Thyroid/COVID News - Updates - September 23, 2021

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Thyroid/COVID News - Updates - September 23, 2021

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September 23, 2021

Today, 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 today 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 today 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 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 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 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 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 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."

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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T3 Treatment

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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.”

SOURCE: ... esh=true#5

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Other relevant studies

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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)

Dworakowska D, Morley S, Mulholland N, Grossman AB - "Covid-19 related thyroiditis: a novel disease entity?" Clin Endocrinol (Oxf) doi: 10.1111/cen.14453 (2021) Epub ahead of print. PMID: 33650180

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

Khoo B, Tan T, Clarke SA, Mills EG, Patel B, Modi M, Phylactou M, Eng PC, Thurston L, Alexander EC, Meeran K, Comninos AN, Abbara A, Dhillo WS - "Thyroid Function Before, During, and After COVID-19" J Clin Endocrinol Metab 106(2):e803-e811 (2021) doi: 10.1210/clinem/dgaa830. PMID: 33180932; PMCID: PMC7823247

Kim SY, Yoo DM, Min CY, Choi HG - "The Effects of Previous Thyroid Disease on the Susceptibility to, Morbidity of, and Mortality Due to COVID-19: A Nationwide Cohort Study in South Korea" J Clin Med 10(16):3522 (2021) doi: 10.3390/jcm10163522. PMID: 34441818; PMCID: PMC8396860.
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."
"The results of thyroid function tests and medication histories, such as thyroid hormone replacement therapy, were unavailable. Subclinical or undiagnosed cases of thyroid disease could not be accounted for. Although the relationships of preexisting thyroid diseases with the occurrence of SARS-CoV-2 infection and morbidity of and mortality due to COVID-19 were analyzed, the duration from the thyroid disease onset to the SARS-CoV-2 infection onset was heterogeneous; therefore, causality between thyroid disease and SARS-CoV-2 infection could not be delineated."

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 - "Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors" Endocrinol Metab (Seoul) 36(3):582-589 (2021) doi: 10.3803/EnM.2021.983. Epub 2021 Jun 8. PMID: 34107601; PMCID: PMC8258341.

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.

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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