Evaluation of the hypothalamo-pituitary-adrenal axis during the post-COVID-19 period in patients treated with steroids during the illness

ABSTRACT Objective: COVID-19 is a multisystem immunoinflammatory disorder, and the hypothalamo-pituitary-adrenal (HPA) axis may be affected by SARS-CoV-2 as well as by steroid treatment during the illness. Information on the HPA axis after recovering from COVID-19, especially in those treated with steroids, is sparse. Hence, this study was performed to evaluate the hypothalamo-pituitary-adrenal axis during the post-COVID-19 period in patients treated with steroids during the illness. Subject and methods: This prospective study involved 60 patients aged 18-60 years who had recovered from moderate or severe COVID-19 and had received steroid treatment during the illness. The HPA axis was assessed with a low-dose (1 mcg) adrenocorticotropic hormone stimulation test at 3, 6 and 9 months in the post-COVID period. Results: The HPA axis was suppressed in 31.66% of the patients at 3 months and 5% at 6 months; however, all patients recovered at 9 months. Cumulative steroid use during the illness was inversely correlated with stimulated cortisol at 3 months in the post-COVID period. Fatigue was present in 58.33% of the patients at 3 months and was more prevalent in those with HPA axis suppression. Conclusion: Nearly one-third of the patients with moderate to severe COVID-19 who were treated with steroids had suppressed HPA axis at 3 months, with gradual recovery over a period of 9 months. Cumulative steroid equivalent dose, but not disease severity, was predictive of HPA axis suppression at 3 months.

Prevalence Of Vitamin D Deficiency In Hashimoto‘S Thyroiditis And Its Relation To Anti–Thyroid Peroxidase Antibodies

Context: vitamin D deficiency has been considered a risk factor for several autoimmune diseases. Few studies examined prevalence of vitamin D deficiency in autoimmune thyroid disease and have produced conflicting results. Aims: To study the prevalence of vitamin D deficiency in Hashimoto’s thyroiditis (HT)and to assess the correlation between vitamin D and Anti– thyroid peroxidase antibodies (TPO–Ab). Settings and Design: This is a cross sectional case control study. Methods and Material:A total of 100 subjects, 50 HT patients and 50 healthy controls who were age and sex matched were included in the study. Serum 25(OH)D, fT4, TSH, TPO–Abwere measured. Subjects were categorized as vitamin D deficient(<12 ng/ml),vitamin D insufficient(12–20 ng/ml) and vitamin D sufficient (>20 ng/ml) based upon recent consensus guidelines. HT patients were categorized into euthyroid, sub clinical hypothyroid and overt hypothyroid based on fT4 and TSH. Results:The mean 25(OH)D level was 13.19±7.43ng/ml and 13.66±8.61ng/ml in HT patients and healthy controls respectively.Prevalence of vitamin D deficiency was 56% in HT and 50% in controls. Vitamin D insufficiency was observed in 20% of HT and 36% of healthy controls. There was no significant difference in 25(OH)D levels of overt hypothyroid, subclinical hypothyroid and euthyroid HT patients(p=0.23). Pearson correlation analysis showed no significant correlation between vitamin D and TPO–Ab,TSH and fT4. Conclusions: The prevalence of vitamin D deficiency in hashimoto’s thyroiditis and healthy controls was similar. Vitamin D deficiency did not differ between euthyroid,sub clinical hypothyroid and overt hypothyroid patients of HT.There was no correlation between vitamin D and TPO–Ab.