Thyroid/COVID News - Updates - May 5, 2024

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Thyroid/COVID News - Updates - May 5, 2024

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May 5, 2024

New case report suggests that in patients with hypothyroidism, COVID-19 infection may trigger and exacerbate vertigo and anxiety (Guzman et al., 2024).
  • Guzman DC, Brizuela NO, Peraza AV, Herrera MO, Mejia GB, Juarez Olguin H - "Post COVID-19 Vertigo in a Patient with Hypothyroidism: A Case Report" Diabetes Metab Syndr Obes 17:1845-1851 (2024). doi: 10.2147/DMSO.S459711

April 14, 2024

A new Croatian study investigated the predictive value of serum TSH levels on the short-term and middle-term outcomes of patients hospitalized for COVID-19. Patients exhibiting low TSH levels during hospitalization were found to have a higher incidence of lingering lung issues in the post-COVID-19 phase (p = 0.028). Furthermore, there was a significant overall rise in TSH levels post-COVID-19 compared to during hospitalization (p < 0.001). This suggests that low or suppressed serum TSH levels during acute COVID-19 could serve as an additional predictive marker for adverse short- and medium-term outcomes.
  • Zrilic Vrkljan A, Majic Tengg A, Palaversa T, Marusic S, Ruzic L, Bilic-Curcic I, Cigrovski Berkovic - "Thyroid Stimulating Hormone as a Possible Additional COVID-19 Outcome Marker" Medicina (Kaunas) 60(2):314 (2024) doi: 10.3390/medicina60020314

March 15, 2024

Another case showing that COVID-19 infection may cause Graves' Disease was published today (Deng et al., 2024).
  • Deng L, Zhang Y, Sun H - "Apathetic Graves' disease with severe hepatic and renal dysfunction induced by COVID-19 infection: Case report and literature review" Medicine (Baltimore) 103(11):e37456 (2024). doi: 10.1097/MD.0000000000037456

March 14, 2024

A US report was published on the case of a 90-year-old female who exhibited a sudden onset of confusion and severe generalized weakness after receiving her second dose of mRNA SARS-CoV-19 vaccination 19 days prior to her admission in 2021.
"These findings indicated limited thyroid destruction in the form of subacute thyroiditis, likely triggered by the mRNA SARS-CoV-2 vaccine. This case illustrates an acute complication due to a novel vaccine. There are three key takeaways for physicians. First, there should be a discussion of the benefits and risks of Covid-19 vaccine. Second, patients who present with encephalopathy should have their thyroid function checked. Third, clinicians must be aware of the signs and symptoms of potentially life-threatening hyperthyroidism. Additional studies are needed to identify those patients at highest risk for Covid-19 vaccine complications." (Kumar et al., 2024)

February 26, 2024

A new study from Taiwan found that "COVID-19 infection was associated with an increased risk of thyroid dysfunction, including thyrotoxicosis and hypothyroidism, regardless of age or sex, during a 12-month follow-up period." (Huang et al., 2024).

January 18, 2024

New research from Italy showed that the risk of thyroid eye disease (TED) was significantly increased after Covid-19 vaccination, especially in people below 50 years of age (Muller et al., 2024)

January 7, 2023
"Our case demonstrates the importance of recognizing COVID-19 as an etiology or a trigger for new onset or exacerbation of GD [Graves Disease]. Our case highlights that being vigilant to recognize the association between COVID-19 and thyroid abnormalities for early diagnosis and treatment is imperative." (Sebastian et al., 2024)
  • Sebastian WP, Parisa A, Pandya M, Anees A - "Graves' Disease Exacerbation with Impending Thyroid Storm After SARS-CoV-2 Infection: A Case Report" Am J Case Rep 25:e941311 (2024) doi: 10.12659/AJCR.941311

January 5, 2024
"Thyroid dysfunction is common in COVID-19 patients, with a high prevalence of non-thyroidal illness syndrome (NTIS) and thyrotoxicosis. Our meta-analysis found a 26% prevalence of NTIS and a 10% prevalence of thyrotoxicosis." (Ashrafi et al., 2024)
  • Ashrafi S, Hatami H, Bidhendi-Yarandi R, Panahi MH - "The prevalence of thyroid disorders in COVID-19 patients: a systematic review and meta-analysis" BMC Endocr Disord 24(1):5 (2024). doi: 10.1186/s12902-023-01534-9
    https://bmcendocrdisord.biomedcentral.c ... 23-01534-9

January 2, 2024

A new study from Oman presented yet another case of Graves disease after COVID vaccination with m-RNA vaccine in a teenager (Al-Jahhafi et al., 2024).
"The patient presented with typical features of hyperthyroidism 30 days post receiving the first dose of the vaccination."
  • Al-Jahhafi AS, Al-Sawaai AA, Al-Bimani ZK, Al-Bulushi NK - "Graves' disease post-COVID-19 m-RNA vaccine in pediatric age group" Asia Ocean J Nucl Med Biol 12(1):65-68 (2024). doi: 10.22038/AOJNMB.2023.73051.1510

December 21, 2023

The results of a new meta-analysis on the effects of COVID-19 on hypothyrodism and sub-clinical hypothyrodism was published today. Authors reported that out of 8 studies evaluating the severity of COVID-19, six studies (565 samples) showed that TSH in the severe group was significantly lower than in the mild group, while FT3 was also lower in the severe group.

"Conclusion: SARS-CoV-2 infection may have detrimental effects on thyroid function in individuals with severe symptoms."

December 15, 2023

Another report of vaccine-induced thyroiditis after vaccination with the Astra-Zeneca vaccine was reported by Indian researchers today (Sachin et al., 2023).

December 4, 2023

From Germany, a new review on thyroid dysfunction associated with COVID-19/vaccinations; a case report of functional hypothyroidism in possible relation to SARS-CoV-2 vaccination; and the usefulness of functional analysis of TSH-R-Ab that can provide valuable insights into disease pathogenesis and help to guide treatment.
"This review highlights the need for continued monitoring and awareness of potential thyroid-related complications following SARS-CoV-2 vaccination." (Lampropoulou et al., 2023)
  • Lampropoulou E, Benz C, Kahaly GJ, Führer D - "Thyroid Inflammation and Immunity During the COVID-19 Pandemic: A Comprehensive Review and Case Study" Horm Metab Res Dec 4 (2023)doi: 10.1055/a-2222-6300. Epub ahead of print ... -2222-6300

November 20, 2023

Indian researchers report late onset thyroid disturbances after vaccination with the Astra Zeneca vaccine (ChAdOx1-nCoV-19) (Kaur et al., 2023).
"Here we report late onset thyroid disturbances and persistent health issues in patients of thyroid disorders after COVID-19 vaccination. Seventy-five patients with post COVID-19 vaccination thyroid disturbances were identified. Among these, 41 had flare of underlying thyroid illness, majority occurring at a median time lag of 28.4 weeks since 2nd dose. Thirty-one cases of new onset hypothyroidism and three of new onset hyperthyroidism were reported, with a median time lag respectively of 17.2 and 22.6 weeks since 2nd dose." (Kaur et al., 2023)
  • Kaur U, Reddy NTS, Reddy J, Krishna DVV, Dehade A, Agrawal NK - "Patterns and outcomes of late onset thyroid disturbances after COVID-19 vaccination: A report of 75 cases" Trop Med Int Health (2023) doi: 10.1111/tmi.13947

November 12, 2023

Ukrainian researchers reported on changes in menstrual cycle associated with thyroid dysfunction after COVID-19 vaccination (Petruk & Lyvtak, 2023).
  • Petruk AO, Lytvak OO - "Clinical Profiles and Characteristics of Menstrual Dysfunction in Women After Suffering from COVID-19 or Vaccination" Wiad Lek 76(10):2252-2257 (2023). doi: 10.36740/WLek202310118

November 8, 2023

Posted on Medline today, from March 2023. These were the first US published cases of thyroiditis in adolescents, occurring after Pfizer vaccinations.
"Two children who received Pfizer-BioNTech COVID-19 messenger RNA vaccines later developed symptoms of thyroid hyperactivity, had positive thyroid-stimulating immunoglobulin (TSI) levels and received treatment directed toward Graves disease." (Chimatapu et al., 2023)

October 22, 2023

Researchers from Serbia detailed another case of subacute thyroiditis after COVID-19 vaccination (Tomic et a., 2023).
"Some authors say SAT is the most common thyroid disease associated with COVID-19." (Tomic et a., 2023)
  • Tomic AZ, Zafirovic SS, Gluvic ZM, Samardzic VS, Macvanin MT, Radunovic ML, Isenovic ER - "Subacute thyroiditis following COVID-19 vaccination: Case presentation" Antivir Ther 28(5):13596535231208831 (2023). doi: 10.1177/13596535231208831 ... 5231208831

October 20, 2023

Another French report of thyroid eye disease after mRNA vaccination, occurring together with pretibial myxedema (Caron et al., 2023).
  • Caron P, Imbert P, Dekeister C, Grunenwald S - "Concurrent Pretibial Myxedema and Thyroid Eye Disease Following mRNA COVID-19 Vaccine in a Patient with History of Graves' Disease". Ann Endocrinol (Paris) 20:S0003-4266(23)00713-8 (2023). doi: 10.1016/j.ando.2023.10.004 ... 6623007138

October 20, 2023

Another case of Hashimoto's Thyroiditis after COVID reported from Singapore (Lee et al., 2023).
  • Lee ZC, Wong YJE, Ti LL, Shrikant DP, Tay TL, Santosa A - "Hashimoto's thyroiditis-related myopathy in a patient with SARS-CoV-2 infection: A case report and systematic literature review" Medicine (Baltimore) 102(42):e35720 (2023). doi: 10.1097/MD.0000000000035720 ... n_a.3.aspx

October 10, 2023

Published today, a report from Greece documenting the case of a 63-year-old woman who presented with new onset hyperthyroidism and moderate-to-severe and active TED 10 days after she received the first dose of a viral vector vaccine against SARS-CoV-2.
"Thyroid-related disorders have been reported after vaccination for COVID-19, and Graves' disease (GD) is the second most common amongst them." (Armeni et al., 2023)
  • Armeni AK, Markantes GΚ, Stathopoulou A, Saltiki K, Zampakis P, Assimakopoulos SF, Michalaki MA - "Thyroid Eye Disease as Initial Manifestation of Graves' Disease Following Viral Vector SARS-CoV-2 Vaccine: Report of a Case and Review of the Literature" Vaccines (Basel) 11(10):1574 (2023) doi: 10.3390/vaccines11101574

September 18, 2023

A Polish study, investigating lasting effects of COVID-19 on the endocrine system 6 months after initial infection, found significantly lower levels of fT3 and fT4, accompanied by higher levels of TSH and aTPO antibodies, in COVID-19 survivors. Differences in testosterone levels were observed in male subjects only.
  • Szczerbiński Ł, Okruszko MA, Szabłowski M, Sołomacha S, Sowa P, Kiszkiel Ł, Gościk J, Krętowski AJ, Moniuszko-Malinowska A, Kamiński K - "Long-term effects of COVID-19 on the endocrine system - a pilot case-control study" Front Endocrinol (Lausanne) 14:1192174 (2018)
    doi: 10.3389/fendo.2023.1192174 ... 92174/full

August 25, 2023

A much higher risk of Thyroid Eye Disease (TED) after vaccination was reported in Italy (Muller et al., 2023).
"The risk of TED was significantly increased after Covid-19 vaccination, especially in subjects below 50 years of age. Possible mechanisms include spike protein interaction with ACE-II receptor, cross-reactivity with thyroid self-proteins, and immune reactions induced by adjuvants. We suggest monitoring of individuals undergoing Covid-19 vaccination, especially if young and at risk for autoimmunity."

August 24, 2023

Italian researchers reported the first case of Graves' disease after COVID mRNA vaccination in a 16-year-old girl (Mainieri et al., 2023).
  • Mainieri F, Chiarelli F, Betterle C, Bernasconi S - "Graves' disease after COVID mRNA vaccination for the first time diagnosed in adolescence-case report. Cause and effect relationship or simple coincidence?" J Pediatr Endocrinol Metab. 2023 Aug 24. doi: 10.1515/jpem-2023-0181

August 16, 2023

Iranian researchers published a new paper discussing the increase of autoimmune thyroid diseases, such as subacute thyroiditis, Graves' disease, and Hashimoto's thyroiditis, in individuals with COVID-19 infection (Mohammadi et al., 2023).

July 8, 2023

In patients who developed urticarial reactions following SARS-COV-2 vaccination, screening for autoantibodies identified significantly increased levels of IgG-anti-thyroid peroxidase (TPO) and IgG-anti-thyroid-related proteins, a.o. (Wang et al., 2023).
  • Wang CW, Chen CB, Lu CW, Chen WT, Hui RC, Chiu TM, Chi MH, Lin JC, Huang YH, Chang YC, Wu J, Chen KY, Lin YY, Ger TY, Lin JY, Tsai WT, Pan YJ, Chung WH - "Characteristics of immune response profile in patients with immediate allergic and autoimmune urticarial reactions induced by SARS-CoV-2 vaccines" J Autoimmun 138:103054 (2023). doi: 10.1016/j.jaut.2023.103054

June 15, 2023

Another case report, this time from Japan, on the occurrence of Graves Disease after a COVID vaccine [BNT162b2, Coronavirus Modified Uridine messenger RNA (mRNA) Vaccine, Pfizer] (Takedani et al., 2023).
  • Takedani K, Notsu M, Ishiai N, Asami Y, Uchida K, Kanasaki K - "Graves' disease after exposure to the SARS-CoV-2 vaccine: a case report and review of the literature" BMC Endocr Disord 23(1):132 (2023) doi: 10.1186/s12902-023-01387-2
    https://bmcendocrdisord.biomedcentral.c ... 23-01387-2

May 18, 2023

Researchers from Israel published a study on 19 consecutive cases of COVID vaccine-related thyroid disease. "Medical records were reviewed for 9 patients with Graves' disease (GD) and 10 with Thyroiditis, all of whom were diagnosed following COVID-19 vaccination." The median time from vaccination to GD diagnosis was 3 months, and 2 months for diagnosis of Thyroiditis. "Thyroid disease should be included among possible complications of COVID-19 vaccine and either a late onset or delayed diagnosis should be considered." (Markus et al., 2023)
  • Markus E, Bel-Ange A, Benbassat C, Steinschneider M, Koren R - "Short- and long-term outcomes of patients with hyper or hypothyroidism following COVID vaccine" J Investig Med. 2023 May 18:10815589231173876. doi: 10.1177/10815589231173876 ... 9231173876

May 3, 2023

Japanese researchers published a report of a 45-year-old man, who received his second mRNA COVID-19 vaccine, developed chest discomfort but showed no signs of myocarditis. Two weeks later, he experienced palpitations, hand tremors, and weight loss, leading to a diagnosis of Graves' disease. Treatment with thiamazole successfully normalized his hormone levels, but one year later, his thyroid antibodies remain elevated, requiring continued medication. This case is the first to document the progression of Graves' disease after mRNA COVID-19 vaccination (Nakamura et al., 2023).
  • Nakamura F, Awaya T, Ohira M, Enomoto Y, Moroi M, Nakamura M - "Graves' Disease after mRNA COVID-19 Vaccination, with the Presence of Autoimmune Antibodies Even One Year Later" Vaccines (Basel) 11(5):934 (2023) doi: 10.3390/vaccines11050934

April 19, 2023
"We report the case of an enlargement of metastatic lymph node from differentiated thyroid cancer after COVID-19 vaccination. We warn clinicians to identify features of inflammatory response due to COVID-19 vaccination in order to prevent unwarranted surgical treatment." (Valerio et al., 2023)
  • Valerio L, Prete A, Santini F, Agate L, Elisei R, Latrofa F - "Enlargement of a metastatic lymph node from differentiated thyroid cancer after COVID-19 vaccination" Endocrine 1–4 (2023) doi: 10.1007/s12020-023-03367-x ... 23-03367-x

April 8, 2023

Researchers from the US published an article on the longest delayed antibody positivity reported to date, amongst cases of new-onset Graves Disease following COVID (Boyle & Mullaly, 2023).
"Mounting evidence implicates COVID-19 as a cause of thyroid dysfunction, including thyrotoxicosis due to both thyroiditis and Graves' disease (GD). In this report, we present a case of thyrotoxicosis following COVID-19 infection that was ultimately found to represent GD with significantly delayed diagnostic serum antibody positivity."

