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. 2024 Sep 24:15:1361479.
doi: 10.3389/fendo.2024.1361479. eCollection 2024.

Association between thyroid function and prognosis of severe COVID-19 among patients with SARS-CoV-2 infection: a retrospective cohort study in China

Yaling Yang  1 , Lifang Qian  2 , Chenwei Wu  1 , Xinyue Xu  1 , Duoduo Qu  1 , Lihua Zhou  1 , Jia Liu  1 , Qin Zhu  1 , Chunhong Wang  1 , Xiaolong Zhao  1
Affiliations

Association between thyroid function and prognosis of severe COVID-19 among patients with SARS-CoV-2 infection: a retrospective cohort study in China

Yaling Yang et al. Front Endocrinol (Lausanne). .

Abstract

Objective: This study aims to examine the thyroid hormone profile and its association with severe coronavirus disease 2019 (COVID-19) in patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Methods: This retrospective cohort study enrolled patients admitted to a tertiary hospital due to SARS-CoV-2 infection between February 18 and May 18, 2022. Clinical data were collected retrospectively from the electronic medical record system. Based on the thyroid function, patients were divided into five groups: normal, non-thyroid illness syndrome (NTIS), hypothyroidism, thyrotoxicosis, and unclassified. The association between thyroid function and severe COVID-19 was detected using multivariable logistic regression and restricted cubic splines analysis.

Results: This study included 3,161 patients, with 7.7% of them developing severe COVID-19. 44.9% of the patients had normal thyroid function, 36.5% had NTIS, 6.7% had hypothyroidism, and 1.0% had thyrotoxicosis on admission. After adjusting for age, sex, and relevant clinical characteristics, NTIS and hypothyroidism were associated with increased risks of severe COVID-19 (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.59-3.56 and OR 2.29, 95% CI 1.23-4.26, respectively), compared to normal thyroid function group. Among patients with NTIS or hypothyroidism, higher levels of total triiodothyronine (TT3) are associated with lower risks of severe COVID-19 (OR 0.73, 95% CI 0.64-0.82, for every 0.1nmol/L increase in TT3 level).

Conclusion: Thyroid hormone profiles of NTIS or hypothyroidism are associated with increased risks of severe COVID-19. The decreased level of TT3 correlated with the increased risk of severe COVID-19 in patients with NTIS or hypothyroidism.

Keywords: SARS-CoV-2; non-thyroid illness syndrome; severe COVID-19; thyroid function; total triiodothyronine.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Distribution of thyroid function patterns on admission. Distribution of thyroid function patterns on admission among all the patients (A), severe COVID-19 patients (B), and not severe COVID-19 patients (C).
Figure 2
Figure 2
Association between thyroid function patterns and severe COVID-19. Model 1 multivariate logistic regression model adjusted age, sex, diabetes, and vaccination; Model 2 multivariate logistic regression model adjusted age, sex, diabetes, vaccination, AST≥3ULN, eGFR<30 ml/min/1.73m2, Ca, WBC, N/ly, D-Dimer. OR odds ratio, CI confidence interval, NTIS non-thyroidal illness syndrome. Missing data were filled using the K-nearest neighbors (KNN) method with a value of K=10.
Figure 3
Figure 3
Association between TT3 level and severe COVID-19 in patients infected with SARS-CoV-2 using restricted cubic splines. The model has 3 knots at 10th, 50th, and 90th percentiles. The Y-axis represents the OR of severe COVID-19 for any value of TT3 compared to individuals with a TT3 level of 1.06 nmol/L. The logistic regression was adjusted for age, sex, diabetes, vaccination, AST≥3ULN, eGFR<30 ml/min/1.73m2, Ca, WBC, N/ly, and D-Dimer. Missing data were filled using the K-nearest neighbors (KNN) method with a value of K=10. N=3161. CI confidence interval, TT3 total triiodothyronine.
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