Infectious Disease

Thyroid illness doesn’t have an effect on the development of COVID-19

March 10, 2021

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Brix does not report any relevant financial information. Another author on the study reports that he participated in research projects funded by Menarini Pharmaceuticals and LEO Pharma, with the funds paid to his institution.

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The risk of testing positive for COVID-19 or developing a more severe illness does not differ between adults treated for hypothyroidism or hyperthyroidism and euthyroid controls, according to a Danish database analysis.

Angiotensin converting enzyme 2 or ACE2 has been established as a COVID-19 receptor for entry into host cells, and the tissue distribution of ACE2 is influenced by serum levels of thyroid hormones. Thomas H.. Brix, MD, PhD, of the Department of Endocrinology at Odense University Hospital, Denmark, and colleagues wrote in correspondence published in The Lancet Diabetes & Endocrinology. In addition, adults with hypothyroidism and hyperthyroidism have an increased exposure to cardiovascular and psychiatric comorbidities, which have also been reported in patients with severe COVID-19. The susceptibility to infections and the course of the infection can be negatively influenced by a dysfunction of the thyroid.

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“Whether these pathophysiological observations lead to an increased risk of acquiring or a poorer prognosis of SARS-CoV-2 infection in patients with thyroid disease is unknown,” the researchers wrote.

In a population-based case-control study, Brix and colleagues analyzed data from all adults in Denmark who tested negative for SARS-CoV-2 (n = 2,400,609) or positive for SARS-CoV-2 (n = 28,078) between February were September 27 and 30, 2020. Patients prescribed levothyroxine had hypothyroidism. Patients prescribed antithyroid drugs had hyperthyroidism. The researchers calculated ORs for SARS-CoV-2 positive tests and compared users of levothyroxine or antithyroid drugs to euthyroid adults. Positive COVID-19 cases were compared 1:10 with COVID-19 negative controls by age, gender and week of the COVID-19 test.

In a separate cohort study, the researchers analyzed data from Danish adults who tested positive for SARS-CoV-2 between February 27 and August 31, 2020 (n = 16,502). The researchers estimated the adjusted risk ratios and differences in risk for mortality, hospitalization after 12 hours, admission to the intensive care unit, use of mechanical ventilation and dialysis during the 30 days after a positive test.

In the case-control study, 809 (2.9%) of the COVID-19 positive patients and 7,994 (2.9%) of the matched COVID-19 negative patients used levothyroxine, while 91 (0.3%) of the COVID -19 positive patients and 936 (0.3%) COVID-19 negative patients used antithyroid drugs.

The researchers found that patients treated for hypothyroidism or hyperthyroidism were not at increased risk of COVID-19 infection, with an adjusted OR of 1.03 for patients with hypothyroidism (95% CI, 0.95-1 , 11) and an AOR of 1.03 for patients with hyperthyroidism (95% CI, 0.82-1.28).

Among the COVID-19 positive patients in the separate cohort study, 572 (3.5%) used levothyroxine and 75 (0.5%) used antithyroid drugs. In analyzes using propensity score weighting, patients prescribed levothyroxine had a COVID-19 diagnosis compared to hospitalization (RR = 1.19; 95% CI, 1.02-1.4) and dialysis (RR = 2.23; 95% CI, 1.06-4.69) more common with those for whom levothyroxine was not prescribed. However, the results of the additional analyzes, which extended the follow-up period to 60 days and took into account different test strategies, did not persist.

There was no association between current antithyroid drug use and the undesirable results of COVID-19 infection after weighting the propensity score.

“These results suggest that treatment for thyroid dysfunction should not affect the clinical management of the patient’s risk of developing SARS-CoV-2 infection or the management of patients who have already contracted the infection,” wrote the researchers. “The rough analysis shows an excessive risk of undesirable outcomes of SARS-CoV-2 infection in patients treated for hypothyroidism and hyperthyroidism. However, these associations weaken after adjustment for comorbidity and temporal changes in the Danish SARS-CoV-2 -Test strategy. “

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