April 6, 2023

Chinese researchers reported that "COVID-19 vaccination seemed to induce increased levels and incidence of TSH surge followed by mood changes in patients with HT [Hashimoto's Thyroiditis]. Higher levels of pre-vaccine serum TSH, CRP, and anti-TPO values were associated with higher incidence in the early post-vaccine phase."
  • Yifei Ma, Jiling Zeng, Yongluo Jiang, et al. - "Thyroid function and associated mood changes after COVID-19 vaccines in patients with Hashimoto thyroiditis" Front. Immunol., 06 April 2023, Sec. Vaccines and Molecular Therapeutics, Volume 14 - 2023 |
March 29, 2023

In the first study to measure the impact of COVID-19 in on thyroid function in pregnant women, it was shown that "lower FT3 values increased the risk of ICU admission, NICU admission, and severe disease...FT3 and TSH correlated positively with lymphocytes and negatively correlated with C-reactive protein (CRP)." FT3 levels were correlated with disease severity (Atalay et al., 2023).

March 13, 2023

A new study from India:
"We conducted an observational, cross-sectional study of thyroid function abnormalities with thyroid autoimmune profile in COVID-19 patients with varying severity from November 2020 to June 2021....Both mean FT3 and FT3/FT4 ratio decreased with increasing severity of COVID-19 illness (p=0.001)...Thyroid function abnormality is common among COVID-19 patients. Both low FT3 and FT3/FT4 ratio are indicators of disease severity while low FT3 is a prognostic marker of COVID-19 associated mortality."
  • Patel D, Naik D, Kamalanathan S, Tamilarasu K, Sahoo J, Roy A, Merugu C, Suryadevara V - "Thyroid Function Abnormalities and Outcomes in Hospitalized Patients with COVID-19 Infection: A Cross-Sectional Study" Horm Metab Res 55(3):169-175 (2023) doi: 10.1055/a-2014-4634. ... -2014-4634

March 8, 2023

In a new study from Turkey, researchers investigated thyroid function and anti-thyroid antibody titers in acutely infected COVID-19 patients.
Thyroid dysfunction was noted in 56.4% of patients on admission, including the non-thyroidal illness syndrome (NTIS) in most cases. Presence vs. absence of thyroid dysfunction on admission was associated with significantly higher rate of severe disease (p < 0.001), while severe vs. mild-to-moderate disease was associated with significantly lower serum fT3 levels (p = 0.001)....The presence of emergent or persistent subclinical hypothyroidism and the significantly increased anti-TPO titers in some patients during the convalescence period suggest the need for follow-up for development of thyroid dysfunction and autoimmunity among COVID-19 survivors." (Alphan et al., 2023)
  • Alphan Uc Z, Yagcı P, Adibelli Z, Duran C - "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?" Endocr Res. 2023 Mar 8:1-11. doi: 10.1080/07435800.2023.2188086 ... 23.2188086

February 16, 2023

Taiwanese investigators described a case where thyroid eye disease (TED) and Graves' Disease were reactivated in a patient following COVID vaccination (Hung, 2023).

February 13, 2023

A new study in China undertook a systematic review and meta-analysis to assess thyroxine levels in COVID-19 patients (Li et al., 2023).
"Conclusions: Compared with the healthy cohort, COVID-19 patients showed decreased TSH and FT3 and increased FT4, similar to non-COVID-19 pneumonia. Thyroid function changes were related to the severity of COVID-19. Thyroxine levels have clinical significance for prognosis evaluation, especially FT3."
  • Li Z, Hou P, Mu S, Wang R, Miao H, Feng M, Wang H, Zhang W, Chen Y, Feng T, Wang S, Fang Y - "Thyroxine changes in COVID-19 pandemic: A systematic review and meta-analysis" Front Endocrinol (Lausanne) 14:1089190 (2023) doi: 10.3389/fendo.2023.1089190 ... 89190/full

February 6, 2023

Researchers from South Korea reported on a thyroid storm triggered by COVID-19 in a pregnant woman (Kim et al., 2023).
  • Kim HE, Yang J, Park JE, Baek JC, Jo HC - "Thyroid storm in a pregnant woman with COVID-19 infection: A case report and review of literature" World J Clin Cases 11(4):888-895 (2023) doi: 10.12998/wjcc.v11.i4.888

January 31, 2023

U.S. researchers have identified a rise in new-onset pediatric Graves Disease diagnoses during the COVID-19 pandemic.
"In addition, youth had increased severity of symptoms and more frequently required beta-blockade treatment at diagnosis." (Donner et al., 2023)

January 19, 2023
"Clinicians should be aware that subacute thyroiditis may occur within a few days following COVID-19 vaccination, especially in patients with anterior cervical pain with no significant abnormal pharyngeal findings and/or severe palpitations, because differentiating them from early non-specific adverse reactions can be challenging." (Le K et al., 2023)
  • Ie K, Ishizuka K, Sakai T, Motohashi I, Asai S, Okuse C - "Subacute Thyroiditis Developing Within 2 Days of Vaccination Against COVID-19 with BNT162b2 mRNA" Eur J Case Rep Intern Med 10(1):003735 (2023). doi: 10.12890/2023_003735

December 25, 2022
"BNT 162b2 mRNA COVID-19 vaccination is associated with a high risk of myocarditis, especially in adolescents. This rare complication of COVID-19-associated thyroid disease is also reported in the adult population. We report a previously healthy 12-year-old boy with atrioventricular (AV) block presenting within 1 month after BNT vaccination and final diagnosis of Hashimoto thyroiditis." (Chien et al., 2022)
  • Chien KJ, Chen CY, Lin CC, Cheng MF, Weng KP - "Coincidence of BNT162b2 mRNA COVID-19 vaccination and Hashimoto thyroiditis presenting as atrioventricular block: Causality or casualty" Pediatr Neonatol. 2022 Dec 25:S1875-9572(22)00266-2. doi: 10.1016/j.pedneo.2022.11.006

December 19, 2022

Brazilian researchers published a review on COVID-19 and thyroid function (Rossetti et al., 2022).
"Overall, the data revealed that abnormal thyroid function may occur during and in the convalescence post-COVID condition phase."
  • Rossetti CL, Cazarin J, Hecht F, Beltrão FEL, Ferreira ACF, Fortunato RS, Ramos HE, de Carvalho DP - "COVID-19 and thyroid function: What do we know so far? Front Endocrinol (Lausanne)" 13:1041676 (2022). doi: 10.3389/fendo.2022.1041676 ... 41676/full

December 12, 2022

A study from Spain reported a notable increase in the incidence of Graves Disease during the pandemic year 2021.
"A total of 180 subjects were diagnosed and treated for GD during the study period. We observed a notable increase in expected GD cases in 2021 compared to 2017-19. The number of GD cases was higher in the second (Q2) quarter. Among 2021 GD cases, 42/66 patients (63.6%) had been vaccinated in the 90 days before symptom onset, but none of them in the first quarter of the year." (Barajas Galindo et al., 2022).
  • Barajas Galindo DE, Ramos Bachiller B, González Roza L, García Ruiz de Morales JM, Sánchez Lasheras F, González Arnáiz E, Ariadel Cobo D, Ballesteros Pomar MD, Rodríguez IC - "Increased incidence of Graves' disease during the SARS-CoV2 pandemic" Clin Endocrinol (Oxf). 2022 Dec 12. doi: 10.1111/cen.14860

December 9, 2022

A pilot study from Bangladesh showed that "abnormalities in thyroid function can be observed during COVID-19 infection and after vaccination, which gradually recovers over time." (Razu et al., 2022)
  • Razu MH, Hossain MI, Ahmed ZB, Bhowmik M, Hasan MKE, Kibria MK, Moni DA, Khan M - "Study of thyroid function among COVID-19-affected and non-affected people during pre and post-vaccination" BMC Endocr Disord 22(1):309 (2022) doi: 10.1186/s12902-022-01187-0
    https://bmcendocrdisord.biomedcentral.c ... 22-01187-0
November 22, 2022

Russian research showed that in COVID-19 patients who developed subclinical thyrotoxicosis, serum TSH values were inversely correlated with interleukin-6 (r=-0.221; p=0.024). "Analysis of the level of hospital mortality, stratified by TSH, revealed statistically significantly lower TSH values in the group of deceased patients (p=0.012). The median TSH in surviving patients was 1.34 [0.85; 1.80], for the deceased 0.44 [0.29; 0.99]." (Kolpakova et al., 2022).
  • Kolpakova EA, Elfimova AR, Nikankina LV, Troshina EA - "The role of systemic immune activation in the development of thyroid dysfunction in COVID-19" Ter Arkh 94(10):1136-1142 (2022) Russian. doi: 10.26442/00403660.2022.10.201879

November 17, 2022

Italian researchers reported that the rate of hypothyroidism was higher (36.5%) in COVID-19-related subacute thyroiditis [SAT] compared to that observed in the pre-COVID era (10%) (Viola et al., 2022).
Clinical, biochemical, and instrumental features of SAT related to SARS-CoV2 are like those observed in SAT cases reported prior to COVID-19 pandemic, but it appears more severe.
  • Viola N, Brancatella A, Sgrò D, Santini F, Latrofa F - "Clinical, biochemical features and functional outcome of patients with SARS-CoV-2-related subacute thyroiditis: a review" Endocrine. 2022 Nov 17. doi: 10.1007/s12020-022-03247-w ... 22-03247-w

November 3, 2022

A Turkish study investigating clinical characteristics and outcomes of COVID-19 patients with pre-existing thyroid dysfunction found that "mortality rates were higher in patients with hyperthyroidism (7.7%) and hypothyroidism (4.4%) than those with normal thyroid function (3.4%) (p<0.001 and p=0.008, respectively). Pre-existing hyperthyroidism was significantly associated with an increased risk of mortality (OR 1.54; 95% CI, 1.02-2.33; p=0.042) along with advanced age, male gender, lymphopenia and chronic kidney disease (p<0.001 for all)." (Sahin et al., 2022)
  • Sahin M, Demirci I, Haymana C, Tasci I, Emral R, Cakal E, Unluturk U, Satman I, Demir T, Ata N, Ertugrul D, Atmaca A, Salman S, Sahin I, Dagdelen S, Celik O, Caglayan M, Sonmez A - "The Clinical Characteristics and Outcomes of COVID-19 Patients with Pre-Existing Thyroid Dysfunction: A Nationwide Study" Horm Metab Res. 2022 Nov 3. doi: 10.1055/a-1971-8781. Epub ahead of print ... -1971-8781

October 30, 2022

Iranian researchers studied thyroid abnormalities after vaccination against COVID-19. Excerpt:
"Among 83 reported cases including in this review, the most cases of thyroid abnormalities were observed after vaccination with mRNA-based vaccines (68.7%), followed by viral vector vaccines (15.7%) and 14.5% cases following inactivated vaccines. Subacute thyroiditis (SAT) was the most common COVID-19 vaccination-related thyroid disease, accounting for 60.2% of all cases, followed by Graves' disease (GD) with 25.3%....Overall, in 58.0% of SAT cases and in 61.9% of GD cases, the onset of the symptoms occurred following the first vaccine dose with a median of 10.0 days (ranged: 3-21 days) and 10.0 days (ranged: 1-60 days) after vaccination, respectively. Moreover, 40.0% of SAT patients and 38.1% of GD patients developed the symptoms after the second dose with a median of 10.5 days (ranged: 0.5-37 days) and 14.0 days (ranged: 2-35 days) after vaccination, respectively." (Jafaezadeh et al., 2022)
  • Jafarzadeh A, Nemati M, Jafarzadeh S, Nozari P, Mortazavi SMJ - "Thyroid dysfunction following vaccination with COVID-19 vaccines: a basic review of the preliminary evidence"J Endocrinol Invest 45(10):1835-1863 (2022) doi: 10.1007/s40618-022-01786-7 ... 22-01786-7

October 28, 2022

Japanese researchers investigating hormonal trends in "Long Covid" patients found that "in patients suffering from general fatigue, the scores of depression and fatigue were positively correlated with serum levels of cortisol and free thyroxin (FT4), respectively. Also, patients suffering from general fatigue had lower levels of serum growth hormone and higher levels of serum FT4, while patients with dysosmia/dysgeusia had a significantly lower level of serum cortisol. Serum thyrotropin (TSH) levels were higher and the ratios of FT4/TSH were lower in the initially severe cases, suggesting occult hypothyroidism." (Sunada et al., 2022)
  • Sunada N, Honda H, Nakano Y, Yamamoto K, Tokumasu K, Sakurada Y, Matsuda Y, Hasegawa T, Otsuka Y, Obika M, Hanayama Y, Hagiya H, Ueda K, Kataoka H, Otsuka F - "Hormonal trends in patients suffering from long COVID symptoms" Endocr J 69(10):1173-1181 (2022) ... 3/_article
October 17, 2022

Researchers from the US and UK reviewed 10 cases of thyroid eye disease (TED) after mRNA COVID vaccinations (Mohamed et al., 2022).
  • Mohamed A, Tzoulis P, Kossler AL, Dosiou C - "New onset or deterioration of thyroid eye disease after mRNA SARS-CoV-2 vaccines:report of 2 cases and literature review" J Clin Endocrinol Metab. 2022 Oct 17:dgac606. doi: 10.1210/clinem/dgac606 ... 06/6762304

October 12, 2022

Case report from Spain, detailing Hashimoto encephalopathy occurring after Moderna vaccination (Viscasillas et al., 2022).

September 21, 2022

Italian researchers suggest that post-vaccines early-onset Graves Disease may be a new nosological entity. One-third of patients evaluated for new-onset Graves Disease in their center had onset within 4 weeks after vaccination (di Filippo et al., 2022).
"Compared to the other 44 patients, the 20 patients with post-vaccine early-onset (PoVEO) GD were older (median age: 51 years vs 35 years, p = 0.003) and more likely male (40.0% vs 13.6%, p = 0.018)."
  • di Filippo L, Castellino L, Allora A, Frara S, Lanzi R, Perticone F, Valsecchi F, Vassallo A, Giubbini R, Rosen CJ, Giustina A - "Distinct clinical features of post COVID-19 vaccination early-onset Graves' disease (PoVEO GD)" J Clin Endocrinol Metab. 2022 Sep 21:dgac550. doi: 10.1210/clinem/dgac550 ... 50/6708407

September 6, 2022

In a study conducted on 103 Italian COVID-19 patients, 37.9% were found to have euthyroid sick syndrome, and this condition was an independent predictor for the severity of COVID-19.

