Purpose

Inflammation plays a critical role in the progression of COVID-19. Nonthyroidal illness syndrome (NTIS) has been increasingly recognized in affected patients. We aim to evaluate the correlation of thyroid hormones with markers of inflammation and association with disease outcome in hospitalized patients with COVID-19, and in two profiles of NTIS (low T3-normal/low FT4 vs. low T3-high FT4).

Methods

consecutive patients admitted to a nonintensive care unit for COVID-19 were recruited. Infection was mild in 22%, moderate in 27.1% and severe in 50.8%; 7.41% died. T4, T3, FT4, FT3, and their ratios (T3/T4, FT3/FT4) were correlated with albumin, ferritin, fibrinogen, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lactate dehydrogenase (LDH), and D-dimer.

Results

Fifty five patients (50.9% men, median age 56 years) were included. Albumin correlated positively with T3 and hormones ratios, but negatively with FT4. T3, FT3, T3/T4, and FT3/FT4 correlated inversely with ferritin, fibrinogen, ESR, CRP, LDH, and D-dimer. FT4 showed direct correlation with fibrinogen and ESR. T3/T4 was lower in severe compared to mild/moderate disease [7.5 (4.5–15.5) vs. 9.2 (5.8–18.1); p = 0.04], and lower in patients who died than in those discharged [5 (4.53–5.6) vs. 8.1 (4.7–18.1); p = 0.03]. A low T3/high FT4 profile was associated with lower albumin, higher ferritin, and severity.

Conclusion

In this cohort, thyroid hormones correlated with inflammation and outcome. T3 and T3/T4 correlated inversely with inflammatory markers; a low T3/T4 ratio was associated with severity and poor prognosis. Patients with low T3 but high FT4 had higher ferritin, lower albumin, and more severe disease at presentation.

中文翻译：

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COVID-19患者炎症参数与垂体-甲状腺轴的相关性

目的

炎症在 COVID-19 的进展中起着关键作用。非甲状腺疾病综合征 (NTIS) 在受影响的患者中得到越来越多的认可。我们旨在评估 COVID-19 住院患者中甲状腺激素与炎症标志物的相关性以及与疾病结果的相关性，以及两种 NTIS 情况（低 T3-正常/低 FT4 与低 T3-高 FT4）。

方法

连续招募了因 COVID-19 入住非重症监护病房的患者。22% 为轻度感染，27.1% 为中度感染，50.8% 为重度感染；7.41% 死亡。T4、T3、FT4、FT3及其比值（T3/T4、FT3/FT4）与白蛋白、铁蛋白、纤维蛋白原、红细胞沉降率（ESR）、C反应蛋白（CRP）、乳酸脱氢酶（LDH）、和 D-二聚体。

结果

包括 55 名患者（50.9% 男性，中位年龄 56 岁）。白蛋白与 T3 和激素比率呈正相关，但与 FT4 呈负相关。T3、FT3、T3/T4 和 FT3/FT4 与铁蛋白、纤维蛋白原、ESR、CRP、LDH 和 D-二聚体呈负相关。FT4 显示与纤维蛋白原和 ESR 直接相关。与轻度/中度疾病相比，重症患者的 T3/T4 较低 [7.5 (4.5-15.5) 与 9.2 (5.8-18.1)；p  = 0.04]，并且在死亡患者中低于出院患者 [5 (4.53–5.6) vs. 8.1 (4.7–18.1)；p  = 0.03]。低 T3/高 FT4 谱与较低的白蛋白、较高的铁蛋白和严重程度相关。

结论

在这个队列中，甲状腺激素与炎症和结果相关。T3 和 T3/T4 与炎症标志物呈负相关；低 T3/T4 比值与严重程度和不良预后相关。T3 低但 FT4 高的患者在就诊时具有更高的铁蛋白、更低的白蛋白和更严重的疾病。