Clinical presentation and prognosis of COVID-19 in older adults with hypothyroidism: data from the GeroCovid observational study.
Aged
COVID-19
GeroCovid study
Hypothyroidism
Prognosis
Journal
Journal of endocrinological investigation
ISSN: 1720-8386
Titre abrégé: J Endocrinol Invest
Pays: Italy
ID NLM: 7806594
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
22
08
2022
accepted:
20
02
2023
medline:
28
7
2023
pubmed:
27
3
2023
entrez:
26
3
2023
Statut:
ppublish
Résumé
The prevalence of hypothyroidism among older patients hospitalized for COVID-19 and its association with mortality is unclear. This study aims to investigate the prevalence of hypothyroidism in older COVID-19 inpatients and verify if this comorbidity is associated with a specific pattern of onset symptoms and a worse prognosis. COVID-19 inpatients aged ≥ 60 years, participating in the GeroCovid acute wards cohort, were included. The history of hypothyroidism was derived from medical records and the use of thyroid hormones. Sociodemographic data, comorbidities, symptoms/signs at the disease onset and inflammatory markers at ward admission were compared between people with vs without history of hypothyroidism. The association between hypothyroidism and in-hospital mortality was tested through Cox regression. Of the 1245 patients included, 8.5% had a history of hypothyroidism. These patients were more likely to present arterial hypertension and obesity compared with those without an history of hypothyroidism. Concerning COVID-19 clinical presentation, patients with hypothyroidism had less frequently low oxygen saturation and anorexia but reported muscle pain and loss of smell more commonly than those without hypothyroidism. Among the inflammatory markers, patients with hypothyroidism had higher lymphocytes values. At Cox regression, hypothyroidism was associated with reduced in-hospital mortality only in the univariable model (HR = 0.66, 95% CI 0.45-0.96, p = 0.03); conversely, no significant result were observed after adjusting for potential confounders (HR = 0.69, 95% CI 0.47-1.03, p = 0.07). Hypothyroidism does not seem to substantially influence the prognosis of COVID-19 in older people, although it may be associated with peculiar clinical and biochemical features at the disease onset.
Sections du résumé
BACKGROUND
BACKGROUND
The prevalence of hypothyroidism among older patients hospitalized for COVID-19 and its association with mortality is unclear. This study aims to investigate the prevalence of hypothyroidism in older COVID-19 inpatients and verify if this comorbidity is associated with a specific pattern of onset symptoms and a worse prognosis.
METHODS
METHODS
COVID-19 inpatients aged ≥ 60 years, participating in the GeroCovid acute wards cohort, were included. The history of hypothyroidism was derived from medical records and the use of thyroid hormones. Sociodemographic data, comorbidities, symptoms/signs at the disease onset and inflammatory markers at ward admission were compared between people with vs without history of hypothyroidism. The association between hypothyroidism and in-hospital mortality was tested through Cox regression.
RESULTS
RESULTS
Of the 1245 patients included, 8.5% had a history of hypothyroidism. These patients were more likely to present arterial hypertension and obesity compared with those without an history of hypothyroidism. Concerning COVID-19 clinical presentation, patients with hypothyroidism had less frequently low oxygen saturation and anorexia but reported muscle pain and loss of smell more commonly than those without hypothyroidism. Among the inflammatory markers, patients with hypothyroidism had higher lymphocytes values. At Cox regression, hypothyroidism was associated with reduced in-hospital mortality only in the univariable model (HR = 0.66, 95% CI 0.45-0.96, p = 0.03); conversely, no significant result were observed after adjusting for potential confounders (HR = 0.69, 95% CI 0.47-1.03, p = 0.07).
CONCLUSIONS
CONCLUSIONS
Hypothyroidism does not seem to substantially influence the prognosis of COVID-19 in older people, although it may be associated with peculiar clinical and biochemical features at the disease onset.