Lower TSH and lower FT3/FT4 ratio correlated with higher mean platelet volume (MPV) (p = 0,001 and p = 0.010), with an opposite trend with respect to what has been documented in non-COVID patients. Increasing MPV and lower FT3 significantly increased the risk, in COVID-19 patients, of an adverse outcome of death/ARDS (Colonnello et al., 2022).
  • Colonnello E, Criniti A, Lorusso E, Curreli M, Santulli M, Angeloni A, Gnessi L, Gandini O, Lubrano C - "Thyroid hormones and platelet activation in COVID-19 patients" J Endocrinol Invest. 2022 Sep 5:1–9. doi: 10.1007/s40618-022-01896-2 ... 22-01896-2

September 1, 2022

Chinese researchers reported that "higher FT4 levels may reduce the risk of COVID-19 severity, suggesting that thyroid function testing may be required for patients with COVID-19." (Zhang et al., 2022).

August 22, 2022

Results from a large Italian study suggest a higher prevalence of SARS-CoV-2 infection and COVID-19 disease in patients with auto-immune thyroid disease (Fallahi et al., 2022).
  • Fallahi P, Ferrari SM, Elia G, Paparo SR, Patrizio A, Balestri E, Mazzi V, Gragnani L, Ferri C, Botrini C, Ragusa F, Antonelli A - "Thyroid autoimmunity and SARS-CoV-2 infection: Report of a large Italian series" Autoimmun Rev 21(11):103183 (2022)

August 3, 2022
"Subacute thyroiditis (SAT) is a thyroid inflammatory disease, whose pathogenesis is still unclear. We report a 52-year-old female with SAT after the third dose of COVID-19 mRNA vaccine BNT162b2 (Pfizer-BioNTech). This case was documented with laboratory tests and ultrasound examination. She needed therapy during the acute phase and subsequently thyroxine supplementation." (Frangos et al., 2022)
  • Frangos S, Haralambous H, Michael K, Economides PA - "Subacute thyroiditis after the third dose of the COVID-19 mRNA vaccine. Case report" Hell J Nucl Med. 2022 Aug 3:s002449912481. doi: 10.1967/s002449912481

July 28, 2022

The August issue of the French journal "Annales d'Endocrinologie" features a report by Florence Brès and colleagues, detailing three cases of thyroiditis after COVID-19 vaccines (2 Pfizer, 1 Moderna) (Brès et al., 2022).

July 19, 2022

Another report of Graves' disease after COVID-19 vaccination (Pfizer) was published today, this time in Belgium (Manta et al., 2022).

July 19, 2022

Al-Shammaa and Abdalkir reviewed a case of subacute thyroiditis after COVID-19 infection (Al-Shammaa & Abdlkadir, 2022)

July 13, 2022

Chinese researchers have developed a prediction score (ThyroCOVID) for identifying abnormal thyroid function in COVID-19 patients (Lui et al., 2022). "Patients with abnormal TFTs [abnormal thyroid function] were older, had more comorbidities such as diabetes, and were more likely to be symptomatic. Regarding the characteristics of COVID-19, patients with abnormal TFTs were more likely to have worse COVID-19 severity (in terms of radiological involvement and oxygen requirement), higher SARS-CoV-2 viral loads, more adverse profiles of acute-phase reactants (higher CRP and lower albumin), haematological parameters (including lower lymphocyte and platelet counts) and biochemical parameters (including lower eGFR)."
  • Lui DTW, Lee CH, Chow WS, Lee ACH, Tam AR, Cheung CYY, Fong CHY, Kwok STM, Law CY, To KKW, Lam CW, Tan KCB, Woo YC, Hung IFN, Lam KSL - "Development of a prediction score (ThyroCOVID) for identifying abnormal thyroid function in COVID-19 patients" J Endocrinol Invest. 2022 Jul 13:1–8. doi: 10.1007/s40618-022-01854-y. Epub ahead of print. PMID: 35831586; PMCID: PMC9281239 ... 22-01854-y

July 1, 2022
"At baseline, 44 patients had positive antithyroid antibodies, 6 had hypothyroidism in substitution and 2 had hyperthyroidism under treatment. During COVID-19 we found an increase in serum values of antithyroid antibodies, and decreased levels of TSH, freeT3 and freeT4 levels. Specific therapies were discontinued in one patient with hyperthyroidism and 3 patients with hypothyroidism." (Toma et al., 2022)
  • Toma L, Zgura A, Isac T, Simu R, Mercan-Stanciu A, Dodot M, Iliescu EL - "Covid-19 and the thyroid function in patients with HCV-associated hepatocellular carcinoma" Avta Endocrinol 18(3):392-396 (2022) doi: 10.4183/aeb.2022.392

June 28, 2022

The study by Nakamura et al. from 2021 was published today (e-published Dec 2021). The authors had done the study to find out if infection with SARS-CoV-2 affected thyroid hormone levels and if these hormones could be better predictors of prognosis in patients with COVID-19.

It was reported that 24% of COVID patients "had serum thyroid-stimulating hormone (TSH) levels lower than the reference range with normal serum free thyroxine (fT4) levels, and 3.4% of the patients had low TSH with high fT4 levels. Over 70% of the patients with moderate and severe COVID-19 had low serum free triiodothyronine (fT3) levels. Serum TSH and fT3 levels were inversely correlated with disease severity. The mortality rate in patients with low serum fT3 levels was significantly higher than that in those with normal serum fT3 levels."
  • Nakamura S, Kido N, Watanabe M, Ohmachi Y, Inayama Y, Kashitani Y, Ishii K, Ishida I, Goda N, Fujita Y, Iida K - "Analysis of thyroid function in Japanese patients with coronavirus disease 2019" Endocr J 69(6):643-648 (2022) ... 9/_article

June 16, 2022

Persani and Campi published a commentary on the earlier study by de Lima Beltrao et al. (2022).
"The whole of these data suggest tissue availability of T3 might play a role in the outcome of COVID-19 and other several other organ-specific conditions." (Persani & Campi, 2022)

June 16, 2022

A new study from Turkey compared subacute thyroiditis (SAT) caused by COVID vaccines to non-vaccine associated SAT diagnosed in the same period (Bostan etal., 2022). Out of a total of 55 patients, "29.1% were diagnosed with COVID-19 vaccine-associated SAT (10 with CoronaVac® and six with Pfizer-BioNTech® vaccine), with a median time to onset of symptoms after vaccination of 6.5 (range, 2-20) days."
  • Bostan H, Kayihan S, Calapkulu M, Hepsen S, Gul U, Ozturk Unsal I, Kizilgul M, Sencar ME, Cakal E, Ucan B - "Evaluation of the diagnostic features and clinical course of COVID-19 vaccine-associated subacute thyroiditis" Hormones (Athens). 2022 Jun 16. doi: 10.1007/s42000-022-00380-z. Epub ahead of print. PMID: 35711078.

May 19, 2022

A study evaluated thyroid functions, glutathione level, and the risk of infection with SARS-CoV-2 after vaccination (two doses of Pfizer vaccine) in foundry workers in Jordan.
"The blood lead, FT3, and FT4 levels were significantly higher (p < 0.0001) and the levels of glutathione and TSH were significantly decreased (p < 0.0001) compared with the control group. In conclusion, long-term exposure to Pb is associated with a risk of infection with COVID-19 despite the 2 doses of the BNT162b2 vaccine (Pfizer-BioNTech). Also, exposure to Pb is associated with hyperthyroidism and a reduction in glutathione." (Saadh, 2022)
  • Saadh M - "How long-term metal and lead exposure among foundry workers affect COVID-19 infection outcomes in Jordan" Environ Sci Pollut Res Int. 19:1–5 (2022) doi: 10.1007/s11356-022-20845-3. Epub ahead of print. PMID: 35589897; PMCID: PMC9119681

May 17, 2022

A paper from Thailand reported concomitant myocarditis and painless thyroiditis after vaccination with the AstraZeneca vaccine (Marsukjai et al., 2022).
  • Marsukjai A, Theerasuwipakorn N, Tumkosit M, Chattranukulchai P, Srichomkwun P, Prechawat S - "Concomitant myocarditis and painless thyroiditis after AstraZeneca coronavirus disease 2019 vaccination: a case report" J Med Case Rep 16(1):212 (2022) doi: 10.1186/s13256-022-03438-z.

May 2, 2022

Chinese researchers from Weifang have published an extensive review on thyroid cancer and COVID-19 implications (Qu et al., 2022).
  • Qu N, Hui Z, Shen Z, Kan C, Hou N, Sun X, Han F - "Thyroid Cancer and COVID-19: Prospects for Therapeutic Approaches and Drug Development" Front Endocrinol (Lausanne) 13:873027 (2022). doi: 10.3389/fendo.2022.873027

May 1, 2022

Researchers from Japan reported a case of subacute thyroiditis associated with thyrotoxic periodic paralysis after COVID-19 vaccination with the Moderna vaccine (Murashita et al., 2022).
  • Murashita M, Wada N, Baba S, Sugawara H, Miyoshi A, Obara S - "Subacute thyroiditis associated with thyrotoxic periodic paralysis after COVID-19 vaccination: a case report" Endocrinol Diabetes Metab Case Rep 2022:22-0236 (2022). doi: 10.1530/EDM-22-0236. Epub ahead of print. PMID: 35578985.

April 29, 2022

Indonesian researchers reported that "COVID-19 could present as a thyroid crisis as the initial clinical manifestation. Clinicians should be aware that presentation of thyroid dysfunction in a patient without previous endocrine disease could be due to COVID-19 infection."(Anwar et al., 2022)
  • Anwar SL, Wahyono A, Dwianingsih EK, Avanti WS - "Thyrotoxicosis occurrence in SARS-CoV-2 infection: A case report" Ann Med Surg (Lond). 2022 Apr 29:103700. doi: 10.1016/j.amsu.2022.103700. Epub ahead of print. PMID: 35505686; PMCID: PMC9050609

April 28, 2022

A new study from Japan investigated hormonal changes in patients suffering from long COVID symptoms.

"As for the characteristics of patients suffering from general fatigue, the scores of depression and fatigue were positively correlated with serum levels of cortisol and free thyroxin (FT4), respectively. Also, patients suffering from general fatigue had lower levels of serum growth hormone and higher levels of serum FT4, while patients with dysosmia/dysgeusia had a significantly lower level of serum cortisol. Serum thyrotropin (TSH) levels were higher and the ratios of FT4/TSH were lower in the initially severe cases, suggesting occult hypothyroidism." (Sunada et al., 2022)
  • Sunada N, Honda H, Nakano Y, Yamamoto K, Tokumasu K, Sakurada Y, Matsuda Y, Hasegawa T, Otsuka Y, Obika M, Hanayama Y, Hagiya H, Ueda K, Kataoka H, Otsuka F - "Hormonal trends in patients suffering from long COVID symptoms" Endocr J. 2022 Apr 28. doi: 10.1507/endocrj.EJ22-0093. Epub ahead of print. PMID: 35491089. ... 3/_article

April 22, 2022

Another USA paper was published, reporting Graves' Disease after vaccination with Moderna and Johnson & Johnson vaccines (Singh & Howland, 2022).

April 15, 2022

In a large single cohort study in India investigating subacute thyroiditis (SAT) after COVID-19, researchers reported that persistent lymphopaenia during the immediate post-COVID recovery period could be a key driver of early, painless SAT. "Close monitoring of thyroid functions for at least 6 months is warranted in all cases." (Mondal et al., 2022)
  • Mondal S, DasGupta R, Lodh M, Ganguly A - "Subacute thyroiditis following recovery from COVID-19 infection: novel clinical findings from an Eastern Indian cohort" Postgrad Med J. 2022 Apr 15:postgradmedj-2021-141429. doi: 10.1136/postgradmedj-2021-141429. Epub ahead of print. PMID: 35428735 ... 41429.long

April 14, 2022

Subacute thyroiditis after vaccination is now reported in Germany as well (Adelmeyer et al., 2022).
  • Adelmeyer J, Goebel JN, Kauka A, Kann PH - "Two Case Reports of Subacute Thyroiditis after Receiving Vaccine for COVID-19" Case Rep Endocrinol. 2022 Apr 14;2022:3180004. doi: 10.1155/2022/3180004. PMID: 35433060; PMCID: PMC9008488

April 9, 2022

"Neuropsychiatric manifestations are reported in up to 20–40% of covid 19 patients (Kumar et al., 2021). We report a unique case of Hashimoto’s encephalopathy presenting as acute mania in a patient following recovery from severe COVID-19 disease." (Das et al., 2022)
  • Das M, Ali A, Menon V - "Hashimoto's encephalopathy presenting as acute mania following recovery from COVID-19" Asian J Psychiatr. 2022 Apr 9;73:103115. doi: 10.1016/j.ajp.2022.103115. Epub ahead of print. PMID: 35430498; PMCID: PMC8994213

April 6, 2022

A Turkish study found the frequencies of haplotypes "HLA-B*35 and HLA-C*04 alleles were higher in SARS-CoV-2 vaccine-induced subacute thyroiditis compared to controls. Homozygosity for HLA-B*35 and HLA-C*04 was associated with thyrotoxicosis and a higher inflammation reaction." Similar findings were reported in December 2021 by Polish researchers investigating SAT triggered by COVID-19 (Stasiak et al., 2021).
  • Şendur SN, Özmen F, Oğuz SH, İremli BG, Malkan UY, Gürlek A, Erbas T, Ünlütürk U - "Association of HLA genotypes with SARS-CoV-2 Vaccine-induced Subacute Thyroiditis" Thyroid. 2022 Apr 6. doi: 10.1089/thy.2022.0010. Epub ahead of print. PMID: 35387473

March 24, 2022

Italian researchers published a commentary on the study by de Lima Beltrão et al. indicating involvement of DIO2 (deiodinase 2) and a role of T3 availability in the outcome of COVID19 and several other organ-specific conditions (Persani et al., 2022).

March 22, 2022

Another report from Turkey was published today, reviewing 6 cases of subacute thyroiditis after COVID vaccination (Kurtulmus & Kayikci, 2022).
  • Kurtulmus N, Kayikci K - "Subacute Thyroiditis Following SARS-CoV-2 Vaccines: Six Cases Report and Review of the Literature" Horm Metab Res. 2022 Mar 22. doi: 10.1055/a-1804-9561. Epub ahead of print. PMID: 35318621.

March 10, 2022

Yet more reports about subacute thyroiditis after COVID-19 vaccination, now from Japan (Kishimoto et al., 2022).
  • Kishimoto M, Ishikawa T, Odawara M - "Subacute thyroiditis with liver dysfunction following coronavirus disease 2019 (COVID-19) vaccination: report of two cases and a literature review" Endocr J. 2022 Mar 10. doi: 10.1507/endocrj.EJ21-0629. Epub ahead of print. PMID: 35264515. ... 9/_article

March 9, 2022

18 more cases of subacute thyroiditis after COVID-19 vaccination were reported from the UK (Bennet et al., 2022)
  • Bennet WM, Elamin A, Newell-Price JD - "Subacute thyroiditis following COVID-19 vaccination: Case report and Society for Endocrinology survey" Clin Endocrinol (Oxf). 2022 Mar 9. doi: 10.1111/cen.14716. Epub ahead of print. PMID: 35261054.

March 3, 2022

A Turkish study reported that the mean thyroid gland volume was significantly lower in COVID-19 survivors (10.3 ± 3.4 mL) than in the controls (14 ± 5.3 mL) (p = 0.001)) (Urhan et al., 2022).
  • Urhan E, Karaca Z, Kara CS, Yuce ZT, Unluhizarci K - "The potential impact of COVID-19 on thyroid gland volumes among COVID-19 survivors" Endocrine. 2022 Mar 3:1–7. doi: 10.1007/s12020-022-03019-6. Epub ahead of print. PMID: 35239124; PMCID: PMC8892112 ... 22-03019-6

March 2, 2022

Another report on 12 cases of Graves' disease after mRNA vaccination (Chee et al., 2022).
  • Chee YJ, Liew H, Hoi WH, Lee Y, Lim B, Chin HX, Lai RTR, Koh Y, Tham M, Seow CJ, Quek ZH, Chen AW, Lim Quek TP, Tan AWK, Dalan R - "SARS-CoV-2 mRNA Vaccination and Graves' Disease: a report of 12 cases and review of the literature" J Clin Endocrinol Metab. 2022 Mar 2:dgac119. doi: 10.1210/clinem/dgac119. Epub ahead of print. PMID: 35235663.

