Thyroid Function Analysis in 50 Patients with COVID-19: A Retrospective Study

[vocalEK]

Conclusions: The changes in serum TSH and TT3 levels may be important manifestations of the courses of COVID-19.

liebertpub.com/doi/full/10....

[diogenes Remembering]

Covid looks to be a kind of nonthyroidal illness, where TSH is often disturbed, along with in many cases FT3. Perhaps another example of the body's response to trauma.

[Polly91 in reply to diogenes]

Interesting paper and discussion Diogenes.

I think I had covid about 6 weeks ago (not tested) as I had a very red painful throat and headache- it lasted about 9 days. I still feel lacking in energy level.

I got my thyroid tested by my GP- and weirdly my TSH is 0.02 (0.27/4.2) and my T4 17.5 (12-22) and T3 3.9 (3.2-6.8).

These are considerably lower than what they were in February when last tested.

If I am right to believe I had covid-19 about 6 weeks ago then my experience seems to correlate well with this Chinese publication.

The paper talks about the thyroid tests reverting to normal after recovery from covid but there was no mention of timeframes ?

I’m curious as to why the TSH would be so low when the thyroid hormones are also low in range- wouldn’t the TSH go up to stimulate “production” of more thyroid hormone ?

Can the pituitary shut down spontaneously & permanently ?

Thanks Polly

[diogenes Remembering in reply to Polly91]

No, TSH return is often very slow and the whole T4/T3/TSH balance is lost for a while.

[Polly91 in reply to diogenes]

Thanks. I will be patient then.

[tattybogle]

Interesting. thanks for finding this.

So , severe covid lowered TSH more than would be expected by Non Thyroidal Illness.

But all TFT's returned to normal on recovery.

Next we need a similar study on those 'long haulers' who are not getting better, to see whether their TFT's have returned to normal or not.

[jimh111]

Interesting study. Looks like NTI / low T3 syndrome. Good that there is recovery afterwards.

It's possible that therapy (glucocorticoids) caused the NTI so that needs to be eliminated (if possible) in a future study.

I'm strongly of the opinion that insufficient attention (if any) is given to the dual roles of TSH: stimulating secretion and stimulating deiodinase. In this case T4 levels were unchanged which suggests there was selective reduction in TSH isoforms responsible for deiodinase. This could be useful for future research.

We need to move on from TSH immunoassays which just measure presence of TSH isoforms, we need to measure TSH activity in terms of stimulating thyroidal secretion and stimulating peripheral deiodinase, especially type-2 deiodinase which controls local T3 levels.

I'll write to the authors but don't expect a reply, medical researchers don't like patient ideas - not invented here.

[posthinking01 in reply to jimh111]

Hi there - interesting post thanks - I have written to many a researcher and medical person and more often than not I have received a reply - the ones who don't I believe still take it on board so keep writing .............I actually got a reply from a consultant I had written to in relation to his field of medicine and he said he found my thoughts on thyroid dysfunction in illness very interesting - many years later I actually read an article where he was writing about the same issue - keep writing.

[knitwitty]

One thing that does worry me somewhat , is that so many of us are self medicating with t3 , and if we were admitted to hospital with covid, we would not be given any T3 and I'm sure we'd go downhill health wise quite quickly.

This is one of the reasons I should like to be prescribed T3 on the NHS because at least then it would be written on my medical records that I have need for the T3.

[jimh111 in reply to knitwitty]

If you take T3 medication it's important to have it on your medical record so that you can at least argue for it to be given to you in hospital, or a relative to do so on your behalf.

There is another question, if low T3 syndrome protects against illnesses such as COVID-19 we should take a reduced dose during severe illness.

[knitwitty in reply to jimh111]

My doctor knows I am self medicating, but I doubt if I was ruched into hospital it would be mentioned if I was too unwell to speak up for myself!

Is it better to have low t3 levels if you are very unwell?

