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Thyroxine changes in COVID-19 pandemic: A systematic review and meta-analysis

FRONTIERS IN ENDOCRINOLOGY (2023)

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Mild and asymptomatic SARS-CoV-2 infection is not associated with progression of thyroid dysfunction or thyroid autoimmunity

Alpesh Goyal et al.

CLINICAL ENDOCRINOLOGY (2023)

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Thyroid Hormone Changes in the Northern Area of Tianjin during the COVID-19 Pandemic

Weiwei Dong et al.

Summary: This study aimed to investigate stress-induced thyroid hormone changes during the COVID-19 pandemic in the northern area of Tianjin. The results showed a decreased detection rate of abnormal thyroid function during the pandemic, with increased levels of FT4 and anxiety scores. However, TSH, FT3, TgAb, and TPOAb levels decreased. Anxiety scores were positively correlated with FT3 and FT4 levels.

INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (2022)

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Article Endocrinology & Metabolism

Wide Spectrum of Thyroid Function Tests in COVID-19: From Nonthyroidal Illness to Isolated Hyperthyroxinemia

Sima Hashemipour et al.

Summary: This study examined thyroid function abnormalities in COVID-19 patients and found some new features like isolated hyperthyroxinemia. There was a strong association between subclinical/overt thyrotoxicosis and atrial fibrillation.

INTERNATIONAL JOURNAL OF ENDOCRINOLOGY AND METABOLISM (2022)

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Article Endocrinology & Metabolism

Is non-thyroidal illness syndrome (NTIS) a clinical predictor of COVID-19 mortality in critically ill oldest old patients?

C. Okoye et al.

JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION (2022)

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Review Endocrinology & Metabolism

Nonthyroidal Illness Syndrome: To Treat or Not to Treat? Have We Answered the Question? A Review of Metanalyses

Salvatore Sciacchitano et al.

Summary: Nonthyroidal illness syndrome (NTIS) is common in patients admitted to intensive care units. Whether NTIS should be treated or not is still debated. There is significant heterogeneity in the type of thyroid hormone supplementation, route of administration, dosages and duration of treatment in the current research, as well as variability in the chosen outcomes to evaluate the results.

FRONTIERS IN ENDOCRINOLOGY (2022)

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Article Endocrinology & Metabolism

The potential impact of COVID-19 on thyroid gland volumes among COVID-19 survivors

Emre Urhan et al.

Summary: This study investigated the effects of COVID-19 on the thyroid gland among survivors and found that at 6 months after acute infection, COVID-19 survivors had smaller thyroid gland volume compared to healthy controls, but only a few of the survivors had abnormal thyroid function.

ENDOCRINE (2022)

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Article Endocrinology & Metabolism

Thyroid Function Analysis in 50 Patients with COVID-19: A Retrospective Study

Min Chen et al.

Summary: This study found that levels of TSH and TT3 in COVID-19 patients were significantly lower compared to healthy controls and non-COVID-19 pneumonia patients, with a positive correlation between the severity of COVID-19 and the decrease in TSH and TT3 levels.

THYROID (2021)

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Article Endocrinology & Metabolism

Thyroid Hormone Profile and Its Prognostic Impact on the Coronavirus Disease 2019 in Korean Patients

Jiyeon Ahn et al.

Summary: This study found that thyroid dysfunction is common in COVID-19 patients, with lower TSH and T3 levels in severe cases. Decreased T3 levels may serve as a prognostic marker for outcomes in COVID-19 patients.

ENDOCRINOLOGY AND METABOLISM (2021)

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Article Biology

Metabolic Changes in SARS-CoV-2 Infection: Clinical Data and Molecular Hypothesis to Explain Alterations of Lipid Profile and Thyroid Function Observed in COVID-19 Patients

Damiano D'Ardes et al.

Summary: The study indicates that SARS-CoV-2 infection may lead to a decrease in total cholesterol, HDL-C, and thyroid-stimulating hormone (TSH) levels, and potentially play a role in viral replication and inflammatory processes. Additionally, the research shows a negative correlation between C-reactive protein (CRP) and LDL-C, as well as HDL-C levels, suggesting a possible impact of COVID-19 on lipid metabolism.

LIFE-BASEL (2021)

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Article Endocrinology & Metabolism

Sick Euthyroid Syndrome on Presentation of Patients With COVID-19: A Potential Marker for Disease Severity

Yair Schwarz et al.