February 24, 2022

Seven cases of Graves' disease after vaccination were reported by Turkish researchers (Bostan et al., 2022).
  • Bostan H, Ucan B, Kizilgul M, Calapkulu M, Hepsen S, Gul U, Ozturk Unsal I, Cakal E - "Relapsed and newly diagnosed Graves' disease due to immunization against COVID-19: A case series and review of the literature" J Autoimmun 128:102809 (2022) doi: 10.1016/j.jaut.2022.102809. Epub ahead of print. PMID: 35220164.

February 22, 2022

A greek study reported that patients with autoimmune thyroiditis present similar immunological response to the Pfizer vaccine as healthy subjects, while vaccination may affect thyroid function (Paschou et al., 2022).
  • Paschou SA, Karalis V, Psaltopoulou T, Vasileiou V, Charitaki I, Bagratuni T, Ktena V, Papandroulaki F, Gumeni S, Kassi GN, Trougakos IP, Terpos E, Dimopoulos MA - "Patients With Autoimmune Thyroiditis Present Similar Immunological Response to COVID-19 BNT162b2 mRNA Vaccine With Healthy Subjects, While Vaccination May Affect Thyroid Function: A Clinical Study" Front Endocrinol (Lausanne). 2022 Feb 22;13:840668. doi: 10.3389/fendo.2022.840668. PMID: 35273575; PMCID: PMC8902239

February 19, 2022

Turkish researchers published details on 11 cases of vaccine-induced subacute thyroiditis (Pfizer). The average time to the onset of symptoms was 22 days (15-37) after vaccination (Yorulmaz & Sahin, 2022).
  • Yorulmaz G, Sahin Tekin M - "SARS-CoV-2 vaccıne-assocıated subacute thyroıdıtıs" J Endocrinol Invest. 2022 Feb 19. doi: 10.1007/s40618-022-01767-w. Epub ahead of print. PMID: 35182366

February 14, 2022

Another case of subacute thyroiditis after receiving the Moderna vaccine was reported in South Korea (Jhon et al., 2022).
  • Jhon M, Lee SH, Oh TH, Kang HC - "Subacute Thyroiditis After Receiving the mRNA COVID-19 Vaccine (Moderna): The First Case Report and Literature Review in Korea" J Korean Med Sci. 2022 Feb 14;37(6):e39. doi: 10.3346/jkms.2022.37.e39. PMID: 35166076

February 9, 2022

de Lima Beltrão et al. published a paper on the role of deiodinase 2 (DIO2) in COVID-19 disease progression.

"While the overall mortality was 17.3%, the lethality was lower in Ala/Thr patients (12.6%) when compared to Thr/Thr patients (21.7%) or Ala/Ala patients (23%). The heterozygous genotype (Thr/Ala) was associated with a 47% reduced risk of intra-hospital mortality whereas the univariate and multivariate logistic regression adjusted for multiple covariates, revealed a reduction that ranged from 51-66%. The association of the Thr/Ala genotype with better clinical outcomes was confirmed in a metanalysis of 5 studies, including the present one."

  • de Lima Beltrão FE, de Almeida Beltrão DC, Carvalhal G, de Lima Beltrão FE, Braga Filho JS, de Brito Oliveira J, de Jesus JDS, Machado GJR, Dos Santos Silva H, Teixeira HMP, Rodrigues JL, de Figueiredo CAV, Dos Santos Costa R, Hecht F, Bianco AC, Rodrigues Gonçalves MDC, Ramos HE - "Heterozygote Advantage of the Type II deiodinase Thr92Ala Polymorphism on Intrahospital Mortality of COVID-19" J Clin Endocrinol Metab. 2022 Feb 9:dgac075. doi: 10.1210/clinem/dgac075. Epub ahead of print. PMID: 35137147; PMCID: PMC8903419.

February 1, 2022

Research from Croatia: Spike protein positivity was found in thyroid tissue in a COVID patient who developed subacute thyroiditis after COVID.
  • Jakovac H, Ferenčić A, Stemberger C, Mohar Vitezić B, Cuculić D - "Detection of Sars-Cov-2 antigens in thyroid gland showing histopathological features of subacute thyroiditis" Eur Thyroid J. 2022 Feb 1:ETJ-22-0005. doi: 10.1530/ETJ-22-0005. Epub ahead of print. PMID: 35166214

January 31, 2022

Chinese researchers conducted a study to determine if thyroid function independently correlates with lymphocyte counts (LYM) in COVID-19. They found that "TSH and fT3 levels showed independent positive correlations with LYM among COVID-19 patients, supporting the interaction between the hypothalamic-pituitary-thyroid axis and immune system in COVID-19." (Lui et al., 2022)
  • Lui DTW, Lee CH, Chow WS, Lee ACH, Tam AR, Pang P, Ho TY, Cheung CYY, Fong CHY, Law CY, To KKW, Lam CW, Tan KCB, Woo YC, Hung IFN, Lam KSL - "The Independent Association of TSH and Free Triiodothyronine Levels With Lymphocyte Counts Among COVID-19 Patients" Front Endocrinol (Lausanne) 12:774346 (2022) ... 74346/full

January 19, 2022

A large study in Brazil has found that hypothyroidism does not lead to worse prognosis in COVID-19. Patients with hypothyroidism had a lower requirement of mechanical ventilation, and showed a trend of lower in-hospital mortality (Pereira et al., 2022).

  • Pereira DN, Silveira LFG, Guimarães MMM, Polanczyk CA, et al. - "Hypothyroidism does not lead to worse prognosis in COVID-19: findings from the Brazilian COVID-19 registry" Int J Infect Dis. 2022 Jan 19:S1201-9712(22)00016-9. doi: 10.1016/j.ijid.2022.01.016. Epub ahead of print. PMID: 35065257

January 16, 2022

In a new study from Greece, researchers found that thyroid hormone supplementation (THS) is not a risk factor for acquiring SARS-CoV-2 infection and that there was lower mortality in COVID-19 patients receiving levothyroxine (Synthroid). In contrast, earlier research in France had indicated that patients who take thyroid hormone may be at a higher risk for COVID-19 (see July 1, 2021; Bacle et al.).
  • Pappa E, Gourna P, Galatas G, Romiou A, Kiki I, Panagiotou L, Christopoulos C - "Thyroid hormone treatment and SARS-CoV-2 infection" Endocrine. 2022 Jan 16. doi: 10.1007/s12020-021-02957-x. Epub ahead of print. PMID: 35034248. ... 21-02957-x

January 16, 2022

Over the past week, three more papers documenting thyroiditis after vaccination against COVID-19 were published (Capezzone et al., 2022; Nakaizumi et al., 2022; Bostan et al., 2022).
  • Capezzone M, Tosti-Balducci M, Morabito EM, Caldarelli GP, Sagnella A, Cantara S, Alessandri M, Castagna MG- "Silent thyroiditis following vaccination against COVID-19: report of two cases" J Endocrinol Invest. 2022 Jan 16. doi: 10.1007/s40618-021-01725-y. Epub ahead of print. PMID: 35034341 ... 21-01725-y
    "When recipients of COVID-19 vaccines complain of symptoms such as fatigue and palpitations, thyrotoxicosis should be considered as a differential diagnosis."

    Nakaizumi N, Fukata S, Akamizu T - "Painless thyroiditis following mRNA vaccination for COVID-19" Hormones (Athens). 2022 Jan 15:1–3. doi: 10.1007/s42000-021-00346-7. Epub ahead of print. PMID: 35032327; PMCID: PMC8760586. ... MC8760586/
    "...the SARS-CoV-2 spike protein and TPO are structurally similar, and antibodies developed against SARS-CoV-2 may promote autoimmune thyroiditis. Indeed, the case of a 13-year-old girl with a significant increase in TPO antibodies after Pfizer-BioNTech COVID-19 vaccination has been reported."

    Bostan H, Unsal IO, Kizilgul M, Gul U, Sencar ME, Ucan B, Cakal E - "Two cases of subacute thyroiditis after different types of SARS-CoV-2 vaccination" Arch Endocrinol Metab. 2022 Jan 13:2359-3997000000430. doi: 10.20945/2359-3997000000430. Epub ahead of print. PMID: 35029854
    "Physicians should be aware of SAT that may occur within a few days following the COVID-19 vaccination."

January 11, 2022

Another case series of thyrotoxicosis after Covid vaccination was reported today, this time from Spain.
"We should pay greater attention to thyroid disorders in patients receiving vaccine against SARS-CoV-2."(Pla Peris et al., 2022)
  • Pla Peris B, Merchante Alfaro AÁ, Maravall Royo FJ, Abellán Galiana P, Pérez Naranjo S, González Boillos M - "Thyrotoxicosis following SARS-COV-2 vaccination: a case series and discussion" J Endocrinol Invest. 2022 Jan 11:1–7. doi: 10.1007/s40618-022-01739-0. Epub ahead of print. PMID: 35015288; PMCID: PMC8749352. ... 22-01739-0

January 6, 2022

Greek researchers describe a 36-year-old woman who presented with subacute thyroiditis 10 days after she had received her first dose of the Pfizer vaccine. The condition receded but then appeared again 10 days after the second dose (Vasileiou et al., 2022).
  • Vasileiou V, Paschou SA, Tzamali X, Mitropoulou M, Kanouta F, Psaltopoulou T, Kassi GN - "Recurring subacute thyroiditis after SARS-CoV-2 mRNA vaccine: A case report" Case Rep Womens Health. 2022 Jan;33:e00378. doi: 10.1016/j.crwh.2021.e00378. Epub 2021 Dec 28. PMID: 34976747; PMCID: PMC8713417.

January 4, 2022

A Chinese meta-analysis has found that COVID-19 patients with abnormal thyroid-related hormones had greater mortality (Chen et al., 2022).
"Conclusions: Low FT3 serum levels, low FT4 serum levels and low TSH serum levels may increase the mortality of COVID-19 patients during admission. On the other hand, the higher the severity level of COVID-19, the higher the probability of decreases in the FT3, FT4, TSH levels."
  • Chen Y, Li X, Dai Y, Zhang J - "The Association Between COVID-19 and Thyroxine Levels: A Meta-Analysis" Front Endocrinol (Lausanne). 2022 Jan 4;12:779692. doi: 10.3389/fendo.2021.779692. PMID: 35058879; PMCID: PMC8763686 ... MC8763686/

January 4, 2022

Faheem et al. reported 3 cases of painless thyroiditis after mRNA vaccination.

January 3, 2022

Chinese researchers have published a review on the possible mechanisms of thyroid dysfunction being responsible for the adverse pregnancy outcomes observed in COVID-19 (Shi et al., 2022).
  • Shi Q, Wu M, Chen P, Wei B, Tan H, Huang P, Chang S - "Criminal of Adverse Pregnant Outcomes: A Perspective From Thyroid Hormone Disturbance Caused by SARS-CoV-2" Front Cell Infect Microbiol. 2022 Jan 3;11:791654. doi: 10.3389/fcimb.2021.791654. PMID: 35047419; PMCID: PMC8761741 ... MC8761741/

December 24, 2021

A Japanese study reported that over 70% of patients with moderate and severe COVID-19 had low serum free triiodothyronine (fT3) levels (Nakamura et al., 2021).
"Serum TSH and fT3 levels were inversely correlated with disease severity. The mortality rate in patients with low serum fT3 levels was significantly higher than that in those with normal serum fT3 levels." (Nakamura et al., 2021)
  • Nakamura S, Kido N, Watanabe M, Ohmachi Y, Inayama Y, Kashitani Y, Ishii K, Ishida I, Goda N, Fujita Y, Iida K - "Analysis of thyroid function in Japanese patients with coronavirus disease 2019" Endocr J. 2021 Dec 24. doi: 10.1507/endocrj.EJ21-0609. Epub ahead of print. PMID: 34955465. ... 9/_article

December 23, 2021

US researchers reported on a case series of new-onset Graves disease following mRNA vaccinations (Weintraub et al., 2021).
  • Weintraub MA, Ameer B, Sinha Gregory N - "Graves Disease Following the SARS-CoV-2 Vaccine: Case Series" J Investig Med High Impact Case Rep. 2021 Jan-Dec;9:23247096211063356

Baldelli et al. from Italy reported that "FT3 and TSH serum levels are lower in patients with more severe symptoms."
  • Baldelli R, Nicastri E, Petrosillo N, Marchioni L, Gubbiotti A, Sperduti I, Di Giacinto P, Rizza L, Rota F, Franco M, Lania A, Aimaretti G, Ippolito G, Zuppi P - "Thyroid dysfunction in COVID-19 patients" J Endocrinol Invest. 44(12):2735-2739 (2021) ... MC8185485/

December 16, 2021

Three more papers were published documenting subacute thyroiditis after COVID-19 infection (Barahona et al, 2021; Ruano et al., 2021; Álvarez Martín et al., 2021).
  • Barahona San Millán R, Tantinyà Daura M, Hurtado Ganoza A, Recasens Sala M - "Painless thyroiditis in SARS-CoV-2 infection" Endocrinol Diabetes Nutr (Engl Ed 68(10):757-758 (2021) ... via%3Dihub

    Ruano R, Zorzano-Martinez M, Campos A, Rius F, Hernández M - "Subacute thyroiditis might be a complication triggered by SARS-CoV-2" Endocrinol Diabetes Nutr (Engl Ed) 68(10):755-756 (2021) ... via%3Dihub

    Álvarez Martín MC, Del Peso Gilsanz C, Hernández López A - "Subacute De Quervain thyroiditis after SARS-CoV-2 infection" Endocrinol Diabetes Nutr (Engl Ed) 68(10):754-755 (2021) ... via%3Dihub

    Also pre-published today:

    Pandya M, Thota G, Wang X, Luo H - "Thyroiditis after Coronavirus Disease 2019 (COVID-19) mRNA Vaccine: A Case Series" AACE Clin Case Rep. 2021 Dec 16. doi: 10.1016/j.aace.2021.12.002. Epub ahead of print. PMID: 34934810; PMCID: PMC8675183

December 13, 2021
"We report the case of overt hypothyroidism in a 61-year-old woman seen after BNT162b2-mRNA vaccination. This case underlines the fact that thyroid function should also be monitored after COVID-19 vaccination, especially in at-risk subjects." (Giusti & Maio, 2021)
  • Giusti M, Maio A - "Acute thyroid swelling with severe hypothyroid myxoedema after COVID-19 vaccination" Clin Case Rep 9(12):e05217 (2021) doi: 10.1002/ccr3.5217. PMID: 34938565; PMCID: PMC8667292

December 10, 2021

Four more cases of subacute thyroiditis after vaccination with the Pfizer vaccine were reported by Turkish researchers (Sözen et al., 2022).
  • Sözen M, Topaloğlu Ö, Çetinarslan B, Selek A, Cantürk Z, Gezer E, Köksalan D, Bayraktaroğlu T - "COVID-19 mRNA vaccine may trigger subacute thyroiditis" Hum Vaccin Immunother 1-6 (2021) doi: 10.1080/21645515.2021.2013083. Epub ahead of print. PMID: 34893014

December 6, 2021

Research by Polish investigators have shown that subacute thyroiditis triggered by COVID-19 can be "HLA-dependent and related to the presence of homozygosity at HLA-B*35" (Stasiak et al., 2021).
  • Stasiak M, Zawadzka-Starczewska K, Lewiński A - "Clinical Manifestation of Subacute Thyroiditis Triggered by SARS-CoV-2 Infection Can Be HLA-Dependent" Viruses 13(12):2447 (2006). doi: 10.3390/v13122447. PMID: 34960716; PMCID: PMC8707017.

