Thyroid complications of SARS and coronavirus disease 2019 (COVID-19)

Endocr J. 2021 Feb 28;68(2):129-136. doi: 10.1507/endocrj.EJ20-0443. Epub 2021 Jan 19.

Abstract

We have reviewed the available literature on thyroid diseases and coronavirus disease 2019 (COVID-19), and data from the previous coronavirus pandemic, the severe acute respiratory syndrome (SARS) epidemic. We learned that both SARS and COVID-19 patients had thyroid abnormalities. In the limited number of SARS cases, where it was examined, decreased serum T3, T4 and TSH levels were detected. In a study of survivors of SARS approximately 7% of the patients had hypothyroidism. In the previous evaluation evidence was found that pituitary function was also affected in SARS. Others suggested a hypothalamic-pituitary-adrenal axis dysfunction. One result published recently indicates that a primary injury to the thyroid gland itself may play a key role in the pathogenesis of thyroid disorders in COVID-19 patients, too. Subacute thyroiditis, autoimmune thyroiditis and an atypical form of thyroiditis are complications of COVID-19. Thyroid hormone dysfunction affects the outcome by increasing mortality in critical illnesses like acute respiratory distress syndrome, which is a leading complication in COVID-19. Angiotensin-converting enzyme 2 is a membrane-bound enzyme, which is also expressed in the thyroid gland and the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) uses it for docking, entering as well as replication. Based on the available results obtained in the SARS-CoV-2 pandemic, beside others, we suggest that it is necessary to monitor thyroid hormones in COVID-19.

Keywords: Acute respiratory distress syndrome (ARDS); Coronavirus disease 2019 (COVID-19); Severe acute respiratory syndrome (SARS); Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2); Thyroid.

Publication types

  • Review

MeSH terms

  • Angiotensin-Converting Enzyme 2 / metabolism
  • COVID-19 / complications
  • COVID-19 / metabolism
  • COVID-19 / physiopathology*
  • Graves Disease / etiology
  • Graves Disease / metabolism
  • Graves Disease / physiopathology*
  • Humans
  • Hypothyroidism / etiology
  • Hypothyroidism / metabolism
  • Hypothyroidism / physiopathology*
  • Mortality
  • Prognosis
  • Receptors, Coronavirus / metabolism
  • Respiratory Distress Syndrome / etiology
  • Respiratory Distress Syndrome / metabolism
  • Respiratory Distress Syndrome / physiopathology*
  • SARS-CoV-2 / metabolism
  • Severe Acute Respiratory Syndrome / complications
  • Severe Acute Respiratory Syndrome / metabolism
  • Severe Acute Respiratory Syndrome / physiopathology
  • Thyroid Gland / metabolism
  • Thyroiditis / etiology
  • Thyroiditis / metabolism
  • Thyroiditis / physiopathology*
  • Thyroiditis, Autoimmune / etiology
  • Thyroiditis, Autoimmune / metabolism
  • Thyroiditis, Autoimmune / physiopathology
  • Thyroiditis, Subacute / etiology
  • Thyroiditis, Subacute / metabolism
  • Thyroiditis, Subacute / physiopathology
  • Thyrotropin / metabolism
  • Thyroxine / metabolism
  • Triiodothyronine / metabolism

Substances

  • Receptors, Coronavirus
  • Triiodothyronine
  • Thyrotropin
  • Angiotensin-Converting Enzyme 2
  • Thyroxine