[jimh111 in reply to knitwitty]

I agree, but getting it on your medical records is at least the first step.

Nobody knows whether low T3 syndrome is 'protective or pathogenic'. i.e. whether it is good or bad. There are big ethical problems with a trial and the results for one disorder (e.g. cardiac arrest) may not apply to others. If it were me and COVID-19 I would probably reduce my L-T3 a little and cover my bets.

[NWA6 in reply to jimh111]

This convo has me perplexed! So if I got Covid I should reduce my T3 dose? I’ve spoken about being hospitalised with hubby and that I need him to make sure I’m given my T3 even though my NHS Endo has said that taking it is dangerous. Hubby is not a forthright man, he would really struggle with being affirmative with any medic. So are we saying not to worry? Or do I need to get my sister involved to be my advocate?

[Thyb in reply to NWA6]

Hi NWA6

I don't know the rules and regulations regarding your Local Hospitals...

Where we live Zero Relatives are allowed in the Hospitals regarding of reason for being admitted.....same if a Child was admitted It's bad but I know of 2 Parents who have experienced this...

I've had 'First hand experience a Month ago' when Ambulance came for my Husband....Paramedics told me 'no point coming to the Hospital they don't allow relatives' - A lengthy message says same when I rang the Hospital....Same is Always on Local Radio Station....

Thankfully, he was home after 12 hours!

[NWA6 in reply to Thyb]

I realise the rules in hospitals atm. My sister lives in NI so it would be phone calls anyway.

They have relaxed the rules here though. And children have been allowed a parent most of the time during Covid. One of my customers fought to have a birthing partner during labour right from the beginning.

So glad to hear that you did t have a long ordeal with your husbands hospital visit. I can imagine how stressful that would have been.

I’ve also spoke with several customers who’ve had to bury loved ones at this time and how awful it’s been 😞

[jimh111 in reply to NWA6]

The truth is nobody knows. I would definitely ensure I still received T3 but perhaps reduce it a little. This is purely a guess on my part, with limited lung function I'd like my metabolism to be a little slower.

[Polly91 in reply to jimh111]

I have read that autopsies of patients who died from Spanish flu 100 years ago described as having atrophied adrenals and I believe the suggestion was that more T3 is needed by adrenal glands when patients are fighting serious infections.

So adequate T3 levels probably are to be maintained at all time’s - when v sick or not.

Just a thought.

P

[jimh111 in reply to Polly91]

Unlikely, Rosalind Pitt-Rivers discovered T3 in 1952, unless the suggestion about more T3 is from a later commentary. Low T3 is probably a defence mechanism but we really don't know.

[Hillwoman in reply to knitwitty]

No, I really don't think it is. Look up the blog posts by Tania on thyroidpatients.ca where she discusses the consequences of low T3 in non-thyroidal illness.

[Parbrook in reply to jimh111]

It was on my husbands med records that he needed the T3 he had been prescribed for years, he had his own supply with him in hospital but the docs messed up despite me continually reminding them, he died 4 weeks later post op, myxeodema coma being one cause, being written on records is no guarantee it will happen especially when ITU medics don't know the importance of it.

[jimh111 in reply to Parbrook]

So sorry. The same happened to Sheila Turner who ran TPA, so even happens to high profile patients. I think the best we can do is get it on our medical records and be ready to engage a solicitor if doctors are non-complaint. I can't think of any other approach.

[NWA6 in reply to Parbrook]

I’m so sorry to hear this Parbrook 😞

[Hillwoman in reply to Parbrook]

I'm so sorry Parbrook.

[Polly91 in reply to Parbrook]

So sorry to hear this about your husband Parbrook - what a dreadful time for you.

[wellness1 in reply to jimh111]

I have wondered about this. If hospitalisation were necessary, would T3 be administered? If some of us require specific brands and brought our own, would it be administered (if medical need documented)? If low T3 syndrome protects against illnesses such as COVID-19, could the body deiodinate the T3 to T2 and would this be beneficial or best just to lower dose? Hoping not to find out.

