Page 19 - HKSEMR2020 Programme book

Oral Presentation (Clinical) Abstracts

Thyroid dysfunction in relation to immune profile, viral load, disease

status and outcome in 191 patients with COVID-19

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David Tak Wai Lui , Chi Ho Lee , Wing Sun Chow , Alan Chun Hong Lee , Anthony
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Raymond Tam , Carol Ho Yi Fong , Chun Yiu Law , Eunice Ka Hong Leung , Kelvin Kai
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Wang To , Kathryn Choon Beng Tan , Yu Cho Woo , Ching Wan Lam , Ivan Fan Ngai
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Hung , Karen Siu Ling Lam
1. Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China; 2. Division of
Chemical Pathology, Queen Mary Hospital, Hong Kong, China; 3. Department of Microbiology, The University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; 4. Department of Pathology, The University of Hong Kong,
Hong Kong, China
Introduction / Background / Objectives: of subclinical hyperthyroidism due to thyroiditis, with a possible
contribution of autoimmunity in two. Autoimmune thyroiditis
Cases of SARS-CoV-2-related thyroiditis have been reported
since May 2020, and were further revealed to occur in cohorts of probably contributed to subclinical hypothyroidism in another
mainly severe COVID-19 patients. Whether thyroid autoimmunity patient. Ten patients had isolated low fT3, likely representing
and SARS-CoV-2 viral load play a role in thyroid dysfunction is non-thyroidal illness (NTI). More febrile patients had low TSH (p
unknown. We evaluated the thyroid function in relation to clinical = 0.030) or low fT3 (p = 0.015). Higher SARS-CoV-2 viral load
features, biochemical, immunological and inflammatory markers, and elevated C-reactive protein were independently associated
and viral load in a cohort of COVID-19 patients. with occurrence of low TSH (p = 0.030) and low fT3 (p = 0.007),
respectively. There was a decreasing trend of fT3 with increasing
COVID-19 severity (p = 0.032). Erythrocyte sedimentation rate (p
Methods: < 0.001) was independently and inversely correlated with fT3/fT4
ratio, the indirect index of deiodinase activity, consistent with the
Consecutive adult patients admitted to Queen Mary Hospital for association between systemic inflammation and NTI. Patients with
COVID-19 from 21 July to 21 August, 2020 were included. Patients low fT3 had more adverse COVID-19-related outcomes, including
with known thyroid disorders, who were on thyroid medications, dexamethasone and/or supplementary oxygen requirement.
or medications that might impact thyroid function, were excluded.
Blood tests including serum levels of thyroid-stimulating hormone
(TSH), free thyroxine, free triiodothyronine (fT3) and anti-thyroid Conclusion:
antibodies were measured in each patient on admission.
Thyroid dysfunction occurred in around 15% of COVID-19 patients.
A direct effect of SARS-CoV-2 on thyroid function was suggested.
Results / Outcomes: Whether the viral infection could trigger autoimmune thyroid
diseases remained speculative. Low fT3 was associated with
Among 191 patients with COVID-19, 84.3% were mild, 12.6% systemic inflammation and may have prognostic significance.
were moderate, and 3.1% were severe. Mean age was 53.5±17.2 Clinicians should be vigilant about the possible presence of thyroid
years, and 51.8% were men. Abnormal thyroid function tests were dysfunction among COVID-19 patients, especially in the context of
found in 13.1%. Ten patients had isolated low TSH, suggestive fever, high viral loads and inflammatory markers.

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