December 1, 2021

Italian researchers have found that low FT3 levels, in the framework of Euthyroid Sick Syndrome ("Low T3 Syndrome"), were a "valid predictor of unfavourable outcomes in a very early stage population of COVID-19" (Soprano et al., 2021). A critical FT3 threshold for levels < 2.7 pmol/l was associated with a 3.5-fold increased risk of negative outcome.
  • Sparano C, Zago E, Morettini A, Nozzoli C, Yannas D, Adornato V, Caldini E, Vaudo M, Maggi M, Petrone L - "Euthyroid sick syndrome as an early surrogate marker of poor outcome in mild SARS-CoV-2 disease" J Endocrinol Invest 1:1–11 (2021) ... MC8632565/

November 24, 2021
"The distinction between coronavirus disease 2019 (COVID-19) and thyroid storm can be extremely difficult to determine on clinical grounds alone as there is significant overlap between the signs and symptoms of each." (Sullivan et al., 2021)

November 23, 2021

Researchers from Hong Kong reported another case of Graves Disease after vaccination with the Pfizer vaccine (Lui et al., 2021). The woman was previously hypothyroid.

November 22, 2021

Two cases of subacute thyroiditis after COVID-19 infection were reported by researchers from Russia/Norway (Semikov et al., 2021). They stated that the condition might be masked by dexamethasone administration. DEX is a fluorinated steroid that reduces serum T3 levels.
  • Semikov VI, Aghayan DL, Shulutko AM, Khorobrykh TV, Aleksandrov YK, Mansurova GT, Kazaryan AM - "Subacute thyroiditis after SARS-CoV-2 infection" Clin Case Rep. 2021 Nov 22;9(11):e05109. doi: 10.1002/ccr3.5109. PMID: 34849227; PMCID: PMC8607799.

November 18, 2021

Another discussion from Spain on three cases of thyroid dysfunction after vaccination was published today (Pujol et al., 2021).
  • Pujol A, Gómez LA, Gallegos C, Nicolau J, Sanchís P, González-Freire M, López-González ÁA, Dotres K, Masmiquel L - "Thyroid as a target of adjuvant autoimmunity/inflammatory syndrome due to mRNA-based SARS-CoV2 vaccination: from Graves' disease to silent thyroiditis" J Endocrinol Invest. 2021 Nov 18:1–8. doi: 10.1007/s40618-021-01707-0. Epub ahead of print. PMID: 34792795; PMCID: PMC8598936.

November 15, 2021

A study from China reported that, "among the three different types of thyroid dysfunction with COVID-19, mild to moderate NTIS and severe NTIS have a higher risk of severe outcomes compared with subclinical hypothyroidism" (Zheng et al., 2021).
  • Zheng J, Cui Z, Shi N, Tian S, Chen T, Zhong X, Qiu K, Zhang J, Zeng T, Chen L, Li H - "Suppression of the hypothalamic-pituitary-thyroid axis is associated with the severity of prognosis in hospitalized patients with COVID-19" BMC Endocr Disord 21(1):228 (2021)

November 14, 2021

Researchers from the USA pre-published a paper today, proposing that organ-specific complications of COVID-19 infection and vasculopathy may be the action of rT3 on actin polymerization. rT3 is elevated - and used as a biomarker - in fluoride poisoning.
"Thought to be biologically inactive, rT3in fact stimulates cancer cell proliferation via avb3 and also may increase actin polymerization. We propose here that rT3 in the NTIS complicating systemic COVIF-19 infection may support coagulation and disordered blood vessel formation via actin polymerization."
  • Davis PJ, Lin HY, Hercbergs A, Keating KA, Mousa SA - "Possible Contributions of Nongenomic Actions of Thyroid Hormones to the Vasculopathic Complex of COVID-19 Infection" Endocr Res. 2021 Nov 14:1-6. doi: 10.1080/07435800.2021.1972307 77. ... 21.1972307

November 13, 2021

Two more cases of subacute thyroiditis were reported from Spain today, one after vaccination with the Pfizer vaccine and one after the Astra-Zeneca vaccine (González López et al., 2021).
  • González López J, Martín Niño I, Arana Molina C - "Subacute thyroiditis after SARS-CoV-2 vaccination: report of two clinical cases" Med Clin (Barc). S0025-7753(21)00643-6 (2021) English, Spanish. doi: 10.1016/j.medcli.2021.11.002. Epub ahead of print. PMID: 34893332; PMCID: PMC8590486

November 11, 2022

Yet another study has identified low FT3 as an independent marker for disease severity in COVID patients (Dutta et al., 2021).

Dutta A, Jevalikar G, Sharma R, Farooqui KJ, Mahendru S, Dewan A, Bhudiraja S, Mithal A - "Low FT3 is an independent marker of disease severity in patients hospitalized for COVID-19" Endocr Connect 10(11):1455-1462 (2021)

November 11, 2021

The reports of thyroiditis after COVID-19 vaccination keep coming. Today another case report of SAT after mRNA vaccination from the US (Plaza-Enriquez et al., 2021).
  • Plaza-Enriquez L, Khatiwada P, Sanchez-Valenzuela M, Sikha A - "A Case Report of Subacute Thyroiditis following mRNA COVID-19 Vaccine" Case Rep Endocrinol. 2021 Nov 11;2021:8952048

November 9, 2021

Two more papers were published today reporting subacute thyroiditis after COVID-19 vaccination with either Astra Zeneca or Pfizer vaccines. Raven et al. also reported another case of Graves' disease after the Pfizer vaccine (Raven et al., 2021)
  • Jeeyavudeen MS, Patrick AW, Gibb FW, Dover AR - "COVID-19 vaccine-associated subacute thyroiditis: an unusual suspect for de Quervain's thyroiditis" BMJ Case Rep 14(11):e246425 (2021)

    Raven LM, McCormack AI, Greenfield JR- "Letter to the Editor from Raven: Three Cases of Subacute Thyroiditis Following SARS-CoV-2 Vaccine" J Clin Endocrinol Metab. 2021 Nov 9:dgab822. doi: 10.1210/clinem/dgab822. Epub ahead of print. PMID: 34752614

November 1, 2021

A study from Belgium reported recurrence of Graves' Disease after Pfizer vaccination (Pierman et al., 2021).
  • Pierman G, Delgrange E, Jonas C - "Recurrence of Graves' Disease (a Th1-type Cytokine Disease) Following SARS-CoV-2 mRNA Vaccine Administration: A Simple Coincidence?" Eur J Case Rep Intern Med 8(9):002807 (2021)

October 29, 2021

Ballasteros and colleagues (Spain) investigated thyroid hormones in COVID-19 patients after ICU admission.
"At ICU admission, there were differences in the levels of fT3 between patients who survived and those who died. On day 5 after ICU admission, we found differences both in fT3 and fT4 levels between survivors and critically ill COVID-19 patients who died. No differences were found in the levels of reverse fT3 or in the incidence of NTIS between both groups. Patients who survived had higher levels of fT3, fT4 and TSH than non-survivors by day 5. By day 5, survivors significantly increased their TSH levels."
  • Ballesteros Vizoso MA, Castilla AF, Barceló A, Raurich JM, Argente Del Castillo P, Morell-García D, Velasco J, Pérez-Bárcena J, Llompart-Pou JA - "Thyroid Disfunction in Critically Ill COVID-19 Patients. Relationship with In-Hospital Mortality" J Clin Med 10(21):5057 (2021)
    NOTE: All were on steroids

October 28, 2021

A case of a "young, healthy man diagnosed with COVID-19 whose inaugural presentation was concurrent myocarditis and incidental thyroiditis" was reported by Iranian researchers (Houshmand et al., 2021).
  • Houshmand G, Ghorashi SM, Mirrazeghi F, Omidi N - "Concomitant active inflammation of myocardium and thyroid, incidental finding in COVID-19 pandemic: A case report" Clin Case Rep 9(10):e04998 (2021)

October 26, 2022
"Low FT3 was associated with death and increased inflammation, suggesting poor prognosis." (Dabas et al, 2021)
  • Dabas A, Singh H, Goswami B, Kumar K, Dubey A, Jhamb U, Yadav S, Garg S - "Thyroid Dysfunction in COVID-19" Indian J Endocrinol Metab 25(3):198-201 (2021). doi: 10.4103/ijem.ijem_195_21. Epub 2021 Oct 26. PMID: 34760673; PMCID: PMC8547402.

October 22, 2021

A new systematic review and meta-analysis of 21 studies, involving 31,339 patients, reported that "thyroid abnormalities increased the risk of COVID-19 composite poor outcomes and were influenced by the patient's age. Abnormal thyroid and hypothyroidism, but not hyperthyroidism, were associated with poor COVID-19 outcomes." (Damara et al., 2021)
  • Damara FA, Muchamad GR, Ikhsani R, Hendro, Syafiyah AH, Bashari MH - "Thyroid disease and hypothyroidism are associated with poor COVID-19 outcomes: A systematic review, meta-analysis, and meta-regression" Diabetes Metab Syndr 15(6):102312 (2021)

October 22, 2021

Subacute thyroiditis in two sisters after mRNA vaccination was reported in another paper from Greece, the second one this month (Chatzi et al., 2021).
  • Chatzi S, Karampela A, Spiliopoulou C, Boutzios G - "Subacute thyroiditis after SARS-CoV-2 vaccination: a report of two sisters and summary of the literature" Hormones (Athens). 2021 Oct 22:1–3. doi: 10.1007/s42000-021-00332-z. Epub ahead of print. PMID: 34686971; PMCID: PMC8536248

October 18, 2021

Kyriacou et al. reported another case of subacute thyroiditis in a 40-year-old woman after the Pfizer/Biontech vaccine (Kyriacou et al., 2021.

October 16, 2021

A report on two more cases of thyroiditis following vaccination against COVID-19 were reported today from Greece (Siolos et al., 2021).

Siolos A, Gartzonika K, Tigas S - "Thyroiditis following vaccination against COVID-19: Report of two cases and review of the literature" Metabol Open. 12:100136 (2021)

October 11, 2021

The reports of subacute thyroiditis after vaccination are getting more frequent. Today a study from Norway announced another case after RNA vaccination (Sigstad et al., 2021).

October 4, 2011

Another SAT report, this time from Iran, after Covaxin (Bharat Biotech) (Soltanpoor & Norouzi, 2021).

October 1, 2021

A study from India reported abnormal thyroid function tests in COVID patients. Low FT3 and low TSH were frequently seen in hospitalized patients of COVID-19. "Although these abnormalities did not correlate with markers of inflammation, this study shows that low FT3 at admission independently predicts severity of COVID-19." (Dutta et al., 2021)
  • Dutta A, Jevalikar G, Sharma R, Farooqui KJ, Mahendru S, Dewan A, Bhudiraja S, Mithal A - "Low FT3 is an independent marker of disease severity in patients hospitalized for COVID-19" Endocr Connect. 2021 Oct 1:EC-21-0362.R1. doi: 10.1530/EC-21-0362. Epub ahead of print. PMID: 34662295.

October 1, 2021

Today, yet another case report of subacute thyroiditis (SAT) after Covid vaccination was published, this time after the inactive CoronaVac vaccine (Saygli & Karakilic, 2021).

September 29, 2021

Researchers from Iran have announced a new systematic review and meta-analysis to probe the association between thyroid disorders and COVID-19 (Doustmohammadian et al., 2021).
  • Doustmohammadian S, Doustmohammadian A, Momeni M - "Association between thyroid disorders and COVID-19: a protocol for a systematic review and meta-analysis" Thyroid Res. 2021 Sep 29;14(1):21. doi: 10.1186/s13044-021-00113-1. PMID: 34587983

September 28, 2021

Another case of subacute thyroiditis (SAT) as a result of COVID vaccination was described in a study from India (Das et al., 2021).
"Our case is the first case of COVID-19 vaccine-related SAT with nodular goitre."
Das L, Bhadada SK, Sood A - "Post-COVID-vaccine autoimmune/inflammatory syndrome in response to adjuvants (ASIA syndrome) manifesting as subacute thyroiditis" J Endocrinol Invest. 2021 Sep 28:1–3. doi: 10.1007/s40618-021-01681-7. Epub ahead of print. PMID: 34585363; PMCID: PMC8478264

September 24, 2021

Rubinstein (USA) reported a case of active thyroid eye disease in a patient with Graves disease after vaccination.
  • Rubinstein TJ - "Thyroid Eye Disease Following COVID-19 Vaccine in a Patient With a History Graves' Disease: A Case Report" Ophthalmic Plast Reconstr Surg. 2021 Sep 24. doi: 10.1097/IOP.0000000000002059. Epub ahead of print. PMID: 34570048

September 23, 2021

US researchers reported the first case of hypopituitarism after vaccination with the Moderna vaccine. "The patient responded well to glucocorticoid and thyroid hormone supplementation and was discharged after 2 days in the hospital." (Murvelashvili & Tessnow, 2021)
  • Murvelashvili N, Tessnow A - "A Case of Hypophysitis Following Immunization With the mRNA-1273 SARS-CoV-2 Vaccine" J Investig Med High Impact Case Rep 9:23247096211043386 (2021)

September 19, 2021

Italian researchers reported on investigations of thyroid glands of patients who had died from COVID-19.

36% of the thyroids deemed infected showed increased activation of interferon (IFN) pathways. Authors stated that the "direct viral insult combined with an intense immune response may trigger or worsen thyroid conditions in predisposed individuals." (Poma et al., 2021)
  • Poma AM, Basolo A, Bonuccelli D, Proietti A, Macerola E, Ugolini C, Torregrossa L, Alì G, Giannini R, Vignali P, Santini F, Toniolo A, Basolo F - "Activation of Type I and Type II Interferon signaling in SARS-CoV-2-positive thyroid tissue of patients dying from COVID-19" Thyroid. 2021 Sep 19. doi: 10.1089/thy.2021.0345. Epub ahead of print. PMID: 34541878

September 13, 2021

A study from Argentina reported that T3 and T3/T4 correlated inversely with inflammatory markers in hospitalized patients with COVID-19; a low T3/T4 ratio was associated with severity and poor prognosis. Patients with low T3 but high FT4 had higher ferritin, lower albumin, and more severe disease at presentation (Ilera et al., 2021).
  • Ilera V, Delfino LC, Zunino A, Glikman P, Drnovsek M, Reyes A, Dios A, Toibaro J, Pachioli V, Lannes N, Guida A, Gauna A - "Correlation between inflammatory parameters and pituitary-thyroid axis in patients with COVID-19" Endocrine. 2021 Sep 13:1–6. doi: 10.1007/s12020-021-02863-2. Epub ahead of print. PMID: 34515958; PMCID: PMC8436010

September 13, 2021

In a Letter to the Editor in a Brasilian journal, Turkish practitioners describe a case of COVID-19 associated with Hashimoto's Disease (Varol et al. 2021).

