Berkebile Gabriel, Barbé Françoise, Malaplate Catherine, Le Collen Lauriane, Guéant Jean-Louis, Klein Marc, Oussalah Abderrahim
Department of Endocrinology, Diabetology, and Nutrition (EDN), University Hospital of Nancy, Nancy F-54000, France.
Department of Genomic Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, University Hospital of Nancy, Nancy F-54000, France; Reference Center for Inborn Errors of Metabolism (ORPHA67872), University Hospital of Nancy, Nancy F-54000, France.
J Infect Public Health. 2025 Mar;18(3):102681. doi: 10.1016/j.jiph.2025.102681. Epub 2025 Jan 22.
Reports have highlighted thyroid abnormalities, including subacute thyroiditis and thyrotoxicosis, in COVID-19 patients, with a potential link between thyroid dysfunction and disease severity. However, population-level studies on COVID-19's impact on thyroid hormone levels are limited. We aimed to assess the impact of the COVID-19 pandemic on thyroid function tests at the population level.
We conducted a repeated cross-sectional study on consecutive patients who underwent thyroid function tests between March 1 and April 15, 2020, during the first wave of COVID-19 in northeastern France, and compared the results with those from the same period in 2018 and 2019.
The study analyzed 3968 tests, including 1534 in 2018, 1547 in 2019, and 887 in 2020. Patients tested in the first wave of COVID-19 had significantly lower TSH and FT3 levels and higher FT4 levels than those in reference periods. On ROC analysis, the optimal thresholds for FT3 and FT4 were ≤ 4.5 pmol/L and > 12 pmol/L, respectively. On multivariable analysis, FT3 ≤ 4.5 pmol/L and FT4 > 12 pmol/L were independently associated with the first wave of COVID-19. The proportion of subjects with concurrent changes in FT3 and FT4 levels was significantly higher in 2020 than in the reference periods, with an odds ratio of 3.62 (95 % CI, 2.77-4.73). A phenome-wide association study of 128 clinical and biological predictors identified an independent association between a low FT3/FT4 ratio and COVID-19, hypertension, or amiodarone therapy, suggesting the contribution of euthyroid sick syndrome to this presentation. This association remained significant after adjustment for potential confounders such as thyroid disease, steroids, and iodinated contrast injection.
These findings suggest that COVID-19 is associated with significant population-level variation in thyroid function tests, which may have implications for managing COVID-19 patients.
报告强调了新冠病毒病（COVID-19）患者存在甲状腺异常，包括亚急性甲状腺炎和甲状腺毒症，甲状腺功能障碍与疾病严重程度之间可能存在关联。然而，关于COVID-19对甲状腺激素水平影响的人群层面研究有限。我们旨在评估COVID-19大流行在人群层面上对甲状腺功能检查的影响。
我们对2020年3月1日至4月15日在法国东北部COVID-19第一波疫情期间连续接受甲状腺功能检查的患者进行了重复横断面研究，并将结果与2018年和2019年同期的结果进行比较。
该研究分析了3968次检查，其中2018年1534次，2019年1547次，2020年887次。在COVID-19第一波疫情期间接受检查的患者，其促甲状腺激素（TSH）和游离三碘甲状腺原氨酸（FT3）水平显著低于参考时期，游离甲状腺素（FT4）水平则高于参考时期。在ROC分析中，FT3和FT4的最佳阈值分别为≤4.5 pmol/L和>12 pmol/L。在多变量分析中，FT3≤4.5 pmol/L和FT4>12 pmol/L与COVID-19第一波疫情独立相关。2020年FT3和FT4水平同时发生变化的受试者比例显著高于参考时期，比值比为3.62（95%CI，2.77 - 4.73）。一项对128种临床和生物学预测指标的全表型关联研究确定，低FT3/FT4比值与COVID-19、高血压或胺碘酮治疗之间存在独立关联，提示正常甲状腺病态综合征对此表现有影响。在对甲状腺疾病、类固醇和碘化造影剂注射等潜在混杂因素进行调整后，这种关联仍然显著。
这些发现表明，COVID-19与甲状腺功能检查在人群层面的显著变化有关，这可能对COVID-19患者的管理产生影响。