Identifiants
pubmed: 36967417
doi: 10.1007/s40618-023-02048-w
pii: 10.1007/s40618-023-02048-w
pmc: PMC10040305
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1891-1899Investigateurs
Rachele Antognoli
(R)
Raffaele Antonelli Incalzi
(RA)
Maria Paola Antonietti
(MP)
Viviana Bagalà
(V)
Giulia Bandini
(G)
Giuseppe Bellelli
(G)
Enrico Benvenuti
(E)
Marina Bergamin
(M)
Marco Bertolotti
(M)
Carlo Adriano Biagini
(CA)
Angelo Bianchetti
(A)
Alessandra Bianchi
(A)
Mariangela Bianchi
(M)
Silvia Bignamini
(S)
Damiano Blandini
(D)
Stefano Boffelli
(S)
Maura Bugada
(M)
Valeria Calsolaro
(V)
Donatella Calvani
(D)
Elisiana Carpagnano
(E)
Barbara Carrieri
(B)
Viviana Castaldo
(V)
Alessandro Cavarape
(A)
Ilaria Cazzulani
(I)
Carilia Celesti
(C)
Chiara Ceolin
(C)
Maria Giorgia Ceresini
(MG)
Antonio Cherubini
(A)
Anita Chizzoli
(A)
Erika Ciarrocchi
(E)
Paola Cicciomessere
(P)
Alessandra Coin
(A)
Annalisa Corsi
(A)
Carlo Custodero
(C)
Federica D'Agostino
(F)
Maria Maddalena D'Errico
(MM)
Aurelio De Iorio
(A)
Alessandro De Marchi
(A)
Giovambattista Desideri
(G)
Evelyn Di Matteo
(E)
Emma Espinosa
(E)
Luigi Esposito
(L)
Chiara Fazio
(C)
Chiara Filippini
(C)
Lucia Fiore
(L)
Caterina Fontana
(C)
Lina Forte
(L)
Riccardo Franci Montorzi
(RF)
Carlo Fumagalli
(C)
Stefano Fumagalli
(S)
Pietro Gareri
(P)
Antonella Giordano
(A)
Evelina Giuliani
(E)
Antonio Greco
(A)
Andrea Herbst
(A)
Giuseppe Ielo
(G)
Antonella La Marca
(A)
Umberto Porta
(U)
Ilaria Lazzari
(I)
Diana Lelli
(D)
Yari Longobucco
(Y)
Flaminia Lucchini
(F)
Daniela Lucente
(D)
Lorenzo Maestri
(L)
Marcello Maggio
(M)
Paola Mainquà
(P)
Alessandra Marengoni
(A)
Benedetta Martin
(B)
Valentina Massa
(V)
Liliana Mazza
(L)
Carmela Mazzoccoli
(C)
Fabio Monzani
(F)
Enrico Mossello
(E)
Federica Morellini
(F)
Chiara Mussi
(C)
Chukwuma Okoye
(C)
Giuseppe Orio
(G)
Annalisa Paglia
(A)
Giulia Pelagalli
(G)
Laura Pelizzoni
(L)
Alessandro Picci
(A)
Anette Hylen Ranhoff
(AH)
Francesca Remelli
(F)
Onofrio Resta
(O)
Antonella Riccardi
(A)
Daniela Rinaldi
(D)
Renzo Rozzini
(R)
Carlo Sabbà
(C)
Leonardo Sacco
(L)
Mariateresa Santoliquido
(M)
Mariella Savino
(M)
Francesco Scarso
(F)
Giuseppe Sergi
(G)
Gaetano Serviddio
(G)
Chiara Sidoli
(C)
Vincenzo Solfrizzi
(V)
Benedetta Soli
(B)
Laura Tafaro
(L)
Andrea Tedde
(A)
Giuseppe Dario Testa
(GD)
Maria Giulia Tinti
(MG)
Francesco Tonarelli
(F)
Elisabetta Tonon
(E)
Caterina Trevisan
(C)
Aurora Vitali
(A)
Stefano Volpato
(S)
Francesca Zoccarato
(F)
Sonia Zotti
(S)
Informations de copyright
© 2023. The Author(s), under exclusive licence to Italian Society of Endocrinology (SIE).
