Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors
- Author:
David Tak Wai LUI
1
;
Chi Ho LEE
;
Wing Sun CHOW
;
Alan Chun Hong LEE
;
Anthony Raymond TAM
;
Carol Ho Yi FONG
;
Chun Yiu LAW
;
Eunice Ka Hong LEUNG
;
Kelvin Kai Wang TO
;
Kathryn Choon Beng TAN
;
Yu Cho WOO
;
Ching Wan LAM
;
Ivan Fan Ngai HUNG
;
Karen Siu Ling LAM
Author Information
- Publication Type:Original Article
- From:Endocrinology and Metabolism 2021;36(3):582-589
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:The occurrence of Graves’ disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors.
Methods:We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months.
Results:In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer.
Conclusion:Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.
