Thyroid Function Before, During, and After COVID-19

Khoo, Bernard; Tan, Tricia; Clarke, Sophie A; Mills, Edouard G; Patel, Bijal; Modi, Manish; Phylactou, Maria; Eng, Pei Chia; Thurston, Layla; Alexander, Emma C; Meeran, Karim; Comninos, Alexander N; Abbara, Ali; Dhillo, Waljit S

CONTEXT: The effects of COVID-19 on the thyroid axis remain uncertain. Recent evidence has been conflicting, with both thyrotoxicosis and suppression of thyroid function reported. OBJECTIVE: We aimed to detail the acute effects of COVID-19 on thyroid function and determine if these effects persisted on recovery from COVID-19. DESIGN: A cohort observational study was conducted. PARTICIPANTS AND SETTING: Adult patients admitted to Imperial College Healthcare National Health Service Trust, London, UK, with suspected COVID-19 between March 9 to April 22, 2020, were included, excluding those with preexisting thyroid disease and those missing either free thyroxine (FT4) or thyrotropin (TSH) measurements. Of 456 patients, 334 had COVID-19 and 122 did not. MAIN OUTCOME MEASURES: TSH and FT4 measurements were recorded at admission, and where available, in 2019 and at COVID-19 follow-up. RESULTS: Most patients (86.6%) presenting with COVID-19 were euthyroid, with none presenting with overt thyrotoxicosis. Patients with COVID-19 had a lower admission TSH and FT4 compared to those without COVID-19. In the COVID-19 patients with matching baseline thyroid function tests from 2019 (n = 185 for TSH and 104 for FT4), TSH and FT4 both were reduced at admission compared to baseline. In a complete case analysis of COVID-19 patients with TSH measurements at follow-up, admission, and baseline (n = 55), TSH was seen to recover to baseline at follow-up. CONCLUSIONS: Most patients with COVID-19 present with euthyroidism. We observed mild reductions in TSH and FT4 in keeping with a nonthyroidal illness syndrome. Furthermore, in survivors of COVID-19, thyroid function tests at follow-up returned to baseline.