Sorry to hear about your husband, Parbrook .

[jimh111 in reply to wellness1]

In low T3 syndrome the body produces more rT3 so possibly you would have to replace T3 with T4 to mimic what normally happens. As you say, best not to find out.

[posthinking01 in reply to jimh111]

Hi Jim - me again - I must admit I haven't had time to read the whole article yet - but is it saying that during Covid T3 drops down. Because this is what happens when the body gets very ill - the thyroid function drops down to conserve energy which is why I was so adamant I wasn't given Ciprofloxacin and their family of antibiotics when I was admitted with Sepsis as this drug drops T3 function even more. I have written to Matt Hancock sending him research on this phenomena and asked him to be aware during Covid treatment. I often wonder if this antibiotic was the cause of so many deaths.

[jimh111 in reply to posthinking01]

Yes, it shows T3 levels drop in COVID-19.

[posthinking01 in reply to jimh111]

It's possible that therapy (glucocorticoids) caused the NTI so that needs to be eliminated (if possible) in a future study.

Hi Jim - not sure what you mean here - are you saying NTI illness caused by steroid therapy. Can you let me know. Odd that glucocorticoids are an issue but it is found that the steroid dexamethasone has been found to work with Covid.

tx

[jimh111 in reply to posthinking01]

I'm quoting the study here and have not studied the effects of glucorticoids on thyroid hormone myself. They do say the dose of glucorticoids was low so I suspect it didn't affect the results but as many patients take adrenal supplements I thought it worth mentioning. I don't have any knowledge of this area.

[posthinking01 in reply to jimh111]

Ok thanks understand - thanks for clarifying

[nightingale-56 in reply to posthinking01]

Hi posthinking01 I have just had Dexamethasone treatment for quick onset Glaucoma and it lowered my FT3 very slightly. It has taken about 2 months for it to rise slightly again.

[posthinking01 in reply to nightingale-56]

Hmm interesting - I am convinced that they were/are giving IV Ciprofloxacin to CV19 patients as they tried to do with me when I had Sepsis - if it hadn't been for the fact I heard the Doctors discussing my treatment and heard the words Cipro and was able to tell them as ill as I was 'if you give me that it will kill me it depletes thyroid hormone and I am unstable enough without that' - thank goodness they listened.

Cipro is used as a last resort antibiotic - so I am sure it will be used - I have sent off info to Matt Hancock's Department to ask them to look into the research and side effects.

[nightingale-56 in reply to posthinking01]

One doesn't seem to know what the other is doing with out health these days. I have had Cipro in the past and never want it again. Well done for writing to Matt Hancock's Department and they need to look into a lot of other antibiotics as well. Trimethoprim was mentioned in The Telegraph on 10/12/2012 as having multiple toxicities and is still on the market. In the end I went to Dr Peatfield and he said it had knocked my Adrenals out. After taking ACE I eventually recovered and was able to stop it. Then Mercury Pharma Levo caused other problems from which I and my son are still suffering. Medication nowadays is dangerous so it seems.

[posthinking01 in reply to nightingale-56]

Hi there - can I ask what is ACE ?

Agree with you Trimethoprim is another thyroid hormone antagonist being a sulphur based drug and the two do not mix well. When I have to take this antibiotic - I take a little more thyroid medication hence why I know it takes it down as I feel so ill on it but can cope with it when I raise my levels.

[nightingale-56 in reply to posthinking01]

ACE is Adrenal Cortex Extract and while I got on well with Thorne ACE the first time I took it, now it has Acacia Powder in it, which is not at all good for me. I would not know what to take if I needed it again. I only took it for a year and it worked well for me. Good tip about the extra thyroid medication, but Trimethoprim really caused me problems such as breakdown of tissue on tips of ears. This cleared when I took the ACE. What Doctors don't know, or maybe just don't tell you, is downright dangerous.

