrossRef
Association of Mild Thyroid Dysfunction and Adverse Prognosis Among Chinese Patients With Acute ST Segment Elevation Myocardial Infarction Mei-Fang Li, Ze-Tao Wei, Shuai Li, Qi-Ming Feng, Jing-Bo Li Frontiers in Endocrinology.2022;[Epub] CrossRef
The Cardiovascular Effects of Subclinical Hyperthyroidism following Percutaneous Coronary Intervention Ricardo Correa, Ricardo Villela Clinical Thyroidology.2022; 34(6): 240. CrossRef
Weight Gain and Body Composition Changes during the Transition of Thyroid Function in Patients with Graves’ Disease Undergoing Radioiodine Treatment Zhenqin Cai, Qiyu Chen, Yan Ling, Henrik Falhammar International Journal of Endocrinology.2022; 2022: 1. CrossRef
Minor perturbations of thyroid homeostasis and major cardiovascular endpoints—Physiological mechanisms and clinical evidence Patrick Müller, Melvin Khee-Shing Leow, Johannes W. Dietrich Frontiers in Cardiovascular Medicine.2022;[Epub] CrossRef
Role of thyroid hormones-induced oxidative stress on cardiovascular physiology María Laura Barreiro Arcos Biochimica et Biophysica Acta (BBA) - General Subjects.2022; 1866(12): 130239. CrossRef
Yearly Incidence of Stroke and Bleeding in Atrial Fibrillation with Concomitant Hyperthyroidism: A National Discharge Database Study Juqian Zhang, Arnaud Bisson, Grégoire Fauchier, Alexandre Bodin, Julien Herbert, Pierre Henri Ducluzeau, Gregory Y. H. Lip, Laurent Fauchier Journal of Clinical Medicine.2022; 11(5): 1342. CrossRef
Platelet abnormalities in autoimmune thyroid diseases: A systematic review and meta-analysis Yu-tian Cao, Kai-yu Zhang, Jing Sun, Yan Lou, Tian-su Lv, Xinyi Yang, Wen-hui Zhang, Jiang-yi Yu, Qi-biao Wu, Xi-qiao Zhou Frontiers in Immunology.2022;[Epub] CrossRef
Subclinical Hyperthyroidism: A Review of the Clinical Literature Karen Tsai, Angela M. Leung Endocrine Practice.2021; 27(3): 254. CrossRef
Thyroid and heart, a clinically relevant relationship G. Corona, L. Croce, C. Sparano, L. Petrone, A. Sforza, M. Maggi, L. Chiovato, M. Rotondi Journal of Endocrinological Investigation.2021; 44(12): 2535. CrossRef
Antithyroid Drug Treatment in Graves’ Disease Jae Hoon Chung Endocrinology and Metabolism.2021; 36(3): 491. CrossRef
Cardiovascular Outcomes in Thyroid Cancer Patients Treated With Thyroidectomy: A Meta-Analysis Eun Kyung Lee, Hwa Young Ahn, Eu Jeong Ku, Won Sang Yoo, Young Ki Lee, Kee-Hyun Nam, Young Jun Chai, Shinje Moon, Yuh-Seog Jung The Journal of Clinical Endocrinology & Metabolism.2021;[Epub] CrossRef
BACKGROUND Patients with type 2 diabetes are known to have an increased risk for osteoporotic fractures compared with non-diabetic subjects. We investigated whether the serum endogenous secretory receptor for advanced glycation end products (esRAGE) or pentosidine was associated with prevalent vertebral fractures in patients with type 2 diabetes. METHODS: We enrolled 140 patients with type 2 diabetes mellitus (73 men aged 50 or older and 67 postmenopausal women). Lateral X-ray films of the spine revealed prevalent vertebral fractures. The serum concentration of esRAGE and pentosidine were measured. RESULTS: The mean age of all patients was 66.2 +/- 6.5 years and 22% of patients had prevalent vertebral fractures. Serum pentosidine levels were similar between those with and without vertebral fractures. There were no significant correlations between serum esRAGE levels and age, body mass index, duration of diabetes, and hemoglobin A1c. However, patients with moderate or severe vertebral fractures have a lower esRAGE level compared to those without after adjusting for age and gender (0.33 +/- 0.12 ng/mL vs. 0.24 +/- 0.03 ng/mL, P < 0.05). Logistic regression analysis demonstrated that patients in the lowest tertile of esRAGE had a higher risk of moderate or severe vertebral fractures (odds ratio, 16.6; 95% confidence interval, 1.4-198.5) than patients in the highest tertile. CONCLUSION: These results revealed that a low esRAGE level was independently associated with moderate or severe vertebral fractures in type 2 diabetic patients.
