Hashimoto thyroiditis amid COVID-19 pandemic: a clinical study

Abstract

During COVID-19 era, a special attention was considered for autoimmune disorders (AD), including at thyroid, which are regarded at higher risk knowing that stress and infections might aggravate the pattern of anti-thyroid antibodies as well as thyroid dysfunction. In this study, we aim to analyse how COVID-19 infection influenced the evolution of HT parameters versus patients with HT who did not go through infection. Study design: an observational, bi-centric study in Romania during first 14 months of pandemic. By the end of April 2022, Romania registered 1,047,520 total cases of COVID-19 infection (a morbidity rate calculated for entire Romanian population of 5.23%) with 27,267 total deaths (a lethality rate of 2.6%) and around 2000 new patients a day. From our database of 2210 HT patients, a number of 386 HT subjects were assessed (14 months). Among them, 33/386 patients had a different form of COVID-19 infection. The prevalence of COVID-19 infection among HT patients was 9.35% which is statistically significant higher when compare with official ratio for entire Romanian population (a morbidity rate of 5.23%, z = 3.162, p = 0.00033). A feminine prevalence was identified (89.37%, N=31/33), while age was not different between subgroups (average age over 50 y). At the moment of diagnostic, thyroid function was similar between the two subgroups (2 = 2.02, p = 0.35). We checked ATPOs levels at every visits. Mean ATPO levels at the diagnostic time was 650 UI/mL in group 1 versus 840 UI/mL in group 2 (both groups had very high ATPO values, normal cut-offs below 34 UI/mL) with not statistical significance difference - student ttest (t), p = 0.16. Group 1: the pattern of ATPO evolution was undulatory in 74.07% of patients, decreasing - 3.7%, increasing - 11.11%, unmodified (stationary) - 11.11%, similarly with group 2, meaning that ATPOs had the same profile, regardless the fact that some subjects went through COVID-19 infection. The rate of associated AD was 28.24% (N=2210), COVID-group of 42.42%, non-COVID group of 38.53% (z = 0.44, p = 0.66). In our COVID cohort of 33 patients with HT, we registered the following clinical stages of coronavirus infection: 4/33 patients who were asymptomatic; all women, average age: 65.65 years; 2/33 patients with lack of smell and taste; women, over 65 years old; 14/33 patients with mild form; from 31 years old to 70.5 years old (only one man); 10 patients with a moderate form; all women, from 34 to 71 years old; one 87-year-old male with a severe form; one 50-year old female with a very severe form in addition to a hematologic disease and a history of severe allergic reactions; and a single patient (a 68-year-old, obese female with a severe allergic background) died of COVID-19 infection (thus generating a lethality rate of 3.03%). Conclusion. Our study showed a higher prevalence of COVID-19 infection among HT patients. These individuals do not associate increased levels of ATPO or a elevated prevalence of AD when compare with non-COVID – HT group, and have similar age and sex ratio. Whether HT exposes the subjects to coronavirus infection is an open issue