Normal Adrenal and Thyroid Function in Patients Who Survive COVID-19 Infection

Author:

Clarke Sophie A12,Phylactou Maria12,Patel Bijal1,Mills Edouard G1,Muzi Beatrice1,Izzi-Engbeaya Chioma12ORCID,Choudhury Sirazum13,Khoo Bernard4,Meeran Karim12,Comninos Alexander N12ORCID,Abbara Ali12ORCID,Tan Tricia12ORCID,Dhillo Waljit S12ORCID

Affiliation:

1. Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK

2. Department of Endocrinology, Imperial College Healthcare NHS Trust, London, W6 8RF, UK

3. Department of Clinical Biochemistry, Imperial College Healthcare NHS Trust, London, W6 8RF, UK

4. Department of Endocrinology, Division of Medicine, Faculty of Medical Sciences, Royal Free Campus, University College London, London, NW3 2QG, UK

Abstract

Abstract Context The COVID-19 pandemic continues to exert an immense burden on global health services. Moreover, up to 63% of patients experience persistent symptoms, including fatigue, after acute illness. Endocrine systems are vulnerable to the effects of COVID-19 as many glands express the ACE2 receptor, used by the SARS-CoV-2 virion for cellular access. However, the effects of COVID-19 on adrenal and thyroid gland function after acute COVID-19 remain unknown. Objective Our objectives were to evaluate adrenal and thyroid gland function in COVID-19 survivors. Methods A prospective, observational study was undertaken at the Clinical Research Facility, Imperial College NHS Healthcare Trust, including 70 patients ≥18 years of age, at least 3 months after diagnosis of COVID-19. Participants attended a research study visit (8:00-9:30 am), during which a short Synacthen test (250 µg IV bolus) and thyroid function assessments were performed. Results All patients had a peak cortisol ≥450 nmol/L after Synacthen, consistent with adequate adrenal reserve. Basal and peak serum cortisol did not differ according to disease severity or history of dexamethasone treatment during COVID-19. There was no difference in baseline or peak cortisol after Synacthen or in thyroid function tests, or thyroid status, in patients with fatigue (n = 44) compared to those without (n = 26). Conclusion Adrenal and thyroid function ≥3 months after presentation with COVID-19 was preserved. While a significant proportion of patients experienced persistent fatigue, their symptoms were not accounted for by alterations in adrenal or thyroid function. These findings have important implications for the clinical care of patients after COVID-19.

Funder

National Institute for Health Research

MRC Clinical Research Training Fellowship

NIHR Clinician Scientist Award

NIHR Professorship

Publisher

The Endocrine Society

Subject

Biochemistry (medical),Clinical Biochemistry,Endocrinology,Biochemistry,Endocrinology, Diabetes and Metabolism

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