Summary: This retrospective cohort study found that free triiodothyronine (FT3) can serve as a prognostic tool for disease severity and death in the early presentation of COVID-19. Patients in the lowest tertile of FT3 had significantly higher rates of mortality, mechanical ventilation, and intensive care unit admission. FT3 remained a significant independent predictor of death even after adjusting for various factors.

ENDOCRINE PRACTICE (2021)

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Review Endocrinology & Metabolism

Impact of COVID-19 on the thyroid gland: an update

Lorenzo Scappaticcio et al.

Summary: COVID-19 has been shown to have a potential impact on the thyroid gland and the entire hypothalamic-pituitary-thyroid (HPT) axis. Evidence suggests that COVID-19-related thyroid disorders include thyrotoxicosis, hypothyroidism, and nonthyroidal illness syndrome. Treatment plans for thyroid cancer are also shifting towards more teleconsultations due to the pandemic.

REVIEWS IN ENDOCRINE & METABOLIC DISORDERS (2021)

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Article Endocrinology & Metabolism

The spectrum of thyroid function tests during hospitalization for SARS COV-2 infection

Irene Campi et al.

Summary: Alterations in thyroid function tests were observed in COVID-19 patients, with some showing normal TFTs and others having low TSH levels correlated with elevated CRP, cortisol, and IL-6 levels. This suggests a potential impact of cytokine storm induced by SARS-CoV-2 on thyroid function.

EUROPEAN JOURNAL OF ENDOCRINOLOGY (2021)

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Article Medicine, General & Internal

The prognostic impact of thyroid disorders on the clinical severity of COVID-19: Results of single-centre pandemic hospital

Mehmet Guven et al.

Summary: This study found that severe thyroid hormonal disorders were more common in critically ill COVID-19 patients. Free triiodothyronine (FT3) level at hospital admission may serve as a potential prognostic marker of COVID-19 patients. Thyroid nodules may be associated with severe COVID-19 disease.

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE (2021)

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Article Endocrinology & Metabolism

The Association of TSH and Thyroid Hormones With Lymphopenia in Bacterial Sepsis and COVID-19

Inge Grondman et al.

Summary: The study found that abnormal thyroid function is associated with lymphopenia in patients with severe infections, such as bacterial sepsis and COVID-19. COVID-19 patients showed quantitative recovery of lymphocyte numbers after one week, while thyroid hormones remained disturbed.

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM (2021)

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Article Endocrinology & Metabolism

Thyroid Function Abnormalities in COVID-19 Patients

Weibin Wang et al.

Summary: Thyroid function abnormalities are common in COVID-19 patients, especially in severe cases. This might be partially explained by nonthyroidal illness syndrome.

FRONTIERS IN ENDOCRINOLOGY (2021)

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Review Endocrinology & Metabolism

COVID-19-Associated Subacute Thyroiditis: Evidence-Based Data From a Systematic Review

Pierpaolo Trimboli et al.

Summary: The size and quality of published data regarding SAT in COVID-19 patients are limited, with only a few case reports and case series available. The clinical presentation of SAT in COVID-19 patients seems to be similar to what is generally expected.

FRONTIERS IN ENDOCRINOLOGY (2021)

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Article Endocrinology & Metabolism

Low FT3 is an independent marker of disease severity in patients hospitalized for COVID-19

Aditya Dutta et al.

Summary: The study found that functional thyroid abnormalities (low FT3 and low TSH) are commonly seen in hospitalized patients with COVID-19, and low FT3 is independently predictive of the severity of COVID-19.

ENDOCRINE CONNECTIONS (2021)

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Article Medicine, General & Internal

Thyroid Disfunction in Critically Ill COVID-19 Patients. Relationship with In-Hospital Mortality

Maria Antonieta Ballesteros Vizoso et al.

Summary: By analyzing the thyroid profile in critically ill COVID-19 patients, variables associated with mortality and the predictive ability of mortality were identified. The study found that fT4 on day 5 after ICU admission was associated with in-hospital mortality.

JOURNAL OF CLINICAL MEDICINE (2021)

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Article Endocrinology & Metabolism

Normal Adrenal and Thyroid Function in Patients Who Survive COVID-19 Infection

Sophie A. Clarke et al.

Summary: The study found that adrenal and thyroid function in COVID-19 survivors remained intact at least 3 months after acute illness, and persistent fatigue symptoms were not attributed to changes in these functions.

