Association between Thyroid Disease and Severe Coronavirus Disease 2019 (COVID-19) Infection: A Meta-Analysis
-
Juan Xu
,
Yang Li
,
Quansong Xia
,
Qiong Shi
Abstract
Background: COVID-19 has resulted in an emerging respiratory infection with a pandemical diffusion since December 2019. We aimed to elucidate whether the presence of thyroid disease might increase the risk of severe COVID-19 infection.
Methods: Studies reporting seriously ill in COVID-19 patients with and without thyroid disease combined were searched and 11 relevant studies were subjected to our analysis, and pooled odds ratios (ORs) together with 95% confidence intervals (CIs) were calculated by using STATA and Review Manager Software.
Results: In total, 2,995 COVID-19 patients were included in this study. The pooled ORs were calculated using a fixed-effects model according to the heterogeneity. The pooled results revealed that thyroid disease was associated with severe COVID-19 infection in patients (OR = 2.14, 95 % CI: 1.23–3.72, P = 0.007). In the subgroup analysis by type of thyroid disease, hypothyroidism was positively associated with risks of severe COVID-19 infection (OR = 4.78, 95 % CI: 1.59–14.36, P = 0.005), however, no obvious difference was found in the risk regarding the severe COVID-19 infection amongst hyperthyroidism or unclassified thyroid disease. In addition, subgroup analysis stratified by ethnic groups demonstrated that thyroid disease was linked to the risks of severe COVID-19 infection in Asian patients (OR = 2.41, 95 % CI: 1.30–4.48, P = 0.005) rather than non-Asian (OR = 1.31, 95 % CI: 0.35–4.87, P = 0.684).
Conclusion: This study indicates a correlation between thyroid disease and severe COVID-19 infection.
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27. Antonelli A, Ferrari SM, Ragusa F, et al (2020). Graves' disease: Epidemiology, genetic and environmental risk factors and viruses. Best Pract Res Clin Endocrinol Metab,34(1):101387.
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29. McKechnie JL, Blish CA (2020). The Innate Immune System: Fighting on the Front Lines or Fanning the Flames of COVID-19? Cell Host Microbe,27(6):863-9.
30. Bashkin A, Abu Ali J, Shehadeh M, Even L, Ronen O (2021). The significance of high thyroxine in hospitalized patients with low thyroid-stimulating hormone. Endocrine,72(2) :445-51.
31. Chen M, Zhou W, Xu W(2021). Thyroid Function Analysis in 50 Patients with COVID-19: A Retrospective Study. Thyroid,31(1) :8-11.
32. Figueroa-Vega N, Alfonso-Perez M, Benedicto I, et al (2010). Increased circulating pro-inflammatory cytokines and Th17 lymphocytes in Hashimoto's thyroiditis. J Clin Endocrinol Metab,95(2):953-62.
33. Lv LF, Jia HY, Zhang HF, Hu YX (2017). Expression level and clinical significance of IL-2, IL-6 and TGF-beta in elderly patients with goiter and hyperthyroidism. Eur Rev Med Pharmacol Sci,21(20):4680-6.
34. Velavan TP, Meyer CG(2020). Mild versus severe COVID-19: Laboratory markers. Int J Infect Dis,95:304-7.
35. Wei L, Sun S, Xu CH, et al (2007). Pathology of the thyroid in severe acute respiratory syndrome. Hum Pathol,38(1):95-102.
36. Luan J, Lu Y, Gao S, Zhang L (2020). A potential inhibitory role for integrin in the receptor targeting of SARS-CoV-2. J Infect,81(2):318-56.
37. Hercbergs A, Mousa SA, Davis PJ (2018). Nonthyroidal Illness Syndrome and Thyroid Hormone Actions at Integrin alphavbeta3. J Clin Endocrinol Metab,103(4):1291-5.
2. Li Q, Guan X, Wu P, et al(2020). Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med,382(13):1199-207.
3. Horton R (2020). Offline: 2019-nCoV outbreak-early lessons. Lancet, 395(10221):322.
4. Cucinotta D, Vanelli M (2020). WHO Declares COVID-19 a Pandemic. Acta Biomed, 91(1):157-60.
5. Pal R, Banerjee M (2020). COVID-19 and the endocrine system: exploring the unexplored. J Endocrinol Invest,43(7):1027-31.
6. Scaroni C, Armigliato M, Cannavo S (2020). COVID-19 outbreak and steroids administration: are patients treated for Sars-Cov-2 at risk of adrenal insufficiency? J Endocrinol Invest,43(7):1035-6.
7. Fliers E, Bianco AC, Langouche L, Boelen A (2015). Thyroid function in critically ill patients. Lancet Diabetes Endocrinol, 3(10):816-25.
8. Davis PJ, Lin HY, Hercbergs A, Keating KA, Mousa SA (2020). Coronaviruses and Integrin alphavbeta3: Does Thyroid Hormone Modify the Relationship? Endocr Res,45(3):210-5.
9. Zhou P, Yang XL, Wang XG, et al (2020). A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature,579(7798):270-3.
10. Stang A (2010). Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol,25(9):603-5.
11. Larson J, Anderson EH, Koslawy M(2000). Thyroid disease: a review for primary care. J Am Acad Nurse Pract,12(6):226-32.
12. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003). Measuring inconsistency in meta-analyses. BMJ,327(7414):557-60.