Citations
Citations to this article as recorded by
Letter: The Association between Serum Endogenous Secretory Receptor for Advanced Glycation End Products and Vertebral Fractures in Type 2 Diabetes (Endocrinol Metab 2012;27:289-94, Cheol Ho Lee et al.) You-Cheol Hwang Endocrinology and Metabolism.2013; 28(1): 76. CrossRef
Agenesis of the dorsal pancreas is a rare congenital anomaly caused by underdevelopment or agenesis of the dorsal pancreatic bud that forms the upper head, neck, body and tail of the pancreas. We report a case of agenesis of the dorsal pancreas, which was found under examination of diabetes mellitus (DM). A 16-year-old girl was transferred to our hospital because of a positive urine glucose reading during a school-conducted examination. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed the deficit of the pancreatic body and tail. Diabetes-associated autoimmune antibodies were negative in a blood test. Decreased beta-cell function was demonstrated by oral glucose tolerance and glucagon stimulation tests. Although the notion that agenesis of the dorsal pancreas leads to decreased endocrine or exocrine function is controversial, the results of this study suggest that we should consider these causes of diabetes mellitus. When treating a young patient with diabetes mellitus, we should consider causes of diabetes mellitus such as congenital anomaly or maturity onset diabetes, in addition to type 1 and type 2 diabetes mellitus.
Minireview: A Need for an Adequate Diet Program for Postmenopausal Women with Obesity in the Republic of Korea So Hee Park, Bo Dam Kim, Jae Hong Sang, Hae-Hyeog Lee, Tae-Hee Kim Journal of Menopausal Medicine.2023; 29(2): 45. CrossRef
A goiter is among the most common presenting symptoms of patients with thyroid diseases and is usually caused by intrinsic thyroid problems. While direct invasion of the trachea by aggressive thyroid tumors is a well-known phenomenon, the reverse situation, that is, a primary tracheal neoplasm invading by direct extension into the thyroid gland, presenting with a goiter is very rare. Here, a case of a tracheal adenoid cystic carcinoma(ACC), presenting with a diffuse goiter, is reported. A 47-year-old woman presented with slowly growing anterior neck swelling. A physical examination showed a diffuse firm goiter. The patient was euthyroiditic, and serum negative for thyroid autoantibodies. Thyroid ultrasonography and neck CT revealed a doughnut-shaped mass, encircling the trachea and displacing the thyroid anteriorly. Ultrasonography-guided fine needle aspiration(FNA) was compatible with an ACC, and a subsequent surgical resection confirmed the diagnosis. Although the occurrence of a tracheal ACC invading the thyroid is rare, this case highlights the need to be aware of unusual lesions arising in the region of the thyroid. This knowledge will help in making the correct cytological diagnosis when these lesions are sampled by FNA
Jae Hong Park, Dong Jin Chung, Jung MIn Kim, Ji Yeon Kim, Myung Soo Kim, Seung Won Yang, Min Young Chung, Tae Hee Lee, Jong Tae Park, Min Young Lee, Jae Hyuk Lee, Chan Choi
J Korean Endocr Soc. 1998;13(3):394-409. Published online January 1, 2001
BACKGROUND Bone mineral density(BMD) is thought to be under genetic control. Polymorphisms at the vitamin D receptor(VDR) gene have recently been shown to contribute to the genetic variability in bone mineral density in Caucasians. However, the relationship between VDR-RFLP(restriction fragment length polymorphisms) and bone mineral density is controversial. METHODS: The VDR-RFLP by BsmI, ApaI, and TaqI were studied in 250(77 premenopausal, 173 postmenopausal) Korean women. Bone mineral densities at the lumbar spine(L2-L4), femoral neck, greater trochanter, and Wards triangle were measured by DEXA(Dual Energy X-ray Absorptiometry; Lunar DPX-L, U.S.A.). RESULTS: There were significant differences in VDR gene allele frequency when compared with those in Caucasians. The BsmI polymorphism was consisted of 0.8% BB homozygotes, 12.4% Bb heterozygotes, and 86.8% bb homozygotes. The ApaI polymorphism was 6.8% AA homozygotes, 42.0% Aa heterozygotes, and 51.2% aa homozygotes, and the TaqI polymorphism was 83.2% TT homozygotes, 16.8% Tt heterozygotes, and 0% tt homozygotes. When these three VDR-RFLP were combined, bbaaTT(51.2%), bbAaTT(29.6%), and BbAaTt(10.0%) were found to be most frequent types. There were no significant relationship between VDR-RFLP and BMD measured at the 2nd to 4th lumbar spine in all subjects. But there were significant relationship between VDR-RFLP and BMD at the proxmial femur in all subjects. Compared with bb or bbaaTT(or bbAaTT), women with the Bb or BbAaTt genotypes had significantly lower bone mineral densities at the proximal femur in all subjects. When we restricted the analysis to early postmenopausal women less than 10 years since menopause, these findings were more pronounced. CONCLUSION: These results suggest that VDR-RFLP may affect on BMD at the proximal femur in Korean women. However, the frequencies of B, A, and t alleles are very low in Korean women compared to those of Caucasians, further studies will be needed, with larger sample sizes.