Population-level impact of COVID-19 on thyroid function tests: Results from a repeated cross-sectional study

IF 4 3区医学 Q1 INFECTIOUS DISEASES Journal of Infection and Public Health Pub Date : 2025-01-22 DOI:10.1016/j.jiph.2025.102681

Gabriel Berkebile , Françoise Barbé , Catherine Malaplate , Lauriane Le Collen , Jean-Louis Guéant , Marc Klein , Abderrahim Oussalah

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Abstract

Purpose

Reports have highlighted thyroid abnormalities, including subacute thyroiditis and thyrotoxicosis, in COVID-19 patients, with a potential link between thyroid dysfunction and disease severity. However, population-level studies on COVID-19’s impact on thyroid hormone levels are limited. We aimed to assess the impact of the COVID-19 pandemic on thyroid function tests at the population level.

Methods

We conducted a repeated cross-sectional study on consecutive patients who underwent thyroid function tests between March 1 and April 15, 2020, during the first wave of COVID-19 in northeastern France, and compared the results with those from the same period in 2018 and 2019.

Results

The study analyzed 3968 tests, including 1534 in 2018, 1547 in 2019, and 887 in 2020. Patients tested in the first wave of COVID-19 had significantly lower TSH and FT3 levels and higher FT4 levels than those in reference periods. On ROC analysis, the optimal thresholds for FT3 and FT4 were ≤ 4.5 pmol/L and > 12 pmol/L, respectively. On multivariable analysis, FT3 ≤ 4.5 pmol/L and FT4 > 12 pmol/L were independently associated with the first wave of COVID-19. The proportion of subjects with concurrent changes in FT3 and FT4 levels was significantly higher in 2020 than in the reference periods, with an odds ratio of 3.62 (95 % CI, 2.77–4.73). A phenome-wide association study of 128 clinical and biological predictors identified an independent association between a low FT3/FT4 ratio and COVID-19, hypertension, or amiodarone therapy, suggesting the contribution of euthyroid sick syndrome to this presentation. This association remained significant after adjustment for potential confounders such as thyroid disease, steroids, and iodinated contrast injection.

Conclusion

These findings suggest that COVID-19 is associated with significant population-level variation in thyroid function tests, which may have implications for managing COVID-19 patients.

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人群水平的COVID-19对甲状腺功能测试的影响：来自重复横断面研究的结果

目的：有报道强调了COVID-19患者的甲状腺异常，包括亚急性甲状腺炎和甲状腺毒症，甲状腺功能障碍与疾病严重程度之间存在潜在联系。然而，关于COVID-19对甲状腺激素水平影响的人群水平研究有限。我们的目的是评估COVID-19大流行对人群水平甲状腺功能检测的影响。方法：我们对2020年3月1日至4月15日法国东北部第一波COVID-19期间连续接受甲状腺功能检查的患者进行了重复横断面研究，并将结果与2018年和2019年同期的结果进行了比较。结果：该研究分析了3968次测试，其中2018年为1534次，2019年为1547次，2020年为887次。第一波新冠肺炎患者的TSH和FT3水平明显低于参考期，FT4水平明显高于参考期。经ROC分析，FT3和FT4的最佳阈值分别为≤ 4.5 pmol/L和> 12 pmol/L。多变量分析FT3 ≤ 4.5 pmol/L、FT4 > 12 pmol/L与第一波新冠肺炎独立相关。2020年FT3和FT4水平同时发生变化的受试者比例显著高于参考期，优势比为3.62（95 % CI, 2.77-4.73）。一项涉及128个临床和生物学预测因子的全现象相关性研究发现，低FT3/FT4比率与COVID-19、高血压或胺碘酮治疗之间存在独立关联，表明甲状腺功能亢进综合征与这种表现有关。在排除甲状腺疾病、类固醇和碘化造影剂等潜在混杂因素后，这种相关性仍然显著。结论：这些研究结果表明，COVID-19与甲状腺功能检查的显着人群水平差异相关，这可能对COVID-19患者的管理具有重要意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.