BACKGROUND: Thyroid dysfunction has been observed in patients with COVID-19, and endocrinologists are requested to understand this clinical issue . Pandemic-related restrictions and reorganization of healthcare services may affect thyroid disease management .
METHODS: To analyze and discuss the relationship between COVID-19 and thyroid diseases from several perspectives . PubMed/MEDLINE, Google Scholar, Scopus, ClinicalTrial.gov were searched for this purpose by using free text words and medical subject headings as follows:``sars cov 2",``covid 19",``subacute thyroiditis",``atypical thyroiditis",``chronic thyroiditis",``hashimoto's thyroiditis",``graves' disease",``thyroid nodule",``differentiated thyroid cancer",``medullary thyroid cancer",``methimazole",``levothyroxine",``multikinase inhibitor",``remdesivir",``tocilizumab". Data were collected, analyzed, and discussed to answer the following clinical questions:``What evidence suggests that COVID-19 may induce detrimental consequences on thyroid function? ``;``Could previous or concomitant thyroid diseases deteriorate the prognosis of COVID-19 once the infection has occurred? ``;``Could medical management of thyroid diseases influence the clinical course of COVID-19? ``;``Does medical management of COVID-19 interfere with thyroid function? ``;``Are there defined strategies to better manage endocrine diseases despite restrictive measures and in-hospital and ambulatory activities reorganizations?".
RESULTS: SARS-CoV-2 may induce thyroid dysfunction that is usually reversible, including subclinical and atypical thyroiditis . Patients with baseline thyroid diseases are not at higher risk of contracting or transmitting SARS-CoV-2, and baseline thyroid dysfunction does not foster a worse progression of COVID-19 . However, it is unclear whether low levels of free triiodothyronine, observed in seriously ill patients with COVID-19, may worsen the disease's clinical progression and, consequently, if triiodothyronine supplementation could be a tool for reducing this burden . Glucocorticoids and heparin may affect thyroid hormone secretion and measurement, respectively, leading to possible misdiagnosis of thyroid dysfunction in severe cases of COVID-19 . High-risk thyroid nodules require a fine-needle aspiration without relevant delay, whereas other non-urgent diagnostic procedures and therapeutic interventions should be postponed .
DISCUSSION: Currently, we know that SARS-CoV-2 could lead to short-term and reversible thyroid dysfunction, but thyroid diseases seem not to affect the progression of COVID-19 . Adequate management of patients with thyroid diseases remains essential during the pandemic, but it could be compromised because of healthcare service restrictions . Endocrine care centers should continuously recognize and classify priority cases for in-person visits and therapeutic procedures . Telemedicine may be a useful tool for managing patients not requiring in-person visits.
Index: COVID-19, Chronic lymphocytic thyroiditis, Graves’ disease, Hyperthyroidism, Hypothyroidism, Pandemic, SARS-CoV-2, Subclinical thyroiditis, Thyroid nodules