ABSTRACT
BACKGROUND/AIM: The aims of the study are to compare characteristics of subacute thyroiditis (SAT) related to different aetiologies, and to identify predictors of recurrence of SAT and incident hypothyroidism. METHODS: This nationwide multicenter retrospective cohort study included 53 endocrinology centers in Turkey. The study participants were divided into either coronavirus disease-2019 (COVID-19)-related SAT (Cov-SAT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine-related SAT (Vac-SAT), or control SAT (Cont-SAT). RESULTS: Of the 811 patients, 258 (31·8%) were included in the Vac-SAT group, 98 (12·1%) in the Cov-SAT group, and 455 (56·1%) in the Cont-SAT group. No difference was found between the groups with regard to laboratory and imaging findings. The aetiology of SAT was not an independent predictor of recurrence or hypothyroidism. In the entire cohort, steroid therapy requirement and younger age were statistically significant predictors for SAT recurrence. C-reactive protein (CRP) measured during SAT onset, female gender, absence of anti-thyroid peroxidase (TPO) positivity, and absence of steroid therapy were statistically significant predictors of incident (early) hypothyroidism, irrespective of SAT aetiology. On the other hand, probable predictors of established hypothyroidism differed from that of incident hypothyroidism. CONCLUSION: Since there is no difference in terms of follow-up parameters and outcomes, COVID-19- and SARS-CoV-2- vaccine related SATs can be treated and followed up like classical SATs. The recurrence was determined by the younger age and steroid therapy requirement. Steroid therapy independently predict incident hypothyroidism that may sometimes be transient in overall SATs and is also associated with lower risk of established hypothyroidism.
ABSTRACT
BACKGROUND: COVID-19 has caused a pandemic and is associated with significant mortality. The pathophysiology of COVID-19, affecting many organs and systems, is still being investigated. The hypothalamus, pituitary gland, and possibly adrenal glands are the targets of SARS-CoV-2 because of its angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) receptors expression. Hypocortisolemia can be seen in the postinfection period. COVID-19 infection tends to be severe in diabetic patients due to immune dysfunction. In this study, our aim was to investigate the relationship between basal cortisol levels and the course of COVID-19 infection in diabetic and non-diabetic patients. METHODS: Our retrospective study included 311 PCR-positive COVID-19 patients over the age of 18 who were hospitalized in Ankara City Hospital Infectious Diseases Department or Intensive Care Unit (ICU) between 15 March 2020 and 15 May 2020. Serum basal cortisol, fasting plasma glucose (FPG), HbA1c values, and diabetes history were recorded within the first 24 h of hospitalization. The presence of pulmonary involvement was noted from the patients' imaging records. Pregnant and breastfeeding women, patients with chronic liver disease or chronic kidney disease, and patients who were already using steroids or had started COVID-19 infection treatment within the 72 h before blood collection were excluded from the study. RESULTS: Of the 311 patients, 100 had Type 2 Diabetes Mellitus (T2D), while 211 did not. The age, serum basal cortisol, and glucose levels of the patients with T2D (64.51 ± 12.29, 19.5 ± 13.12, and 143.5 (77-345)) were higher than those of the patients without T2D (46.67 ± 16.38, 15.26 ± 8.75, and 96 (65-202)), and the differences were statistically significant (p = 0.004, p = 0.004, and p < 0.001, respectively). The basal cortisol values of the ICU patients (27.89 (13.91-75)) were significantly higher than those of the ward patients (13.68 (1.48-51.93)) and patients who were transferred to the ICU from the ward due to worsening conditions (19.28 (7.74-55.21)) (p < 0.001 and p = 0.007, respectively). The factors affecting ICU admission were determined to be age, T2D history, basal cortisol, and elevation in FPG using univariate logistic regression analysis. In the multiple logistic regression analysis, age, basal cortisol level, and infiltrative involvement in thorax CT were determined to be the risk factors affecting intensive care admission. CONCLUSION: High basal cortisol levels in patients with T2D may predict the severity of COVID-19 infection or mortality. Although high basal cortisol levels are among the risk factors affecting ICU admission, patients with COVID-19 should also be evaluated in terms of clinical and laboratory findings and relative adrenal insufficiency.