13. Luo D, Wan X, Liu J, Tong T (2018). Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res,27(6):1785-805.
14. Xu M, Li M, Zhan W, Han T, et al (2020). Clinical analysis of 23 patients with coronavirus disease 2019 in Xinyang City of Henan Province. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue,32(4):421-5.
15. Sun Y, Dong Y, Wang L, et al (2020). Characteristics and prognostic factors of disease severity in patients with COVID-19: The Beijing experience. J Autoimmun,112:102473.
16. Almazeedi S, Al-Youha S, Jamal MH, et al (2020). Characteristics, risk factors and outcomes among the first consecutive 1096 patients diagnosed with COVID-19 in Kuwait. EClinicalMedicine,24:100448.
17. Zhang JJ, Dong X, Cao YY, et al(2020). Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy,75(7):1730-41.
18. Yue H, Bai X, Wang J, et al (2020). Clinical characteristics of coronavirus disease 2019 in Gansu province, China. Ann Palliat Med,9(4):1404-12.
19. Cao M, Zhang D, Wang Y, et al (2020). Clinical Features of Patients Infected with the 2019 Novel Coronavirus (COVID-19) in Shanghai, China. medRxiv.
20. Wang Y, Liu Y, Liu L, Wang X, Luo N, Li L (2020). Clinical Outcomes in 55 Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Who Were Asymptomatic at Hospital Admission in Shenzhen, China. J Infect Dis,221(11):1770-4.
21. Shabrawishi M, Al-Gethamy MM, Naser AY, et al (2020). Clinical, radiological and therapeutic characteristics of patients with COVID-19 in Saudi Arabia. PLoS One,15(8):e0237130.
22. Lee JY, Hong SW, Hyun M, et al(2020). Epidemiological and clinical characteristics of coronavirus disease 2019 in Daegu, South Korea. Int J Infect Dis,98:462-6.
23. Siso-Almirall A, Kostov B, Mas-Heredia M, et al (2020). Prognostic factors in Spanish COVID-19 patients: A case series from Barcelona. PLoS One,15(8):e0237960.
24. Yan S , Song X , Lin F , et al (2020). Clinical Characteristics of Coronavirus Disease 2019 in Hainan, China. medRxiv. doi: https://doi.org/10.1101/2020.03.19.20038539
25. Zhao Y, Zhao Z, Wang Y, Zhou Y, Ma Y, Zuo W (2020). Single-Cell RNA Expression Profiling of ACE2, the Receptor of SARS-CoV-2. Am J Respir Crit Care Med,202(5):756-9.
26. Boelaert K, Visser WE, Taylor PN, Moran C, Leger J, Persani L (2020). Endocrinology in the time of COVID-19: Management of hyperthyroidism and hypothyroidism. Eur J Endocrinol,183(1):G33-G9.
27. Antonelli A, Ferrari SM, Ragusa F, et al (2020). Graves' disease: Epidemiology, genetic and environmental risk factors and viruses. Best Pract Res Clin Endocrinol Metab,34(1):101387.
28. Montesinos MDM, Pellizas CG (2019). Thyroid Hormone Action on Innate Immunity. Front Endocrinol (Lausanne), 10:350.
29. McKechnie JL, Blish CA (2020). The Innate Immune System: Fighting on the Front Lines or Fanning the Flames of COVID-19? Cell Host Microbe,27(6):863-9.
30. Bashkin A, Abu Ali J, Shehadeh M, Even L, Ronen O (2021). The significance of high thyroxine in hospitalized patients with low thyroid-stimulating hormone. Endocrine,72(2) :445-51.
31. Chen M, Zhou W, Xu W(2021). Thyroid Function Analysis in 50 Patients with COVID-19: A Retrospective Study. Thyroid,31(1) :8-11.
32. Figueroa-Vega N, Alfonso-Perez M, Benedicto I, et al (2010). Increased circulating pro-inflammatory cytokines and Th17 lymphocytes in Hashimoto's thyroiditis. J Clin Endocrinol Metab,95(2):953-62.
33. Lv LF, Jia HY, Zhang HF, Hu YX (2017). Expression level and clinical significance of IL-2, IL-6 and TGF-beta in elderly patients with goiter and hyperthyroidism. Eur Rev Med Pharmacol Sci,21(20):4680-6.
34. Velavan TP, Meyer CG(2020). Mild versus severe COVID-19: Laboratory markers. Int J Infect Dis,95:304-7.
35. Wei L, Sun S, Xu CH, et al (2007). Pathology of the thyroid in severe acute respiratory syndrome. Hum Pathol,38(1):95-102.
36. Luan J, Lu Y, Gao S, Zhang L (2020). A potential inhibitory role for integrin in the receptor targeting of SARS-CoV-2. J Infect,81(2):318-56.
37. Hercbergs A, Mousa SA, Davis PJ (2018). Nonthyroidal Illness Syndrome and Thyroid Hormone Actions at Integrin alphavbeta3. J Clin Endocrinol Metab,103(4):1291-5.
| Files | ||
| Issue | Vol 50 No 8 (2021) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v50i8.6797 | |
| Keywords | ||
| COVID-19 SARS-CoV-2 Thyroid disease Meta-analysis | ||
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How to Cite
1.
Xu J, Li Y, Xia Q, Shi Q. Association between Thyroid Disease and Severe Coronavirus Disease 2019 (COVID-19) Infection: A Meta-Analysis. Iran J Public Health. 2021;50(8):1517-1525.