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Thyroid function analysis in COVID-19: A retrospective study from a single center

Jahanzeb Malik et al.

Summary: This pilot study from Pakistan demonstrates that changes in serum TSH and TT3 levels may be important manifestations of the courses of COVID-19 pneumonia.

PLOS ONE (2021)

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Review Endocrinology & Metabolism

Thyroid sequelae of COVID-19: a systematic review of reviews

Pierpaolo Trimboli et al.

Summary: This systematic review provides insights into potential thyroid consequences in COVID-19 patients, including thyrotoxicosis, low-T3 syndrome, and subacute thyroiditis. It concludes that having a thyroid disease does not increase the risk of SARS-CoV-2 infection, and that thyroid patients do not require a specific COVID-19-adapted follow-up. However, factors like critical illness and medication may affect thyroid laboratory tests.

REVIEWS IN ENDOCRINE & METABOLIC DISORDERS (2021)

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Review Endocrinology & Metabolism

Thyroid and COVID-19: a review on pathophysiological, clinical and organizational aspects

G. Lisco et al.

Summary: Thyroid dysfunction can be induced by SARS-CoV-2, but does not seem to impact the progression of COVID-19. Adequate management of patients with thyroid diseases remains essential during the pandemic, even though it may be compromised due to healthcare service restrictions. Endocrine care centers should prioritize in-person visits for high-risk cases and consider utilizing telemedicine for patients who do not require in-person visits.

JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION (2021)

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Review Medical Laboratory Technology

Low free-T3 serum levels and prognosis of COVID-19: systematic review and meta-analysis

Michael Llamas et al.

Summary: The meta-analysis revealed that COVID-19 patients with lower serum fT3 levels are more likely to require intensive care and have a higher mortality rate. Therefore, serum fT3 concentration can serve as an important indicator for predicting the prognosis of COVID-19 patients.

CLINICAL CHEMISTRY AND LABORATORY MEDICINE (2021)

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Letter Medical Laboratory Technology

Low serum TSH in the acute phase of COVID-19 pneumonia: thyrotoxicosis or a face of non-thyroidal illness syndrome?

Stelios F. Assimakopoulos et al.

CLINICAL CHEMISTRY AND LABORATORY MEDICINE (2021)

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Article Endocrinology & Metabolism

Long COVID in Patients With Mild to Moderate Disease: Do Thyroid Function and Autoimmunity Play a Role?

David Tak Wai Lui et al.

Summary: The study revealed that 20.1% of COVID-19 survivors developed long COVID (LC), with females and those with higher viral loads in the acute phase being more vulnerable. Most abnormal thyroid function tests in acute COVID-19 resolved upon follow-up, but incident anti-TPO positivity was observed.

ENDOCRINE PRACTICE (2021)

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Article Endocrinology & Metabolism

Association between Thyroid Function and Prognosis of COVID-19: A Retrospective Observational Study

Shan Lang et al.

Summary: This study revealed that a low FT3 state is associated with an increased risk of in-hospital mortality for COVID-19 patients. Non-survivors showed lower serum levels of TSH and FT3 than survivors, with FT3 level negatively correlating with the risk of death. Thyroid function may play a role in the prognosis of COVID-19 patients.

ENDOCRINE RESEARCH (2021)

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Article Endocrinology & Metabolism

The Association of Thyroid Hormone Changes with Inflammatory Status and Prognosis in COVID-19

Ceyda Dincer Yazan et al.

Summary: In this study, 34.1% of COVID-19 patients were found to have normal thyroid function, with shorter hospitalization, lower oxygen demand, and lower ICU admission rates, and none of them died. Additionally, evaluation of thyroid function during COVID-19 infection may provide insights into disease prognosis.

INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (2021)

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Article Endocrinology & Metabolism

Prognostic significance of low TSH concentration in patients with COVID-19 presenting with non-thyroidal illness syndrome

Jing Gong et al.

Summary: This study found that low TSH levels are significantly associated with mortality in patients with COVID-19 presenting with NTI, while low FT4 levels are also linked to mortality.

BMC ENDOCRINE DISORDERS (2021)

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Article Endocrinology & Metabolism

Thyroid dysfunction in COVID-19 patients

R. Baldelli et al.

Summary: Patients with COVID-19 may experience abnormal thyroid function, with lower levels of FT3 and TSH associated with more severe symptoms.

JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION (2021)

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Article Endocrinology & Metabolism

Spectrum of Endocrine Dysfunction and Association With Disease Severity in Patients With COVID-19: Insights From a Cross-Sectional, Observational Study

Liza Das et al.

Summary: Evidence on new-onset endocrine dysfunction and its association with disease severity in COVID-19 patients is limited. Patients with moderate-to-severe disease show higher prevalence of hypocortisolism and male hypogonadism compared to those with mild disease. Low T3 syndrome is a common finding regardless of disease severity.

FRONTIERS IN ENDOCRINOLOGY (2021)

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Article Endocrinology & Metabolism

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

Clara Lundetoft Clausen et al.

Summary: 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. However, TSH levels were not associated with 30- or 90-day mortality in COVID-19 patients.

ENDOCRINE CONNECTIONS (2021)

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Analysis of thyroid function in Japanese patients with coronavirus disease 2019

Sachiko Nakamura et al.

Summary: Thyroid dysfunction caused by SARS-CoV-2 is increasingly recognized, with a significant proportion of patients showing abnormal thyroid hormone levels, particularly in severe cases. Thyroid hormone levels were inversely correlated with disease severity, and patients with low serum fT3 levels had a significantly higher mortality rate.

ENDOCRINE JOURNAL (2021)

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Correlation between inflammatory parameters and pituitary-thyroid axis in patients with COVID-19

Veronica Ilera et al.

Summary: This study evaluated the correlation between thyroid hormones and inflammatory markers, as well as the association with disease outcome in hospitalized COVID-19 patients. The results showed that T3 and T3/T4 were inversely correlated with inflammatory markers, and a low T3/T4 ratio was associated with disease severity and poor prognosis.

ENDOCRINE (2021)

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Article Endocrinology & Metabolism

Higher SARS-CoV-2 viral loads correlated with smaller thyroid volumes on ultrasound among male COVID-19 survivors

David Tak Wai Lui et al.

Summary: Thyroid dysfunction, including thyroiditis, is common in COVID-19 patients, but all abnormal thyroid function tests during acute COVID-19 recovered upon follow-up. Higher SARS-CoV-2 viral load on presentation were associated with smaller thyroid volumes, especially in men. There was no increased rate of ultrasonographic features suggestive of thyroiditis in COVID-19 survivors.

ENDOCRINE (2021)

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Assessment of thyroid function of newly diagnosed SARS-CoV-2 infected patients in Nigeria

Chika Juliet Okwor et al.

Summary: The study found that COVID-19 patients had significantly higher plasma levels of FT3 and TSH compared to controls, although most of them were euthyroid. However, some COVID-19 patients did exhibit thyroid function abnormalities, indicating the importance of monitoring thyroid function during and after COVID-19 treatment.

PAN AFRICAN MEDICAL JOURNAL (2021)

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Violating the normality assumption may be the lesser of two evils

Ulrich Knief et al.

Summary: The study finds that Gaussian models are robust to non-normal data, with p values remaining reliable in most conditions and showing good power. Parameter estimates are mostly unbiased and precise, except in cases of influential outliers or small sample sizes/highly skewed predictor distributions. Data transformation and visual inspection for outliers and heteroscedasticity are recommended before analysis.

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Thyroid Function Before, During, and After COVID-19

Bernard Khoo et al.

Summary: Most patients with COVID-19 present with euthyroidism. Mild reductions in TSH and FT4 were observed in COVID-19 patients, consistent with a nonthyroidal illness syndrome. In survivors of COVID-19, thyroid function tests at follow-up returned to baseline.

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Thyroid Dysfunction in Relation to Immune Profile, Disease Status, and Outcome in 191 Patients with COVID-19

David Tak Wai Lui et al.

Summary: SARS-CoV-2-related thyroid dysfunction was observed in approximately 15% of mild to moderate COVID-19 patients, suggesting a direct impact of the virus on thyroid function and potential exacerbation of pre-existing autoimmune thyroid disease. Low fT3 levels, associated with systemic inflammation, may have prognostic implications for COVID-19 outcomes.

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W. Gao et al.

Summary: This study aimed to investigate the characteristics of thyroid hormone levels in COVID-19 patients, finding significantly lower free T3 concentrations in severe patients, with reduced FT3 independently predicting increased all-cause mortality in patients with severe COVID-19.

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