[Hillwoman in reply to jimh111]

I used to think this was correct, but as TSS has mentioned many times in her blog posts, the patients (non-Covid) with NTI and low T3 have far worse outcomes, including higher mortality.

[jimh111 in reply to Hillwoman]

I haven't read Tania's blog but it is true patients with lower T3 levels have worse outcomes. Is this because lower T3 increases mortality, or more severe illness lowers T3 more? Nobody knows.

[Hillwoman in reply to jimh111]

A few months ago I posted about Polar T3 Syndrome, something I'd never heard of until I watched a documentary film about the small number of people who, from time to time, spend a whole year living and working on stations in the Antarctic. Some of them are affected by this syndrome. They're all very fit and healthy people - they have to be - but the thyroid function of some seems to be compromised by months of living in the intense cold. It has been distinguised from the effects of full-spectrum light deprivation.

TSH rises, as you would expect, but peripheral conversion cannot keep up with demand. Cognitive issues ensue, mostly inconsequential, if annoying and inconvenient. Physical movement and co-ordination become a matter of conscious thought, so individual productivity decreases and the risk of accident rises. Even more concerning are changes in mental health, with the attendant risks in such an extreme environment.

This strikes me as a kind of NTI in otherwise very fit people. There may, or may not, be a precise parallel with people who develop NTI in consequence of serious illness, but it strikes me there are dangers inherent in delayed adaptation, or failure to sustain adaptation, rather than any protective effect.

[posthinking01 in reply to jimh111]

I suffer with complex adrenal hormones issues and immune issues and when I am ill - I have to up my thyroid hormone to compensate for the immune response to the illness - if I didn't do this I would be very poorly - I also have to up my steroids for 3 days - which is quite common with adrenal insufficiency but I am able to up my thyroid meds because I take a liquid which makes it possible to do. So although a bit of a blanket statement I would say people get ill and then thyroid hormone drops down which could cause higher mortality and even the illness itself. I also have to up my meds when it is cold and bring them down when it is hot - which might answer the other post below this one. After all the thyroid is a thermostat - so need is increased when cold and decreased when hot.

[penny]

Hmm. I’ve often wondered about hospitalisation and my T3 and have told my husband to make sure that I am medicated with T3 (200mcg/day); this is not on my medical records as the last intervention by my old GP was to write saying that I was not hypothyroid at all (not diagnosed by nhs) and he was stopping my T3 prescription forthwith.

My problem with lower T3 intake is that my brain ceases to function properly and my cognitive ability is really bad; this happens really quickly if I miss my dose or experiment with a slightly lower dose for a few days.

[bantam12 in reply to penny]

My experience is that your husband won't be able "to make sure that I am medicated". No matter how many times I spoke to doctors and nurses on ITU as well as the Pharmacists covering ITU the fact is they are treating the patient and if they believe a medication is not right they won't give it, especially if the prescription is not even on your meds records. This all happened in a major specialist hospital with the most experienced docs in the country, my husbands T4 was 0.48 and T3 2.1 but because his TSH was 0.62 they believed Levo was working and he didn't need T3 !

I suggest you at least get your need for T3 on your records because should the worst happen you will need written evidence.

[penny]

That’s very worrying, bantam12. I cannot see how I can get my privately-sourced T3 on record when the last GP has stated that I am not hypothyroid. ThE OH. Will have to bring my pills to hospital and force them down my throat. :- 0 As I’ve changed surgeries I can give this a go at some point but am not hopeful.

[bantam12 in reply to penny]

If you are unconscious and on a ventilator your husband won't be able to give you any pills ! Another problem before my husband died was that when they finally agreed to give him some IV T3 they didn't have any and neither did the neighboring hospital so another 2 days went by before they could source some. I hope you don't ever find yourself in a similar situation but its something to seriously consider !!

[nightingale-56 in reply to bantam12]

I've always understood T3 is a staple in Operating Theatres. What a worrying world we live in currently.