Department of Endocrinology, Division of Medicine, Royal Free Campus, University College London, London, UK.
Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
J Clin Endocrinol Metab. 2021 Jan 23;106(2):e803-e811. doi: 10.1210/clinem/dgaa830.
The effects of COVID-19 on the thyroid axis remain uncertain. Recent evidence has been conflicting, with both thyrotoxicosis and suppression of thyroid function reported.
We aimed to detail the acute effects of COVID-19 on thyroid function and determine if these effects persisted on recovery from COVID-19.
A cohort observational study was conducted.
Adult patients admitted to Imperial College Healthcare National Health Service Trust, London, UK, with suspected COVID-19 between March 9 to April 22, 2020, were included, excluding those with preexisting thyroid disease and those missing either free thyroxine (FT4) or thyrotropin (TSH) measurements. Of 456 patients, 334 had COVID-19 and 122 did not.
TSH and FT4 measurements were recorded at admission, and where available, in 2019 and at COVID-19 follow-up.
Most patients (86.6%) presenting with COVID-19 were euthyroid, with none presenting with overt thyrotoxicosis. Patients with COVID-19 had a lower admission TSH and FT4 compared to those without COVID-19. In the COVID-19 patients with matching baseline thyroid function tests from 2019 (n = 185 for TSH and 104 for FT4), TSH and FT4 both were reduced at admission compared to baseline. In a complete case analysis of COVID-19 patients with TSH measurements at follow-up, admission, and baseline (n = 55), TSH was seen to recover to baseline at follow-up.
Most patients with COVID-19 present with euthyroidism. We observed mild reductions in TSH and FT4 in keeping with a nonthyroidal illness syndrome. Furthermore, in survivors of COVID-19, thyroid function tests at follow-up returned to baseline.
COVID-19 对甲状腺轴的影响仍不确定。最近的证据相互矛盾，既有报道称甲状腺功能亢进，也有报道称甲状腺功能抑制。
我们旨在详细描述 COVID-19 对甲状腺功能的急性影响，并确定这些影响在 COVID-19 康复后是否持续存在。
进行了一项队列观察性研究。
2020 年 3 月 9 日至 4 月 22 日期间，英国伦敦帝国学院医疗保健国民保健服务信托收治的疑似 COVID-19 的成年患者被纳入研究，排除了有甲状腺疾病病史的患者和游离甲状腺素（FT4）或促甲状腺激素（TSH）测量值缺失的患者。在 456 例患者中，334 例确诊为 COVID-19，122 例未确诊。
入院时记录 TSH 和 FT4 测量值，如可行，还记录 2019 年和 COVID-19 随访时的 TSH 和 FT4 测量值。
大多数（86.6%）出现 COVID-19 的患者表现为甲状腺功能正常，无明显甲状腺毒症。出现 COVID-19 的患者入院时 TSH 和 FT4 水平低于未出现 COVID-19 的患者。在 2019 年有匹配基线甲状腺功能检查的 COVID-19 患者中（n=185 例 TSH，104 例 FT4），与基线相比，入院时 TSH 和 FT4 均降低。在有 TSH 随访测量值的 COVID-19 患者的完整病例分析中（n=55），入院时 TSH 恢复至基线。
大多数 COVID-19 患者表现为甲状腺功能正常。我们观察到 TSH 和 FT4 轻度降低，与非甲状腺疾病综合征一致。此外，在 COVID-19 幸存者中，随访时的甲状腺功能检查恢复至基线。
