Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
Thyroid. 2024 Apr;34(4):442-449. doi: 10.1089/thy.2023.0626. Epub 2024 Mar 20.
The COVID-19 pandemic's impact on thyroid function is a growing concern. Previous studies have produced inconclusive results, and there is a lack of comprehensive research into the long-term risks of thyroid dysfunction following COVID-19 infection. In this retrospective cohort study, we used data from the TriNetX international database, which includes electronic health records from a broad, diverse patient population. We compared patients with COVID-19 (cases) to those without (controls), matching for age, sex, race, and comorbidities using propensity score matching. The primary outcome was the diagnosis of thyroid dysfunction (thyrotoxicosis or hypothyroidism) within a 12-month period, analyzed using hazard ratios (HRs) and Kaplan-Meier curves, and stratified by age and sex. Initially, the study included 1,379,311 COVID-19 patients and 6,896,814 non-COVID-19 patients from the TriNetX database. After matching, the cohorts were comparable in demographics and baseline characteristics. This study consistently demonstrated a significant increase in the risk of thyroid dysfunction, including thyrotoxicosis and hypothyroidism, among COVID-19 patients compared to non-COVID-19 patients. In the short term (3 months postexposure), the COVID-19 group exhibited a HR of 2.07 (95% confidence interval [CI] 2.01-2.12) for thyroid dysfunction, which included both thyrotoxicosis (HR 2.10, CI 1.92-2.29) and hypothyroidism (HR 2.08, CI 2.01-2.13). This heightened risk persisted over the long term (up to 12 months), with HRs indicating an ∼2.01-fold increased risk for overall thyroid dysfunction, a 1.8-fold increased risk for thyrotoxicosis, and a 2.04-fold increased risk for hypothyroidism. Subgroup analysis, stratified by age and sex, revealed a notably higher risk of thyroid dysfunction in patients aged 65 and above (HR 2.18, CI 2.11-2.25), compared to those in the under-65 age group (HR 1.97, CI 1.91-2.03). Both male and female patients were associated with an elevated risk, with females showing a slightly higher association with thyroid dysfunction (HR 2.12, CI 2.06-2.16) compared to males (HR 1.76, CI 1.69-1.82). COVID-19 infection was associated with an increased risk of thyroid dysfunction, including thyrotoxicosis and hypothyroidism, regardless of age or sex, during a 12-month follow-up period. Further research is required to validate these findings.
COVID-19 大流行对甲状腺功能的影响是一个日益受到关注的问题。先前的研究结果并不一致，而且缺乏对 COVID-19 感染后甲状腺功能障碍的长期风险的综合研究。在这项回顾性队列研究中，我们使用了来自 TriNetX 国际数据库的数据，该数据库包含了来自广泛、多样化患者群体的电子健康记录。我们将 COVID-19 患者（病例）与没有 COVID-19 的患者（对照组）进行了比较，通过倾向评分匹配来匹配年龄、性别、种族和合并症。主要结局是在 12 个月内诊断出甲状腺功能障碍（甲状腺功能亢进或甲状腺功能减退），使用风险比（HR）和 Kaplan-Meier 曲线进行分析，并按年龄和性别分层。
最初，该研究包括了来自 TriNetX 数据库的 1379311 例 COVID-19 患者和 6896814 例非 COVID-19 患者。在匹配后，队列在人口统计学和基线特征方面具有可比性。这项研究一致表明，与非 COVID-19 患者相比，COVID-19 患者发生甲状腺功能障碍（包括甲状腺功能亢进和甲状腺功能减退）的风险显著增加。在短期（暴露后 3 个月），COVID-19 组的甲状腺功能障碍风险为 2.07（95%置信区间 [CI] 2.01-2.12），包括甲状腺功能亢进（HR 2.10，CI 1.92-2.29）和甲状腺功能减退（HR 2.08，CI 2.01-2.13）。这种高风险持续存在于长期（长达 12 个月），风险比表明整体甲状腺功能障碍的风险增加了约 2.01 倍，甲状腺功能亢进的风险增加了 1.8 倍，甲状腺功能减退的风险增加了 2.04 倍。按年龄和性别分层的亚组分析显示，65 岁及以上患者发生甲状腺功能障碍的风险明显更高（HR 2.18，CI 2.11-2.25），而 65 岁以下患者的风险（HR 1.97，CI 1.91-2.03）。男性和女性患者均与风险升高相关，女性与甲状腺功能障碍的相关性略高（HR 2.12，CI 2.06-2.16），而男性（HR 1.76，CI 1.69-1.82）。
COVID-19 感染与甲状腺功能障碍（包括甲状腺功能亢进和甲状腺功能减退）风险增加相关，无论年龄或性别如何，在 12 个月的随访期间均如此。需要进一步研究来验证这些发现。
