Endocrinology Division, Hospital José María Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina.
Internal Medicine Division, Hospital José María Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina.
Endocrine. 2021 Dec;74(3):455-460. doi: 10.1007/s12020-021-02863-2. Epub 2021 Sep 13.
Inflammation plays a critical role in the progression of COVID-19. Nonthyroidal illness syndrome (NTIS) has been increasingly recognized in affected patients. We aim to evaluate the correlation of thyroid hormones with markers of inflammation and association with disease outcome in hospitalized patients with COVID-19, and in two profiles of NTIS (low T3-normal/low FT4 vs. low T3-high FT4).
consecutive patients admitted to a nonintensive care unit for COVID-19 were recruited. Infection was mild in 22%, moderate in 27.1% and severe in 50.8%; 7.41% died. T4, T3, FT4, FT3, and their ratios (T3/T4, FT3/FT4) were correlated with albumin, ferritin, fibrinogen, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lactate dehydrogenase (LDH), and D-dimer.
Fifty five patients (50.9% men, median age 56 years) were included. Albumin correlated positively with T3 and hormones ratios, but negatively with FT4. T3, FT3, T3/T4, and FT3/FT4 correlated inversely with ferritin, fibrinogen, ESR, CRP, LDH, and D-dimer. FT4 showed direct correlation with fibrinogen and ESR. T3/T4 was lower in severe compared to mild/moderate disease [7.5 (4.5-15.5) vs. 9.2 (5.8-18.1); p = 0.04], and lower in patients who died than in those discharged [5 (4.53-5.6) vs. 8.1 (4.7-18.1); p = 0.03]. A low T3/high FT4 profile was associated with lower albumin, higher ferritin, and severity.
In this cohort, thyroid hormones correlated with inflammation and outcome. T3 and T3/T4 correlated inversely with inflammatory markers; 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.
炎症在 COVID-19 的进展中起着关键作用。非甲状腺疾病综合征（NTIS）在受影响的患者中越来越被认识到。我们旨在评估甲状腺激素与炎症标志物的相关性，并在 COVID-19 住院患者中以及在两种 NTIS 谱（低 T3-正常/低 FT4 与低 T3-高 FT4）中评估其与疾病结局的相关性。
连续招募因 COVID-19 入住非重症监护病房的患者。感染程度为轻度的占 22%，中度的占 27.1%，重度的占 50.8%；7.41%的患者死亡。T4、T3、FT4、FT3 及其比值（T3/T4、FT3/FT4）与白蛋白、铁蛋白、纤维蛋白原、红细胞沉降率（ESR）、C 反应蛋白（CRP）、乳酸脱氢酶（LDH）和 D-二聚体相关。
55 名患者（50.9%为男性，中位年龄 56 岁）被纳入研究。白蛋白与 T3 和激素比值呈正相关，但与 FT4 呈负相关。T3、FT3、T3/T4 和 FT3/FT4 与铁蛋白、纤维蛋白原、ESR、CRP、LDH 和 D-二聚体呈负相关。FT4 与纤维蛋白原和 ESR 呈正相关。与轻度/中度疾病相比，重度疾病患者的 T3/T4 比值较低[7.5（4.5-15.5）与 9.2（5.8-18.1）；p=0.04]，死亡患者的 T3/T4 比值低于出院患者[5（4.53-5.6）与 8.1（4.7-18.1）；p=0.03]。低 T3/高 FT4 谱与较低的白蛋白、较高的铁蛋白和严重程度相关。
在本队列中，甲状腺激素与炎症和预后相关。T3 和 T3/T4 与炎症标志物呈负相关；T3/T4 比值降低与严重程度和不良预后相关。T3 降低但 FT4 升高的患者在就诊时铁蛋白更高、白蛋白更低且疾病更严重。