September 9, 2021

Another US study reported a case of subacute thyroiditis after vaccination with SARS-CoV-2 vaccine (Patel et al., 2021).
  • Patel KR, Cunnane ME, Deschler DG - "SARS-CoV-2 vaccine-induced subacute thyroiditis" Am J Otolaryngol 43(1):103211 (2021) doi: 10.1016/j.amjoto.2021.103211. Epub ahead of print. PMID: 34534760; PMCID: PMC8426324

September 2, 2021

A study from Nigeria reported that the "mean plasma FT3 and TSH concentrations were significantly higher in COVID-19 patients compared to controls (p < 0.001, p < 0.001 respectively). Euthyroidism was observed in all uninfected controls, whereas 35 (77.8%) COVID-19 patients were euthyroid. Sick euthyroid and subclinical hypothyroidism was observed in 7 (15.6%) and 3 (6.7%) COVID-19 patients, respectively....significantly higher mean plasma levels of TSH and FT3, sick euthyroid syndrome and subclinical hypothyroidism observed among some COVID-19 patients may be indicative of disease-related thyroid function changes. Hence, there is need to pay attention to thyroid function during and after treatment of COVID-19." (Okwor et al., 2021)
  • Okwor CJ, Meka IA, Akinwande KS, Edem VF, Okwor VC - "Assessment of thyroid function of newly diagnosed SARS-CoV-2 infected patients in Nigeria" Pan Afr Med J 40:9 (2021)

September 1, 2021

Two new studies were published today. Clausen et al. (Denmark) reported that IL-8 levels, IP-10, and GM-CSF were significantly higher in patients with serum TSH <0.4 mIU/L.

Liu and his team in Hong Kong reported that higher SARS-CoV-2 viral loads correlated with smaller thyroid volumes in male survivors.

  • Clausen CL, Rasmussen ÅK, Johannsen TH, Hilsted LM, Skakkebæk NE, Szecsi PB, Pedersen L, Benfield T, Juul A - "Thyroid function in COVID-19 and the association to cytokine levels and mortality" Endocr Connect. 2021 Sep 1:EC-21-0301.R1. doi: 10.1530/EC-21-0301
    (No FT3 tested)

    Lui DTW, Fung MMH, Chiu KWH, Lee CH, Chow WS, Lee AC - "Higher SARS-CoV-2 viral loads correlated with smaller thyroid volumes on ultrasound among male COVID-19 survivors" Endocrine. 2021 Sep 1:1–10. doi: 10.1007/s12020-021-02855-2. Epub ahead of print. PMID: 34467467; PMCID: PMC8408037

August 26, 2021

In a new e-published study Feghali et al. (USA) report three cases of thyroid dysfunction (Hashimoto thyroiditis, Graves' disease and subacute thyroiditis) which developed few weeks after resolution of acute phase of COVID -19 infection in patients with no prior thyroid disease. (-->Auto-immune thyroid disease)
  • Feghali K, Atallah J, Norman C - "Manifestations of thyroid disease post COVID-19 illness: Report of Hashimoto thyroiditis, Graves' disease, and subacute thyroiditis" J Clin Transl Endocrinol Case Rep. 2021 Dec;22:100094. doi: 10.1016/j.jecr.2021.100094. Epub 2021 Aug 26. PMID: 34462717; PMCID: PMC8387132

August 31, 2021

Xu et al. reported that hypothyroidism was positively associated with risks of severe COVID-19 infection and that subgroup analysis stratified by ethnic groups demonstrated that thyroid disease was linked to the risks of severe COVID-19 infection in Asian patients rather than non-Asian ones (Xu et al., 2021).

August 23, 2021

Two papers were published today, one from South Korea and one from Pakistan.

The paper by Malik et al. (Pakistan) is their second one on the subject of thyroid/COVID-19 - a systematic review on the incidence of hypothyroidism in COVID-19.

They reported that most of the COVID-19 patients had lower mean T3 and normal or low TSH levels. Increased TSH was seen in 5.1% to 8% of patients, while low T3 was present in up to 28% of the patients. Once again, a positive correlation between low mean T3 and clinical severity of COVID-19 was reported.
  • Malik J, Zaidi SMJ, Waqar AU, Khawaja H, Malik A, Ishaq U, Rana AS, Awan AH - "Association of hypothyroidism with acute COVID-19: a systematic review" Expert Rev Endocrinol Metab. 2021 Aug 23:1-7. doi: 10.1080/17446651.2021.1968830. Epub ahead of print. PMID: 34424110 ... ode=iere20
    "This systematic review reveals a significant proportion of hypothyroidism associated with COVID-19. Therefore, routine assessment of thyroid function is warranted in hospitalized COVID-19 patients."

Ahn et al. (South Korea) provided further evidence that TSH and T3 are 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." (Ahn et al., 2021)
  • Ahn J, Lee MK, Lee JH, Sohn SY - "Thyroid Hormone Profile and Its Prognostic Impact on the Coronavirus Disease 2019 in Korean Patients" Endocrinol Metab (Seoul) 36(4):769-777 (2021)

August 22, 2021

Italian researchers reported today that TSH levels were significantly lower in COVID-19 patients (D'Ardes et al., 2021). Thyroid hormones were not measured.
  • D'Ardes D, Rossi I, Bucciarelli B, Allegra M, Bianco F, Sinjari B, Marchioni M, Di Nicola M, Santilli F, Guagnano MT, Cipollone F, Bucci M - "Metabolic Changes in SARS-CoV-2 Infection: Clinical Data and Molecular Hypothesis to Explain Alterations of Lipid Profile and Thyroid Function Observed in COVID-19 Patients" Life (Basel) 11(8):860 (2021)

August 13, 2021

A new study from Turkey reports that only 34.1% of COVID-19 patients were euthyroid. None of the euthyroid patients died. Inflammatory parameters were higher in patients with thyroid dysfunction (Dincer et al., 2021).
  • Dincer Yazan C, Ilgin C, Elbasan O, Apaydin T, Dashdamirova S, Yigit T, Sili U, Karahasan Yagci A, Sirikci O, Haklar G, Gozu H - "The Association of Thyroid Hormone Changes with Inflammatory Status and Prognosis in COVID-19" Int J Endocrinol 2021:2395212 (2021) ... 395212.pdf
    "In cluster analysis, a high-risk group with a lower median FT3 value (median = 2.34 ng/L; IQR = 0.86), a higher median FT4 value (median = 1.04 ng/dL; IQR = 0.33), and a lower median TSH value (median = 0.62 mIU/L; IQR = 0.59) included 8 of 9 died patients and 25 of the 31 patients that were admitted to ICU."

August 10, 2021

A Swiss meta-analysis of the published literature on COVID-19 and free T3 (fT3) shows that lower fT3 serum levels were "consistently observed in intensive care unit (ICU) than in non-ICU patients and in non-survivors than survivors, respectively." (Llamas et al., 2021)
Conclusions: Serum fT3 concentrations are significantly lower in patients with severe COVID-19 than in non-severely ill patients and predict all-cause mortality of patients with severe COVID-19. Accordingly, fT3 may become a simple tool for stratified management of patients with severe COVID-19.
  • Llamas M, Garo ML, Giovanella L - "Low free-T3 serum levels and prognosis of COVID-19: systematic review and meta-analysis" Clin Chem Lab Med. 2021 Aug 10. doi: 10.1515/cclm-2021-0805. Epub ahead of print. PMID: 34380183 ... -0805/html

July 27, 2021

Another study from Brazil has confirmed thyroid hormone levels (FT3, rT3) in COVID-19 patients correlating with illness severity, mortality, and other biomarkers of critical illness (Beltrão et al., 2021).
  • Beltrão FEL, Beltrão DCA, Cordeiro GCA, Beltrão FEL, Brito ADS, Capistrano KHR, Bastos IHA, Hecht F, Daltro CHDC, Bianco AC, Gonçalves MDCR, Ramos HE - "Thyroid hormone levels during hospital admission inform disease severity and mortality in COVID-19 patients" Thyroid. 2021 Jul 27. doi: 10.1089/thy.2021.0225. Epub ahead of print. PMID: 34314259

July 26, 2021

In an Italian study published today, investigating COVID-associated severe multisystem inflammatory syndrome in children, ALL children showed abnormal thyroid hormone levels, low FT3 being observed most often (65.3%) (Calcaterra et al., 2021).
A low FT3 level was noted in 15/23 (65.3%), while the other subjects had varying combinations of hormone abnormalities (8/23, 34.7%)...In particular, we noted: an isolated decrease in the FT3 level in 15/23 (65.3%) subjects; low FT3 and FT4 levels in 5/23 (21.7%); low FT3, FT4 and TSH values in 2/23 cases (8.7%) and an increase in TSH level in one patient (4.3%).
  • Calcaterra V, Biganzoli G, Dilillo D, Mannarino S, Fiori L, Pelizzo G, Zoia E, Fabiano V, Carlucci P, Camporesi A, Corti C, Mercurio G, Izzo F, Biganzoli E, Zuccotti G - "Non-thyroidal illness syndrome and SARS-CoV-2-associated multisystem inflammatory syndrome in children" J Endocrinol Invest. 2021 Jul 26. doi: 10.1007/s40618-021-01647-9. Epub ahead of print. PMID: 34312809 ... 21-01647-9

July 17, 2021

A British paper reported on a case of subacute thyroiditis related to vaccination with the AstraZeneca vaccine (Ratnayake et al., 2021).
"Furthermore, the spike protein shows molecular mimicry towards thyroid peroxidase."

July 13, 2021

US Patent 11,058,647 was granted to Goren & McCoy (Applied Biology, Inc), involving treatment of COVID-19 with anti-thyroid agents, a.o.
"The present disclosure includes methods, systems, kits and compositions for treating, preventing and diagnosing viral infections, specifically SARS-CoV-2 infections, with an anti-androgen and anti-thyroid medication, a thyroid receptor antagonist, a TGF-.beta. inhibitor or a combination thereof. The present disclosure also describes methods and compositions for the treatment of viral respiratory diseases, specifically SARS-CoV-2 infections, including anti-androgens, anti-thyroid medications, thyroid receptor antagonists, TGF-.beta. inhibitors, RXR inhibitors, furin inhibitors or other agents to disrupt the androgen signaling."
  • Goren et al. "Systems, methods, and kits for diagnostics and treatment of viral respiratory infection" US Patent 11,058,647 (July 3, 2021) ... 11,058,647
    "... viral spike protein priming may be mediated through furin protease in addition to TMPRSS2. Furin expression has been demonstrated to be up-regulated by thyroid hormone T3 and its expression was cooperative with transforming growth factor beta or TGF-.beta."

July 12, 2021

Journalist Sharyl Attkisson published a story summarizing the two recent studies showing thyroid disease as a result from vaccines.

July 12, 2021

A study from Greece on thyroid status in patients with acute COVID-19 pneumonia again showed altered thyroid hormones and reported that anti-thyroid peroxidase antibodies (Ab-TPO) had prognostic significance (Assimakopoulos et al., 2021).
"The frequently observed pattern of subnormal TSH, low-normal T3/FT3, normal T4, and high-normal FT4 might represent a unique type of NTIS, manifesting during the acute phase of COVID-19 pneumonia...The only thyroid parameter with a prognostic significance in our study was Ab-TPO...Although the pre-COVID-19 Ab-TPO levels of our patients are unknown, none of them had known rheumatologic/autoimmune diseases and, therefore, it seems that SARS-CoV-2 might trigger thyroid autoimmunity in the context of a generalized immune response, as recently shown [19]. In this framework, Ab-TPO positivity could identify COVID-19 patients with exaggerated immune system activation, being at increased risk of severe/complicated illness."
  • Assimakopoulos SF, Markantes GK, Papageorgiou D, Mamali I, Markou KB, Marangos M, Michalaki MA - "Low serum TSH in the acute phase of COVID-19 pneumonia: thyrotoxicosis or a face of 'non-thyroidal illness syndrome'?" Clin Chem Lab Med. 2021 Jul 12. doi: 10.1515/cclm-2021-0511. Epub ahead of print. PMID: 34246200.

July 2, 2021

A study from Pakistan reports that there was a major difference in serum TSH levels observed among severe/critical COVID-19 patients, while Free T3 and T4 levels were not found to be linked with disease severity. Low serum TSH (<0.996 uIU/mL) was found to be statistically significant with disease severity, and Cox proportional hazard model showed a significantly higher risk of disease severity with low TSH levels (Asghar et al 2021).
  • Asghar MS, Yasmin F, Dapke K, Phadke R, Shah SMI, Bin Zafar MD - "Derangements of Biochemical Markers and Thyroid Function Analysis Among COVID-19 Positive Patients: A Developing Country Single-Center Experience"J Med Virol (Jul 2 2021)

July 1, 2021

In an article published today, French researchers state that "it might be relevant to consider thyroid patients as a priority group in vaccination campaigns." In their investigation, the number of patients treated with replacement hormone was significantly higher in the COVID-19 group than in the control group (Bacle et al., 2021). [See also: Lui et al., January 23, 2021]
"More importantly, as many countries in the world are still facing a wave of the pandemic, it might be relevant to consider thyroid patients as a priority group in vaccination campaigns."

June 24, 2021

Japanese researchers published another review on COVID and thyroid dysfunction (Inaba & Aiziwa, 2021).

June 11, 2021

Constantinos Pantos and colleagues have reported first results of their clinical trial using T3 in the treatment of COVID-19. (see

A preliminary analysis showed a trend for lower troponin levels in patients receiving T3 treatment.
  • Pantos C, Apostolaki V, Kokkinos L, Trikas A, Mourouzis I - "Acute triiodothyronine treatment and red blood cell sedimentation rate (ESR) in critically ill COVID-19 patients: A novel association?" Clin Hemorheol Microcirc. 2021 Jun 11. doi: 10.3233/CH-211215. Epub ahead of print. PMID: 34151781 ... n/ch211215
    Note: All patients were on dexamethasone treatment which reduces T3 levels.
    Administration of triiodothyronine was associated with an acute drop in ESR (erythrocyte sedimentation rate). "ESR remains a common clinical tool to assess the acute phase response and disease progression and is an indirect index of red blood cell aggregation and altered red blood cell rheology."

    SEE also:

June 2, 2021

A new review from Italy was pre-published today (Ruggeri et al., 2021).
"COVID-19-related thyroid disorders include destructive thyroiditis and onset or relapse of autoimmune thyroid disorders, leading to a broad spectrum of thyroid dysfunction ranging from thyrotoxicosis to hypothyroidism, that may worsen COVID-19 clinical course and affect prognosis."
  • Ruggeri RM, Campennì A, Deandreis D, Siracusa M, Tozzoli R, Petranović Ovčariček P, Giovanella L - "SARS-COV-2-related immune-inflammatory thyroid disorders: facts and perspectives" Expert Rev Clin Immunol 1-23 (2021) doi: 10.1080/1744666X.2021.1932467. Epub ahead of print. PMID: 34015983

May 27, 2021

Two items today:

1) Subacute thyroiditis is now also being reported after vaccinations (İremli et al., 2021).

2) Low FT4 and TSH concentrations were associated with mortality in Chinese patients with COVID-19 presenting with NTI; moreover, low TSH levels were an independent risk factor for mortality in these patients (Gong et al., 2021).
  • İremli BG, Şendur SN, Ünlütürk U - "Three Cases of Subacute Thyroiditis Following SARS-CoV-2 Vaccine: Post-vaccination ASIA Syndrome" J Clin Endocrinol Metab May 27:dgab373 (2021)

    Gong J, Wang DK, Dong H, Xia QS, Huang ZY, Zhao Y, Chen X, Yuan F, Li JB, Lu FE - "Prognostic significance of low TSH concentration in patients with COVID-19 presenting with non-thyroidal illness syndrome" BMC Endocr Disord 21(1):111 (2021)

May 20, 2022
"Serum FT3 level is lower in non-survivors among moderate-to-critical patients with COVID-19, and the low FT3 state is associated with an increased risk of in-hospital mortality of COVID-19." (Lang et al, 2021)
  • Lang S, Liu Y, Qu X, Lu R, Fu W, Zhang W, Wang H, Hong T - "Association between Thyroid Function and Prognosis of COVID-19: A Retrospective Observational Study" Endocr Res 46(4):170-177 (2021)

May 12, 2021

From a new study pre-published May 11, 2021 - investigating subacute thyroiditis and COVID-19.
"All 5 patients were female patients (30.4 years) with odynophagia and pain in the front lower region of the neck. These patients had no previous history of thyroiditis. COVID-19 PCR tests of the patients diagnosed with SAT were positive, and there were no typical COVID-19 signs and symptoms except odynophagia and neck pain.

