Article from the Lancet re covid-19 and thyroid

[thyr01d]

This might not be new but I've only just seen it and thought it might be of interest. If anyone can put it into simple language I'd be very interested. Is it saying people with thyroid problems are more at risk, that thyroid problems can occur when infected with covid-19, or something else?

thelancet.com/journals/land...

[greygoose]

I have to say I didn't read it all, because my brain kept switching off! But, what they seem to be say is that COVID 19 can cause temporary thyroiditis - non-thyroidal illness syndrome. But, as Hidden says, their obvious ignorance of how it all works, did tend to muddy the waters. But, they weren't saying that thyroid patients were at more risk - I don't think they even considered that. So, as you were, chaps, false alarm! lol

[thyr01d in reply to greygoose]

I hope I didn't alarm anyone but did find it interesting, when my brain didn't switch off. It made me wonder if our thyroid problems are actually protective in some way - you know, like the way inflammation is intended to help the body yet also causes pain. Not a very good example, but there are things the body does that seem harmful and yet with greater medicaly understanding are discovered to be good.

[greygoose in reply to thyr01d]

Oh, yes, that's exactly it. The body does go into hypo mode to save energy when it is facing illness or deprivation of some kind. This is why we say that rT3 rarely tells you anything about thyroid. If you caughte COVID 19, and had a fever, etc. your body would reduce it's conversion of T4 to T3, and start converting to more rT3, so that the body would slow down and use its resources to find the virus, instead of living a normal life. Badly explained, but you know what I mean. They didn't appear to mention that mechanism in the article - unless I blinked and missed it.

[thyr01d in reply to greygoose]

Ha ha, as always you made me laugh, with your final comment. Yes, I do know what you mean, it's what I wanted to say but didn't know how.

[jimh111]

An infuriating study. The ‘good’ news is that the UK is no worse than other countries when it comes to thyroid care – incompetence is a global achievement!

The paper is an awful lot of waffle and confusion. The useful information is in the Supplementary appendix which is linked to in the original paper, you can find it here thelancet.com/journals/land... .

The first thing to note is that thyroid testing is automated as it is in many UK hospitals, using a cascade principle. The algorithm in the assay machine will only measure fT3 and fT4 IF TSH < 0.45 mIU/L and fT4 only is measured IF TSH > 3.5 mIU/L. This makes the comparisons of fT3 and fT4 between groups of little value, only a subset of patients is included.

Patients with (TSH > 4.3 AND fT4 <= 21.9) OR (fT4 < 10.3) are considered hypothyroid.

Patients with TSH < 0.28 OR fT4 > 21.9 are considered thyrotoxic. This is a nonsense. As can be seen in Table 2 of the Appendix all these ‘thyrotoxic’ patients had low or low normal fT3 with just a few having a marginally high fT4.

What the paper does show is that COVID-19 patients tend to have low TSH, low fT3 and normal or high fT4.

The low TSH / fT3 is most likely non-thyroidal illness (NTI) which is common in severe illness. The patients’ thyroid profile returned to normal when they recovered.

The highish fT4 levels might be due to concurrent subacute thyroiditis caused by the virus or response to the infection. The life-saving interventions and treatments the patients received could also have affected thyroid hormone levels.

[thyr01d in reply to jimh111]

Thanks Jim, I thought the waffle and confusion was coming from my brain! So, is it clear that the nti is a body's response to covid-19 and not that some of these people already had some kind of thyroid problem? I suppose, what I'm thinking, is that presumably these people's thyroids were not tested before they developed covid-19, or were they?

[jimh111 in reply to thyr01d]

The COVID-19 group were not tested before they developed COVID but they compared them with a group of patients from the previous year and found they were similar. More imporantly the COVID-19 patients had normal TFTs after they recovered ('normal' in the sense they had a typical mix of good and bad TFTs).

[thyr01d in reply to jimh111]

Hi Jim, I understand fully the temporary nature of this, I'm not clear yet though about something so if you don't mind explaining a little more this bit? How could you compare with a group of patients from a previous year when covid-19 was not around then? What am I missing?

[jimh111 in reply to thyr01d]

Comparing with a group of patients admitted to the high intensity of care unit (HICU) the previous year, so comparing two groups of seriously ill patients but with different illnesses.

[thyr01d in reply to jimh111]

Thanks Jim, especially as that information must have been there and I must have missed it.

[diogenes Remembering]

I would class the relationships being a form of nonthyroidal illness. It seems the brain can be affected, so the whole HPT axis could be disturbed. I myself would not alter medication in this state. Simply because the body is responding as best it can to coronavirus influences and doesn't need any further strains to be put on it, thank you very much.

[thyr01d in reply to diogenes]

Thanks for your reply Diogenes.

[thyr01d]

Glad you too staggered though it Scrumbler!!!

[thyr01d]

That was my thinking Scrumbler