Références
Zhou F et al (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395(10229):1054–1062. https://doi.org/10.1016/S0140-6736(20)30566-3
pubmed: 32171076
pmcid: 7270627
Reilev M et al (2020) Characteristics and predictors of hospitalization and death in the first 11 122 cases with a positive RT-PCR test for SARS-CoV-2 in Denmark: a nationwide cohort. Int J Epidemiol 49(5):1468–1481. https://doi.org/10.1093/ije/dyaa140
pubmed: 32887982
pmcid: 7499657
Tsivgoulis G et al (2021) Hypothyroidism is associated with prolonged COVID-19-induced anosmia: a case–control study. J Neurol Neurosurg Psychiatry 92(8):911–912. https://doi.org/10.1136/jnnp-2021-326587
Bakshi SS, Kalidoss VK (2021) Is there an association between hypothyroidism and COVID 19? Wien Klin Wochenschr 133(7–8):414–415. https://doi.org/10.1007/s00508-021-01813-2
pubmed: 33537842
pmcid: 7857644
Lania A, Sandri MT, Cellini M, Mirani M, Lavezzi E, Mazziotti G (2020) Thyrotoxicosis in patients with COVID-19: the THYRCOV study. Eur J Endocrinol 183(4):381–387. https://doi.org/10.1530/EJE-20-0335
pubmed: 32698147
pmcid: 9494315
Murugan AK, Alzahrani AS (2021) SARS-CoV-2: emerging role in the pathogenesis of various thyroid diseases. J Inflamm Res 14:6191–6221. https://doi.org/10.2147/JIR.S332705
pubmed: 34853527
pmcid: 8628126
Venditti P, di Meo S (2006) Thyroid hormone-induced oxidative stress. Cell Mol Life Sci 63(4):414–434. https://doi.org/10.1007/s00018-005-5457-9
pubmed: 16389448
Beck MA, Handy J, Levander OA (2006) The role of oxidative stress in viral infections. Ann N Y Acad Sci 917(1):906–912. https://doi.org/10.1111/j.1749-6632.2000.tb05456.x
de Vito P, Incerpi S, Pedersen JZ, Luly P, Davis FB, Davis PJ (2011) Thyroid hormones as modulators of immune activities at the cellular level. Thyroid 21(8):879–890. https://doi.org/10.1089/thy.2010.0429
pubmed: 21745103
Trevisan C et al (2021) Assessing the impact of COVID-19 on the health of geriatric patients: the European GeroCovid observational study. Eur J Intern Med 87:29–35. https://doi.org/10.1016/j.ejim.2021.01.017
pubmed: 33573885
pmcid: 7847394
Monzani F (2022) Infezione da SARS-COV-2 e funzione tiroidea. Conference proceedings of 67° national conference of S.I.G.G., Rome, Italy, p 5–6
WHO R&D Blueprint (2020) novel Coronavirus COVID-19 - therapeutic trial synopsis. Geneva, Switzerland. https://www.who.int/publications/i/item/covid-19-therapeutic-trial-synopsis . Accessed Jan 2022
Decandia F (2018) Risk factors for cardiovascular disease in subclinical hypothyroidism. Ir J Med Sci 187(1):39–43. https://doi.org/10.1007/s11845-017-1617-9
pubmed: 28493136
Narasaki Y, Sohn P, Rhee CM (2021) The interplay between thyroid dysfunction and kidney disease. Semin Nephrol 41(2):133–143. https://doi.org/10.1016/j.semnephrol.2021.03.008
pubmed: 34140092
pmcid: 8221115
Iglesias P, Bajo MA, Selgas R, Díez JJ (2017) Thyroid dysfunction and kidney disease: an update. Rev Endocr Metab Disord 18(1):131–144. https://doi.org/10.1007/s11154-016-9395-7