Result: It comes in view that SARS-COV-2 affects thyroid functions and causes SAT and the main symptoms in patients are pain in the neck and odynophagia."
  • Seyed Resuli A, Bezgal M - "Subacute Thyroiditis in COVID-19 Patients" Ear Nose Throat J (2021) May 11:1455613211012114. doi: 10.1177/01455613211012114. Epub ahead of print. PMID: 33974811
May 3, 2021

Two cases of Graves' Disease following SARS-CoV-2 vaccination.
  • Vera-Lastra O, Ordinola Navarro A, Cruz Domiguez MP, Medina G, Sánchez Valadez TI, Jara LJ - "Two Cases of Graves' Disease Following SARS-CoV-2 Vaccination: An Autoimmune/Inflammatory Syndrome Induced by Adjuvants" Thyroid. 2021 May 3. doi: 10.1089/thy.2021.0142. Epub ahead of print. PMID: 33858208.
April 26, 2021

A very informative German review was published today, detailing the possible effects of thyroid hormone metabolites in COVID-19.
"The observed alterations of TH levels in COVID-19 may result from a combination of thyrotoxic effects and NTIS. Outcome of local and systemic administration of L-T3 in critically ill patients potentially may provide further insight into the still unclear relationship between SARS-CoV-2 and thyroid metabolism."
  • Fröhlich E, Wahl R - "Physiological Role and Use of Thyroid Hormone Metabolites - Potential Utility in COVID-19 Patients" Front Endocrinol (Lausanne) 12:587518. (2021). doi: 10.3389/fendo.2021.587518. PMID: 33981284; PMCID: PMC8109250 ... 587518.pdf
April 24, 2021

The first study from India on 2000 deaths from COVID-19 reports that hypothyroidism is a "COVID-19 associated co-morbidity", confirming the earlier findings in Austria by Bakshi & Kalidoss (2021).
  • Koya SF, Ebrahim SH, Bhat LD, Vijayan B, Khan S, Jose SD, Pilakkadavath Z, Rajeev P, Azariah JL - "COVID-19 and Comorbidities: Audit of 2,000 COVID-19 Deaths in India" J Epidemiol Glob Health doi: 10.2991/jegh.k.210303.001 (2021)
April 20, 2021

Hypothyroidism was independently associated with higher likelihood of persistent olfactory dysfunction among patients with COVID-19 (Tsivgoulis et al., 2021).
  • Tsivgoulis G, Fragkou PC, Karofylakis E, Paneta M, Papathanasiou K, Palaiodimou L, Psarros C, Papathanasiou M, Lachanis S, Sfikakis PP, Tsiodras S - " Hypothyroidism is associated with prolonged COVID-19-induced anosmia: a case-control study" J Neurol Neurosurg Psychiatry jnnp-2021-326587 (2021)

April 15, 2021

Graves' Disease following mild COVID-19 infection (Harris, 2021), as well as following COVID-19 vaccines (Vera-Lastra et al., 2021) have now been documented.
  • Vera-Lastra O, Ordinola Navarro A, Cruz Dominguez MP, Medina G, Sanchez Valadez TI, Jara LJ - "Two cases of Graves' disease following SARS-CoV-2 vaccination: An autoimmune/inflammatory syndrome induced by adjuvants" Thyroid (2021) doi: 10.1089/thy.2021.0142

    Harris A, Al Mushref M - "Graves' Thyrotoxicosis Following SARS-CoV-2 Infection" AACE Clin Case Rep 7(1):14-16 (2021) doi: 10.1016/j.aace.2020.12.005. Epub 2020 Dec 28. PMID: 33521256; PMCID: PMC7834282

March 30, 2021

Malik et al. report that 75% of patients with COVID-19 had thyroid abnormalities (Malik et al, 2021).
  • Malik J, Malik A, Javaid M, Zahid T, Ishaq U, Shoaib M - "Thyroid function analysis in COVID-19: A retrospective study from a single center" PLoS One. 16(3):e0249421 (2021)

March 25, 2021

Giovanella et al. report that low FT3 levels are independently associated with increased all-cause mortality in COVID-19 and may serve as a surrogate prognostic biomarker.
  • Giovanella L, Ruggeri RM, Petranović Ovčariček P, Campenni A, Treglia G, Deandreis D - "SARS-CoV-2-related thyroid disorders: a synopsis for nuclear medicine thyroidologists" Eur J Nucl Med Mol Imaging (March 25, 2021)

March 3, 2021

A new study from Turkey reports that overt thyroid hormonal disorders were more common in critically-ill COVID-19 patients.
"FT3 level at hospital admission is a potential prognostic marker of COVID-19 patients. Thyroid nodules may be associated with severe COVID-19 disease."
  • Güven M, Gültekin H - "The Prognostic Impact of Thyroid Disorders on the Clinical Severity of COVID-19: Results of Single Center Pandemic Hospital" Int J Clin Pract (2021) Mar 2:e14129. doi: 10.1111/ijcp.14129. Epub ahead of print. PMID: 33655591

February 26, 2021

Fascinating new discoveries regarding cytokines and thyroid hormone. More treatment possibilities.
"We report here that TREM2 is a thyroid hormone regulated gene and its expression in macrophages and microglia is stimulated by thyroid hormone. Both endogenous thyroid hormone and sobetirome, a synthetic thyroid hormone agonist drug, suppress pro-inflammatory cytokine production from myeloid cells including macrophages that have been treated with the SARS-CoV-2 spike protein which produces a strong, pro-inflammatory phenotype...Our findings represent the first report of endocrine regulation of TREM2 and provide a unique opportunity to drug the TREM2 signaling pathway with orally active small molecule therapeutic agents."
  • Ferrara SJ, Chaudhary P, DeBell MJ, Marracci G, Miller H, Calkins E, Pocius E, Napier BA, Emery B, Bourdette D, Scanlan TS - "TREM2 is thyroid hormone regulated making the TREM2 pathway druggable with ligands for thyroid hormone receptor" bioRxiv [Preprint]. 2021 Jan 27:2021.01.25.428149. doi: 10.1101/2021.01.25.428149. PMID: 33532772; PMCID: PMC7852265.

February 9, 2021

A new paper was published yesterday, summarizing "available studies regarding thyroid function alterations in patients with COVID-19 and to overview the possible physio-pathological explanations." (Croce et al, 2021)
  • Croce L, Gangemi D, Ancona G, Liboà F, Bendotti G, Minelli L, Chiovato L - "The cytokine storm and thyroid hormone changes in COVID-19" J Endocrinol Invest (2021) doi: 10.1007/s40618-021-01506-7. Epub ahead of print. PMID: 33559848. ... 21-01506-7

February 5, 2021
"Patients with TD [thyroid dysfunction] had a significantly higher fatality rate than did those without TD during hospitalization (20% vs 0%, P = 0.002). Patients with TD were more likely to stay in the hospital for more than 28 days than were those without TD (80% vs 56.52%, P = 0.048)."
  • Zhang Y, Lin F, Tu W, Zhang J, Choudhry AA, Ahmed O, Cheng J, Cui Y, Liu B, Dai M, Chen L, Han D, Fan Y, Zeng Y, Li W, Li S, Chen X, Shen M, Pan P; medical team from Xiangya Hospital to support Hubei, China - "Thyroid dysfunction may be associated with poor outcomes in patients with COVID-19" Mol Cell Endocrinol 521:111097 (2021) doi: 10.1016/j.mce.2020.111097. Epub 2020 Dec 2. PMID: 33278491; PMCID: PMC7709789

February 3, 2021

A letter to the Editor, published today in an Austrian journal, highlighted the association of hypothyroidism with COVID-19.
"Although our sample size is small and the cause for hypothyroidism has not been assessed, we would still like to point out the increased association of COVID infection and hypothyroidism in our patients."
  • Bakshi SS, Kalidoss VK - "Is there an association between hypothyroidism and COVID 19? : A preliminary report" Wien Klin Wochenschr. 2021 Feb 3:1–2. doi: 10.1007/s00508-021-01813-2. Epub ahead of print. PMID: 33537842; PMCID: PMC7857644.

January 23, 2021

Lui et al. and colleagues from Hong Kong reported today that lower SARS-Cov-2 PCR cycle threshold values and elevated C-reactive protein were independently associated with occurrence of low TSH and low FT3, respectively. A decreasing trend of FT3 with increasing COVID-19 severity was found. Patients with low FT3 had more adverse COVID-19-related outcomes.
Around 15% of patients with mild to moderate COVID-19 had thyroid dysfunction. There may be a direct effect of SARS-CoV-2 on thyroid function, potentially leading to exacerbation of pre-existing autoimmune thyroid disease. Low fT3, associated with systemic inflammation, may have a prognostic significance.
Lui DTW, Lee CH, Chow WS, Lee ACH, Tam AR, Fong CHY, Law CY, Leung EKH, To KKW, Tan KCB, Woo YC, Lam CW, Hung IFN, Lam KSL - "Thyroid Dysfunction in Relation to Immune Profile, Disease Status, and Outcome in 191 Patients with COVID-19" J Clin Endocrinol Metab 106(2):e926-e935 (2021) doi: 10.1210/clinem/dgaa813. PMID: 33141191; PMCID: PMC7665541

January 19, 2021

Another review was pre-published today.

"Subacute thyroiditis, autoimmune thyroiditis and an atypical form of thyroiditis are complications of COVID-19. Thyroid hormone dysfunction affects the outcome by increasing mortality in critical illnesses like acute respiratory distress syndrome, which is a leading complication in COVID-19."

January 19, 2021

Interesting article published by Vojdani et al., showed similarities and homology between spike, nucleoprotein, and many other SARS-CoV-2 proteins with the human tissue antigens mitochondria M2, F-actin and thyroid peroxidase.
  • Vojdani A, Vojdani E, Kharrazian D - "Reaction of Human Monoclonal Antibodies to SARS-CoV-2 Proteins With Tissue Antigens: Implications for Autoimmune Diseases" Front Immunol 11:617089 (2021)

January 12, 2021

A study from India investigating thyroid function in COVID-10 patients was published today.
"Thyroid function may be abnormal in all categories of patients during COVID-19 infection, even in absence of pre-existing thyroid ailments. Although low TSH is the commonest abnormality and typical pattern of thyroiditis can be seen in a subsection of patients, in majority of the patients, thyroid function abnormality does not follow any characteristic pattern and likely represents a combination of thyroiditis and sick euthyroid syndrome in different points of its spectrum."
  • Sen K, Sinha A, Sen S, Chakraborty S, Alam MS - "Thyroid Function Test in COVID-19 Patients: A Cross-Sectional Study in a Tertiary Care Hospital" Indian J Endocrinol Metab 24(6):532-536 (2020) doi: 10.4103/ijem.IJEM_779_20. Epub 2021 Jan 12. PMID: 33643870; PMCID: PMC7906107
January 11, 2021

Today, Chinese researchers have published another review on the interaction of COVID-19 and thyroid (Chen et al., 2021).
"COVID-19 and thyroid disease may mutually aggravate the disease burden. Patients with SARS-CoV-2 infection should not ignore the effect in thyroid function, especially when there are obvious related symptoms."
December 25, 2020

Kumari et al. just published a review from India where fluoride poisoning is endemic and "hypothyroidism and hyperthyroidism are more common...being 11%, compared to only 2% in the UK and 4.6% in the US" (Kumari al., 2020).

The authors state that "the malfunction of thyroid hormone synthesis may aggravate SARS-CoV-2 infection and thus monitoring the thyroid hormone may help in understanding the pathogenesis of COVID-19."

December 7, 2020
"Pregnant women in their first trimester in Shanghai during the COVID-19 outbreak were at an increased risk of having higher FT3 concentrations, lower FT4 concentrations, and isolated hypothyroxinemia. The association between thyroid hormones, pregnancy outcomes, and the COVID-19 outbreak should be explored further."
  • Lin TT, Zhang C, Zhang HQ, Wang Y, Chen L, Dennis CL, Huang H, Wu YT - "Thyroid Hormone Changes in Early Pregnancy Along With the COVID-19 Pandemic" Front Endocrinol (Lausanne). 2020 Dec 7;11:606723. doi: 10.3389/fendo.2020.606723. PMID: 33365014; PMCID: PMC7750518.

November 25, 2020
"Our literature search provided greater evidence that the thyroid gland and the entire hypothalamic–pituitary–thyroid (HPT) axis could be relevant targets of damage by SARS-CoV-2. Specifically, COVID-19-related thyroid disorders include thyrotoxicosis, hypothyroidism, as well as nonthyroidal illness syndrome."
  • Scappaticcio L, Pitoia F, Esposito K, Piccardo A, Trimboli P - "Impact of COVID-19 on the thyroid gland: an update" Rev Endocr Metab Disord. 2020 Nov 25:1–13 doi: 10.1007/s11154-020-09615-z. Epub ahead of print. PMID: 33241508; PMCID: PMC7688298.

November 4, 2020

A new study from China shows that FT3 levels were significantly lower in patients with severe COVID-19 than in non-severely ill patients. Reduced FT3 independently predicted all-cause mortality of patients with severe COVID-19 (Gao et al., 2020).

November 3, 2020

Another study from China was published today, investigating TSH, FT4, FT3 and anti-thyroid antibodies in 191 patients (Lui et al., 2020).

"Ten patients had isolated low TSH, suggestive of subclinical thyrotoxicosis due to thyroiditis, although the contribution of autoimmunity was likely in two of them. Autoimmune thyroiditis probably also contributed to subclinical hypothyroidism in another patient. Ten patients had isolated low fT3, likely representing non-thyroidal illness syndrome. Lower SARS-Cov-2 PCR cycle threshold values and elevated C-reactive protein were independently associated with occurrence of low TSH (p=0.030) and low fT3 (p=0.007) respectively. A decreasing trend of fT3 with increasing COVID-19 severity (p=0.032) was found. Patients with low fT3 had more adverse COVID-19-related outcomes."

  • Lui DTW, Lee CH, Chow WS, Lee ACH, Tam AR, Fong CHY, Law CY, Leung EKH, To KKW, Tan KCB, Woo YC, Lam CW, Hung IFN, Lam KSL- "Thyroid Dysfunction in Relation to Immune Profile, Disease Status and Outcome in 191 Patients with COVID-19" J Clin Endocrinol Metab Nov 3:dgaa813 (2020) ... 13/5952837

November 2, 2020

"Experimental hormone therapy may speed recovery for COVID patients."

Duluth patients (USA) were among the first to get T3 as an experimental treatment to mitigate lung failure.

October 27, 2020

"Symptoms of thyrotoxicosis such as sore throat, fatigue, chills, anorexia, and weight loss can be easily confused for COVID-19 symptoms.2 Therefore, a high clinical suspicion is required to rule out both diseases simultaneously."

