Endocrinol Metab.  2021 Aug;36(4):769-777. 10.3803/EnM.2021.1109.

Thyroid Hormone Profile and Its Prognostic Impact on the Coronavirus Disease 2019 in Korean Patients

• Ahn J
• Lee MK
• Lee JH
• Sohn SY

• KMID: 2519665
• DOI: http://doi.org/10.3803/EnM.2021.1109

Abstract

Background
Data on the association between coronavirus disease 2019 (COVID-19) and thyroid have been reported, including overt thyrotoxicosis and suppression of thyroid function. We aimed to evaluate the thyroid hormone profile and its association with the prognosis of COVID-19 in Korean patients.
Methods
The clinical data of 119 patients with COVID-19, admitted in the Myongji Hospital, Goyang, South Korea, were retrospectively evaluated. The thyroid hormone profiles were analyzed and compared based on disease severity (non-severe disease vs. severe to critical disease). Clinical outcomes were analyzed according to the tertiles of thyroid hormones.
Results
Of the 119 patients, 76 (63.9%) were euthyroid, and none presented with overt thyroid dysfunction. Non-thyroidal illness syndrome was the most common manifestation (18.5%), followed by subclinical thyrotoxicosis (14.3%) among patients with thyroid dysfunction. Thyroid stimulating hormone (TSH) and triiodothyronine (T3) levels were significantly lower in patients with severe to critical disease than in those with non-severe disease (P<0.05). Patients in the lowest T3 tertile (<0.77 ng/mL) had higher rates of mechanical ventilation, intensive care unit admission, and death than those in the middle and highest (>1.00 ng/mL) T3 tertiles (P<0.05). COVID-19 patients in the lowest T3 tertile were independently associated with mortality (hazard ratio, 5.27; 95% confidence interval, 1.09 to 25.32; P=0.038) compared with those in the highest T3 tertile.
Conclusion
Thyroid dysfunction is common in COVID-19 patients. Changes in serum TSH and T3 levels may be important markers of disease severity in COVID-19. Decreased T3 levels may have a prognostic significance in COVID-19 related outcome.

Keyword

COVID-19; Thyroid hormones; Triiodothyronine; Euthyroid sick syndromes; Mortality

Figure

• 

  Fig. 1 Scatterplots of thyroid hormones and C-reactive protein (CRP) or white blood cell (WBC). The Pearson correlation coefficient is shown at the top with its associated P value. The regression line (solid line) and 95% confidence interval (dotted line) are plotted. (A) Correlation between triiodothyronine (T3) and CRP. (B) Correlation between thyroid stimulating hormone (TSH) and CRP. (C) Correlation between T3 and WBC count. (D) Correlation between TSH and WBC count.

• 

  Fig. 2 Kaplan-Meier curves for in-hospital mortality according to triiodothyronine (T3) tertiles.

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