pubmed: 27864708
Wu K et al (2017) Thyrotropin alters T cell development in the thymus in subclinical hypothyroidism mouse model. Scand J Immunol 85(1):35–42. https://doi.org/10.1111/sji.12507
pubmed: 27864993
Pascual A, Aranda A (2013) Thyroid hormone receptors, cell growth and differentiation. Biochim Biophys Acta 1830(7):3908–3916. https://doi.org/10.1016/j.bbagen.2012.03.012
pubmed: 22484490
Amin A, Dhillo WS, Murphy KG (2011) The central effects of thyroid hormones on appetite. J Thyroid Res 2011:1–7. https://doi.org/10.4061/2011/306510
Salvatore D, Simonides WS, Dentice M, Zavacki AM, Larsen PR (2014) Thyroid hormones and skeletal muscle—new insights and potential implications. Nat Rev Endocrinol 10(4):206–214. https://doi.org/10.1038/nrendo.2013.238
pubmed: 24322650
Baskoy K et al (2016) Is there any effect on smell and taste functions with levothyroxine treatment in subclinical hypothyroidism? PLoS One 11(2):e0149979. https://doi.org/10.1371/journal.pone.0149979
pubmed: 26927632
pmcid: 4771174
Tan L et al (2020) Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduct Target Ther 5(1):33. https://doi.org/10.1038/s41392-020-0148-4
pubmed: 32296069
pmcid: 7100419
Schwarz Y, Percik R, Oberman B, Yaffe D, Zimlichman E, Tirosh A (2021) Sick euthyroid syndrome on presentation of patients with COVID-19: a potential marker for disease severity. Endocr Pract 27(2):101–109. https://doi.org/10.1016/j.eprac.2021.01.001
pubmed: 33551316
pmcid: 7834506
Ruggeri RM et al (2021) SARS-COV-2-related immune-inflammatory thyroid disorders: facts and perspectives. Expert Rev Clin Immunol 17(7):737–759. https://doi.org/10.1080/1744666X.2021.1932467
pubmed: 34015983
Malik J et al (2021) Association of hypothyroidism with acute COVID-19: a systematic review. Expert Rev Endocrinol Metab 16(5):251–257. https://doi.org/10.1080/17446651.2021.1968830
pubmed: 34424110
Horisberger A, Moi L, Ribi C, Comte D (2020) Autoimmune diseases in the context of pandemic COVID-19. Rev Med Suisse 16(N° 691–2):827–830
pubmed: 32348045
Pereira DN et al (2022) Hypothyroidism does not lead to worse prognosis in COVID-19: findings from the Brazilian COVID-19 registry. Int J Infect Dis 116:319–327. https://doi.org/10.1016/j.ijid.2022.01.016
pubmed: 35065257
pmcid: 8769529
Society for Endocrinology (2020) BTA/SFE statement regarding issues specific to thyroid dysfunction during the COVID-19 pandemic. https://www.british-thyroid-association.org/sandbox/bta2016/management-of-thyroid-dysfunction-during-covid-19_final.pdf . Accessed Feb 2022
Journy NMY, Bernier M-O, Doody MM, Alexander BH, Linet MS, Kitahara CM (2017) Hyperthyroidism, hypothyroidism, and cause-specific mortality in a large cohort of women. Thyroid 27(8):1001–1010. https://doi.org/10.1089/thy.2017.0063
pubmed: 28578598
pmcid: 5564026
Naymagon L et al (2020) Admission D-dimer levels, D-dimer trends, and outcomes in COVID-19. Thromb Res 196:99–105. https://doi.org/10.1016/j.thromres.2020.08.032
pubmed: 32853982
pmcid: 7439969