Department of Endocrinology, Farhikhtegan Hospital, Faculty of Medicine, Tehran Medical Sciences Islamic Azad University, Tehran, Iran.
Mini Rev Med Chem. 2024;24(3):265-271. doi: 10.2174/1389557523666230413090332.
Coronavirus disease 2019 (COVID-19) affects thyroid function. These changes are due to the direct impact of the virus on thyroid cells via angiotensin-converting-enzyme 2 (ACE2) receptors, inflammatory reaction, apoptosis in thyroid follicular cells, suppression of hypothalamus-pituitarythyroid axis, an increase in activity of adrenocortical axis, and excess cortisol release due to cytokine storm of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Euthyroid sick syndrome (ESS), thyroiditis, clinical and subclinical hypothyroidism, central hypothyroidism, exacerbation of underlying autoimmune thyroid disease, and clinical and subclinical hyperthyroidism can be associated with coronavirus. Adjuvants in coronavirus vaccines induce autoimmune/inflammatory syndrome known as vaccine adjuvants (ASIA) syndrome. Thyroiditis and Graves' disease have been reported to be associated with ASIA syndrome after some coronavirus vaccinations. Some coronavirus medications, such as hydroxychloroquine, monoclonal antibodies, lopinavir/ritonavir, remdesivir, naproxen, anticoagulants, and glucocorticoids can also affect thyroid tests, and correct diagnosis of thyroid disorders will be more difficult. Changes in thyroid tests may be one of the most important manifestations of COVID-19. These changes can be confusing for clinicians and can lead to inappropriate diagnoses and decisions. Prospective studies should be conducted in the future to increase epidemiological and clinical data and optimize the management of thyroid dysfunctions in patients with COVID-19.
新型冠状病毒病 2019（COVID-19）会影响甲状腺功能。这些变化是由于病毒通过血管紧张素转换酶 2（ACE2）受体对甲状腺细胞的直接影响、炎症反应、甲状腺滤泡细胞凋亡、下丘脑-垂体-甲状腺轴抑制、肾上腺皮质轴活性增加以及细胞因子风暴引起的皮质醇过量释放所致严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）。甲状腺功能正常的病态综合征（ESS）、甲状腺炎、临床和亚临床甲状腺功能减退症、中枢性甲状腺功能减退症、潜在自身免疫性甲状腺疾病的加重以及临床和亚临床甲状腺功能亢进症都可能与冠状病毒有关。冠状病毒疫苗中的佐剂会引起自身免疫/炎症综合征，称为疫苗佐剂（ASIA）综合征。有报道称，一些冠状病毒疫苗接种后会出现甲状腺炎和格雷夫斯病与 ASIA 综合征有关。一些冠状病毒药物，如羟氯喹、单克隆抗体、洛匹那韦/利托那韦、瑞德西韦、萘普生、抗凝剂和糖皮质激素，也会影响甲状腺功能检查，甲状腺疾病的正确诊断将更加困难。甲状腺功能检查的变化可能是 COVID-19 的最重要表现之一。这些变化可能会使临床医生感到困惑，并导致不适当的诊断和决策。未来应进行前瞻性研究，以增加流行病学和临床数据，并优化 COVID-19 患者甲状腺功能障碍的管理。