October 27, 2020

An overview from France was published this month, highlighting the abnormal thyroid function tests observed so far in COVID-19.
  • Caron P - "Thyroid disorders and SARS-CoV-2 infection: From pathophysiological mechanism to patient management" Ann Endocrinol (Paris) 81(5):507-510 (Oct. 2020) 10.1016/j.ando.2020.09.001. Epub 2020 Sep 18. PMID: 32950466; PMCID: PMC7498405

October 14, 2020

It appears that thyroid dysfunction is being reported more and more, particularly thyrotoxicosis/thyroiditis. Hopefully this will initiate more research.
"This study provides first evidence that COVID-19 may be associated with high risk of thyrotoxicosis in relationship with systemic immune activation induced by the SARS-CoV-2 infection."

October 1, 2020

We were alerted to a study from China today, from July of this year.
"The levels of TSH and serum total triiodothyronine (TT3) of the patients with COVID-19 were significantly lower than those of the healthy control group and non-COVID-19 pneumonia patients. The more severe the COVID-19, the lower the TSH and TT3 levels were, with statistical significance (p < 0.001)."

September 20, 2020

More studies are coming in, reporting on thyroid dysfunction in COVID-19. Subacute thyroiditis (deQuervain's) is increasingly observed (Brancatella et al., 2020; Ippolito et al., 2020; Mattar et al., 2020; Asfuroglu Kalkan & Ates, 2020).
  • Brancatella A, Ricci D, Cappellani D, Viola N, Sgrò D, Santini F, Latrofa F - "Is Subacute Thyroiditis an Underestimated Manifestation of SARS-CoV-2 Infection? Insights From a Case Series" J Clin Endocrinol Metab 105(10):dgaa537 (2020)

    Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F - "Subacute Thyroiditis After Sars-COV-2 Infection" J Clin Endocrinol Metab 105(7):dgaa276 (2020) doi: 10.1210/clinem/dgaa276. PMID: 32436948; PMCID: PMC7314004

    Ippolito S, Dentali F, Tanda ML - "SARS-CoV-2: a potential trigger for subacute thyroiditis? Insights from a case report" J Endocrinol Invest 43(8):1171-1172 (2020) doi: 10.1007/s40618-020-01312-7. Epub 2020 Jun 2. PMID: 32488726; PMCID: PMC7266411

    Mattar SAM, Koh SJQ, Rama Chandran S, Cherng BPZ - "Subacute thyroiditis associated with COVID-19" BMJ Case Rep 13(8):e237336 (2020) doi: 10.1136/bcr-2020-237336. PMID: 32843467; PMCID: PMC7449350.

    Asfuroglu Kalkan E, Ates I - "A case of subacute thyroiditis associated with Covid-19 infection" J Endocrinol Invest 43(8):1173-1174 (2020) doi: 10.1007/s40618-020-01316-3. Epub 2020 Jun 5. PMID: 32504458; PMCID: PMC7273820

September 18, 2020

A study from Greece was brought to our attention, reporting on subacute thyroiditis in a person with COVID-19 (Ruggeri et al., 2020).
  • Ruggeri RM, Campennì A, Siracusa M, Frazzetto G, Gullo D - "Subacute thyroiditis in a patient infected with SARS-COV-2: an endocrine complication linked to the COVID-19 pandemic" Hormones (Athens) 16:1–3 (2020) doi: 10.1007/s42000-020-00230-w. Epub ahead of print. PMID: 32676935; PMCID: PMC7365600. ... /32676935/

September 11, 2020

Interesting editorial review published today, on COVID-19 and thyroid observations.

September 1, 2020

Today (Epub July 30, 2020) the first description of thyroid alterations in hospitalised patients with COVID-19 was published (Muller et al., 2020).
  • Muller I, Cannavaro D, Dazzi D, Covelli D, Mantovani G, Muscatello A, Ferrante E, Orsi E, Resi V, Longari V, Cuzzocrea M, Bandera A, Lazzaroni E, Dolci A, Ceriotti F, Re TE, Gori A, Arosio M, Salvi M - "SARS-CoV-2-related atypical thyroiditis" Lancet Diabetes Endocrinol 8(9):739-741 (2020)
July 29, 2020

Researchers from Indonesia reported the results of a meta-analysis showing that thyroid disease is associated with a more severe COVID-19 disease (Hariyanto & Kurniawan, 2020).
June 6, 2020

Today we read the first two articles on COVID-19 and possible thyroid involvement. Bellastella et al. offer a very concise summary of the knowledge so far, while Pal & Banerjee's work describe the knowledge - and lack thereof - regarding the endocrine system overall.

We are still waiting for the first study reporting on COVID-19 effects/interactions with TSH and thryoid hormones (serum and tissue levels), and status of the thyroid.
  • Bellastella G, Maiorino MI, Esposito K - "Endocrine complications of COVID-19: what happens to the thyroid and adrenal glands?" J Endocrinol Invest 1–2 (2020).doi: 10.1007/s40618-020-01311-8. Epub ahead of print. PMID: 32488724; PMCID: PMC7265876

    Pal R, Banerjee M - "COVID-19 and the endocrine system: exploring the unexplored" J Endocrinol Invest May 2:1–5 ( (2020) doi: 10.1007/s40618-020-01276-8. Epub ahead of print. PMID: 32361826; PMCID: PMC7195612
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Experimental hormone therapy may speed recovery for COVID patients

Duluth patients were among the first to get an experimental treatment that uses a thyroid hormone to mitigate lung failure. It's now part of a Phase 2 FDA study.

Star Tribune - November 2, 2020

By Katie Galioto and Jeremy Olson

DULUTH — Every time the phone rang, it seemed to Kristine Smoley like more bad news about her husband, who contracted COVID-19 and was in a hospital intensive care unit on a ventilator because he couldn’t breathe on his own.

Smoley was prepared for the worst when a nurse from Duluth’s Essentia Health called with hope — albeit with risks and no solid evidence it would save her husband.

“They asked if I wanted to consider signing off on an experimental treatment for him,” Smoley said. “A treatment that had never been done before.”

Essentia’s Dr. Tim Rich and the University of Minnesota Medical School’s Dr. David Ingbar had studied for years whether a common thyroid hormone could be repurposed for the treatment of acute respiratory distress syndrome (ARDS), an often fatal type of lung failure. The doctors received federal approval late last year to test the therapy, so when COVID-19 caused a sudden surge in ARDS, they were ready for their first patient — Smoley’s husband, Bob Schlicht.

“It was scary,” Smoley said. “But I don’t know that I really had an option. Because the other option wasn’t good.”

The turnaround that followed was so remarkable that Rich and Ingbar have advanced their research — unique for a regional medical provider in a world of urban and academic COVID-19 studies — to a phase 2 U.S. Food and Drug Administration (FDA) study. The doctors have optimism about the impact their treatment could have amid the pandemic.

“There has been a lot of highly technical science to understand this biology, but the elegance now is in its simplicity,” said Rich, a pulmonologist. “This is not a designer drug. This is something we know the lung needs and uses.”

New therapies are needed against a pandemic that has caused 150,672 known infections, 10,334 hospitalizations and 2,475 deaths among Minnesotans. Only the antiviral remdesivir has received full FDA approval as a COVID-19 therapy for hospitalized patients, while treatments such as plasma infusions remain experimental and available only under emergency authorization.

Rich and Ingbar made a key discovery during the H1N1 pandemic of 2009, when families of those who died from influenza-related ARDS permitted autopsies. Rich found the victims’ lungs lacked T3, a thyroid hormone that would normally be detectable.

Ingbar said T3 reduces inflammation and coaxes epithelial cells in the lungs to absorb fluids — which is vital for patients with ARDS.

“A part of this acute lung injury with ARDS is the lungs get leaky, and they tend to fill with fluid,” Ingbar said. “That makes it really hard to get oxygen in or carbon dioxide out.”

Schlicht was coughing and congested when Smoley dropped him at an emergency room in Grand Rapids on March 26, a few days after the retired couple cut cross-country travels short due to the spread of the novel coronavirus that causes COVID-19.

Schlicht, 68, was Itasca County’s first known positive case of COVID-19. Smoley watched medical staff garbed in full protective gear take her husband to an isolated room. He was transferred to Duluth within two days.

A few weeks later, Mary Ellen Evangelista found herself in a similar situation. Her brother, Tim White, was a corrections officer at the Moose Lake prison, where inmates and workers tested positive for COVID-19 in early April.

Evangelista, who lives in Georgia, urged White to call an ambulance after he spent a week getting sicker at home. He was placed on a ventilator in Duluth late that night because the virus led to ARDS.

Doctors told Evengelista that her 51-year-old brother might not survive and asked to try the thyroid hormone.

“And every day, I just had a little more glimmer of hope,” she said.

White spent more than a month in the Duluth hospital but has been back home since spring and is working to gain enough strength to return to work. Chest X-rays for months have shown healthy lungs.

“This is really a much faster recovery than we see with typical ARDS,” said Ingbar, noting that many survivors have lung scarring that can cause breathing problems for years and the need for supplemental oxygen.

White plans to visit his family in Georgia for the holidays. Evangelista choked up discussing the trip.

“That he’s going to be with us at Christmas was not a foregone conclusion back in April,” she said.

Schlicht said he feels “100% healthy” and has been helping build an event center near home for his son’s upcoming wedding.

“Each visit really puts in perspective how close we were to death,” he said.

While the timing of recovery and abrupt reversal of symptoms suggest that T3 worked, doctors can’t rule out that the men recovered due to other medical care.

The trial was paused for months following the treatment of Schlicht and White for a safety review, but Rich and Ingbar recently received the go-ahead to give the therapy to more patients in Duluth and plan to expand to three Twin Cities-area hospitals.

The next step to prove cause and effect is to recruit 68 patients with ARDS from COVID-19 or other causes for the FDA-approved study, and to compare 50 who receive supplemental T3 with 18 who receive standard care.

ARDS stems from a variety of causes, including heat, physical trauma or inhaled substances. Research showed that any such lung injury produces more of an enzyme that breaks down T3.

“There’s a real local destruction of the hormone that explains why its concentration is so low,” Ingbar said.

Doctors administer the hormone directly to a patient’s lungs through a breathing tube. That is a novel part of this study, as sick people have received thyroid hormones for years, but never straight into their lungs in this manner.

The U’s Center for Translational Medicine is working to produce a patented powder T3 formulation. That inhaled or nebulized form would be cheaper and easier to administer, meaning more patients could receive it if it proves safe and effective.

“Our hope is actually that this therapy should work for some other illnesses in addition to ARDS,” Ingbar said. He and Rich may explore administering the treatment earlier to see if it prevents patients’ lungs from suffering distress.

Success of the ongoing study will be measured by whether supplemental T3 sops up enough lung fluid and allows for healthy blood oxygen levels. Rich said the overriding hope is not only survival but a return to life without chronic breathing problems and disabilities.

“Any survival of ARDS, especially this COVID ARDS, is exciting, but it’s not enough to survive,” Rich said. “It’s to not have the morbidity of a compromised lung for the rest of your life.”

The recoveries of Schlicht and White will be featured in an upcoming medical journal. The two men, the first people in the world to receive this experimental treatment, met after White’s October checkup at the hospital where they spent so many sick days. They exchanged an elbow bump.

“I’m a very lucky man,” White said, “to be sitting here today.”

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Baldelli R, Nicastri E, Petrosillo N, Marchioni L, Gubbiotti A, Sperduti I, Di Giacinto P, Rizza L, Rota F, Franco M, Lania A, Aimaretti G, Ippolito G, Zuppi P - "Thyroid dysfunction in COVID-19 patients" J Endocrinol Invest. 2021 Jun 8:1–5. doi: 10.1007/s40618-021-01599-0. Epub ahead of print. PMID: 34101132; PMCID: PMC8185485

Campi I, Bulgarelli I, Dubini A, Perego GB, Tortorici E, Torlasco C, Torresani E, Rocco L, Persani L, Fugazzola L - "The spectrum of thyroid function tests during hospitalization for SARS COV-2 infection" Eur J Endocrinol 184(5):699-709 (2021)

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Harris A, Al Mushref M - "Graves' Thyrotoxicosis Following SARS-CoV-2 Infection" AACE Clin Case Rep 7(1):14–6 (2020) doi: 10.1016/j.aace.2020.12.005. Epub ahead of print. PMID: 33521256; PMCID: PMC7834282

Ippolito S, Gallo D, Rossini A, Patera B, Lanzo N, Fazzino GFM, Piantanida E, Tanda ML - "SARS-CoV-2 vaccine-associated subacute thyroiditis: insights from a systematic review." J Endocrinol Invest. 2022 Jan 29. doi: 10.1007/s40618-022-01747-0. Epub ahead of print. PMID: 35094372

Khan F, Brassill MJ - " Subacute thyroiditis post-Pfizer-BioNTech mRNA vaccination for COVID-19" Endocrinol Diabetes Metab Case Rep 2021:EDM210142 (2021) doi: 10.1530/EDM-21-0142. Epub ahead of print. PMID: 34907904

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Reports that "previous histories of hypothyroidism, hyperthyroidism, Graves’ disease, thyroiditis, and autoimmune thyroiditis were not related to susceptibility to COVID-19. In addition, prior histories of thyroid diseases were not related to increased risks of COVID-19-related morbidity and mortality."
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Murugan AK, Alzahrani AS - "SARS-CoV-2: Emerging Role in the Pathogenesis of Various Thyroid Diseases" J Inflamm Res 14:6191-6221 (2021) ... rticle-JIR

Piticchio T, Le Moli R, Tumino D, Frasca - "Relationship between betacoronaviruses and the endocrine system: a new key to understand the COVID-19 pandemic-A comprehensive review" J Endocrinol Invest. 2021 Feb 13:1–18 (2021) doi: 10.1007/s40618-020-01486-0. Epub ahead of print. PMID: 33583003; PMCID: PMC7882054.

Pizzocaro A, Colombo P, Vena W, Ariano S, Magnoni P, Reggiani F, Favacchio G, Mirani M, Lavezzi E, Voza A, Calatroni M, Mazziotti G, Lania A; Humanitas COVID-19 Task force. - "Outcome of Sars-COV-2-related thyrotoxicosis in survivors of Covid-19: a prospective study" Endocrine 73(2):255-260 (2021) doi: 10.1007/s12020-021-02758-2. Epub 2021 May 28. PMID: 34047879; PMCID: PMC8161706

Rotondi M, Coperchini F, Ricci G, Denegri M, Croce L, Ngnitejeu ST, Villani L, Magri F, Latrofa F, Chiovato L - "Detection of SARS-COV-2 receptor ACE-2 mRNA in thyroid cells: a clue for COVID-19-related subacute thyroiditis" J Endocrinol Invest. 2020 Oct 6:1–6. doi: 10.1007/s40618-020-01436-w. Epub ahead of print. PMID: 33025553; PMCID: PMC7538193.
  • Sciacchitano S, Capalbo C, Napoli C, Negro A, De Biase L, Marcolongo A, Anibaldi P, Salvati V, Petrella L, Merlo L, Alampi D, Alessandri E, Loffredo C, Ulivieri A, Lavra L, Magi F, Morgante A, Salehi LB, De Vitis C, Mancini R, Coluzzi F, Rocco M - "Nonthyroidal illness syndrome (NTIS) in severe COVID-19 patients: role of T3 on the Na/K pump gene expression and on hydroelectrolytic equilibrium" J Transl Med 19(1):491 (2021)
van Gerwen M, Alsen M, Little C, Barlow J, Naymagon L, Tremblay D, Sinclair CF, Genden E - "Outcomes of Patients With Hypothyroidism and COVID-19: A Retrospective Cohort Study" Front Endocrinol (Lausanne). 2020 Aug 18;11:565. doi: 10.3389/fendo.2020.00565. PMID: 33013686; PMCID: PMC7461836
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