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Clausen CL, Rasmussen ÅK, Johannsen TH, et al. Thyroid function in COVID-19 and the association with cytokine levels and mortality. Endocr Connect. 2021;10(10):1234-1242doi: 10.1530/EC-21-0301.
Clausen, C. L., Rasmussen, �. �. K., Johannsen, T. H., Hilsted, L. M., Skakkebæk, N. E., Szecsi, P. B., Pedersen, L., Benfield, T., & Juul, A. (2021). Thyroid function in COVID-19 and the association with cytokine levels and mortality. Endocrine connections, 10(10), 1234-1242. https://doi.org/10.1530/EC-21-0301
Clausen, Clara Lundetoft, et al. "Thyroid function in COVID-19 and the association with cytokine levels and mortality." Endocrine connections vol. 10,10 (2021): 1234-1242. doi: https://doi.org/10.1530/EC-21-0301
Clausen CL, Rasmussen ÅK, Johannsen TH, Hilsted LM, Skakkebæk NE, Szecsi PB, Pedersen L, Benfield T, Juul A. Thyroid function in COVID-19 and the association with cytokine levels and mortality. Endocr Connect. 2021 Sep 28;10(10):1234-1242. doi: 10.1530/EC-21-0301. PMID: 34468398; PMCID: PMC8494417.
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Endocr Connect. 2021 Sep 28;10(10):1234-1242. doi: 10.1530/EC-21-0301.

Thyroid function in COVID-19 and the association with cytokine levels and mortality.

Endocrine connections

Clara Lundetoft Clausen, Åse Krogh Rasmussen, Trine Holm Johannsen, Linda Maria Hilsted, Niels Erik Skakkebæk, Pal Bela Szecsi, Lise Pedersen, Thomas Benfield, Anders Juul

Affiliations

  1. Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.
  2. Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Copenhagen, Denmark.
  3. Department of Growth and Reproduction, Copenhagen University Hospital, Copenhagen, Denmark.
  4. Department of Clinical Biochemistry, Copenhagen University Hospital, Copenhagen, Denmark.
  5. Department of Clinical Biochemistry, Holbæk Hospital, Holbæk, Denmark.
  6. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

PMID: 34468398 PMCID: PMC8494417 DOI: 10.1530/EC-21-0301

Abstract

The hypothalamic-pituitary-thyroid hormone axis might be affected in COVID-19, but existing studies have shown varying results. It has been hypothesized that hyperinflammation, as reflected by the secretion of cytokines, might induce thyroid dysfunction among patients with COVID-19. We explored thyroid hormone involvement in the acute phase of symptomatic COVID-19 and its possible associations with cytokine levels and mortality risk. This was a single-center study of 116 consecutive patients hospitalized for moderate-to-severe COVID-19 disease. Serum concentrations of thyroid-stimulating hormone (TSH), free thyroxine (T4), and 45 cytokines/chemokines were measured in all patients within 3 days of admission. Data were extracted retrospectively through a manual review of health records. At admission, 95 (81.9%) were euthyroid; while 21 (18.1%) had biochemically thyroid dysfunction including subclinical thyrotoxicosis (n = 11), overt thyrotoxicosis (n = 2), hypothyroidism (n = 1), non-thyroidal illness (n = 2), and normal TSH but high free T4 (n = 5). TSH levels were inversely correlated with IL-8 (rs = -0.248), IL-10 (rs = -0.253), IL-15 (rs = -0.213), IP-10 (rs = -0.334), and GM-CSF (rs = -0.254). Moreover, IL-8 levels, IP-10, and GM-CSF were significantly higher in patients with serum TSH < 0.4 mIU/L. Lastly, a two-fold increment of IL-8 and IL-10 was associated with significantly higher odds of having TSH < 0.4 mIU/L (odds ratio 1.86 (1.11-3.10) and 1.78 (1.03-3.06)). Serum TSH was not associated with 30- or 90-day mortality. In conclusion, this study suggests that fluctuations of TSH levels in patients with COVID-19 may be influenced by circulating IL-8, IL-10, IL-15, IP-10, and GM-CSF as previously described in autoimmune thyroid diseases.

Keywords: COVID-19; IL-10; IL-8; SARS-CoV-2; cytokines; mortality; thyroid function; thyroid gland

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