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Repercussão da infeção por SARS-CoV-2 na função tiroideia
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Apesar do novo coronavírus que viria a ser conhecido por SARS-CoV-2 ter sido detetado já no final de 2019, as questões sobre as consequências no funcionamento da glândula tiroide no decurso da doença que origina (COVID-19) são ainda mal conhecidas. Esta glândula pode ser particularmente suscetível ao SARS-CoV-2 pois este vírus entra nas células através dos recetores ACE-2, que são expressos na tiroide. Realizámos um estudo observacional, retrospetivo e longitudinal investigando os níveis séricos da hormona tiroestimulante (TSH) e da fração livre da hormona tiroxina (fT4) em doentes adultos com infeção por SARS-CoV-2 internados numa enfermaria de medicina interna de um hospital terciário. Deste modo, foi avaliada a função tiroideia de 221 doentes e estudada a correlação entre estas alterações e a gravidade e mortalidade da doença. Num subgrupo de 20 doentes com registos de valores de função tiroideia em seguimento após a alta hospitalar, foram investigadas igualmente eventuais alterações nesta função. Verificámos um elevado valor preditivo dos valores de TSH e fT4 séricos para o grau de gravidade da COVID-19 (OR=2,5; p=0,02) (teste qui-quadrado de Pearson). Foi possível demonstrar que valores baixos de TSH (média 0,18 um/L) e de fT4 (média 0,6 pmol/L) têm um valor preditivo para a mortalidade (OR = 2,3; p= 0.046) superior a outros parâmetros registados aquando do internamento hospitalar como: sexo, hipertensão arterial, diabetes mellitus, obesidade, tabagismo, IL-6 e PCR. Na avaliação dos doentes, após a doença aguda, os valores da função tiroideia têm tendência a retornar aos valores normais. Os registos da diminuição de TSH e fT4 observados podem estar em linha com a Síndrome do Doente Eutirodeu que tem vindo a ser descrita nos doentes com COVID-19, podendo esta síndrome revelar-se como elemento (de pior) prognóstico na evolução clínica da infeção por SARS-CoV-2.
The new coronavirus, also known as SARS-CoV-2, was detected at the end of 2019. Despite this fact, there are several questions about its consequences on the functioning of the thyroid gland which are still poorly understood. This gland may be particularly susceptible to SARS-CoV-2 as this virus enters cells through ACE-2 receptors, which are expressed in large numbers in the thyroid. We performed an observational, retrospective and longitudinal study where we examined the serum levels of thyroid-stimulating hormone (TSH) and the free fraction of the hormone thyroxine (fT4) in adult patients with SARS-CoV-2 infection admitted to an internal medicine ward of a tertiary hospital. Thus, the thyroid function of 221 patients was evaluated and the correlation between these alterations and the severity and mortality of the disease was studied. In a subgroup of 20 patients we evaluated thyroid function after hospital discharge. We found a high predictive value of serum TSH and fT4 values for the severity of COVID-19 (OR=2.5; p=0.02) (Pearson's chi-square test). It was possible to demonstrate that low values of TSH (mean 0.18 pmol/L) and fT4 (mean 0.6 pmol/L) have a higher predictive value for mortality (OR = 2.3; p= 0.046) than other commonly used input data: sex, arterial hypertension, diabetes mellitus, obesity, smoking, IL-6 and CRP. In the follow up cohort, thyroid function values tend to return to normal values over time. TSH and fT4 decreased values may be in line with the Euthyroid Sick Syndrome that has been described in acute diseases as well as in patients with COVID-19. This syndrome may prove to have a higher prognostic value in the clinical course of the infection by SARS-CoV-2 than other commonly used input data.
The new coronavirus, also known as SARS-CoV-2, was detected at the end of 2019. Despite this fact, there are several questions about its consequences on the functioning of the thyroid gland which are still poorly understood. This gland may be particularly susceptible to SARS-CoV-2 as this virus enters cells through ACE-2 receptors, which are expressed in large numbers in the thyroid. We performed an observational, retrospective and longitudinal study where we examined the serum levels of thyroid-stimulating hormone (TSH) and the free fraction of the hormone thyroxine (fT4) in adult patients with SARS-CoV-2 infection admitted to an internal medicine ward of a tertiary hospital. Thus, the thyroid function of 221 patients was evaluated and the correlation between these alterations and the severity and mortality of the disease was studied. In a subgroup of 20 patients we evaluated thyroid function after hospital discharge. We found a high predictive value of serum TSH and fT4 values for the severity of COVID-19 (OR=2.5; p=0.02) (Pearson's chi-square test). It was possible to demonstrate that low values of TSH (mean 0.18 pmol/L) and fT4 (mean 0.6 pmol/L) have a higher predictive value for mortality (OR = 2.3; p= 0.046) than other commonly used input data: sex, arterial hypertension, diabetes mellitus, obesity, smoking, IL-6 and CRP. In the follow up cohort, thyroid function values tend to return to normal values over time. TSH and fT4 decreased values may be in line with the Euthyroid Sick Syndrome that has been described in acute diseases as well as in patients with COVID-19. This syndrome may prove to have a higher prognostic value in the clinical course of the infection by SARS-CoV-2 than other commonly used input data.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
SARS-CoV-2 COVID-19 Função tiroideia Glândula tiroide Síndrome do doente eutiroideu