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San Juan MDJ, Florencio MQV, Joven MH. SUBACUTE THYROIDITIS IN A PATIENT WITH CORONAVIRUS DISEASE 2019. AACE Clin Case Rep 2020; 6:e361-e364. [PMID: 33244504 PMCID: PMC7685420 DOI: 10.4158/accr-2020-0524] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/21/2020] [Indexed: 12/24/2022] Open
Abstract
Objective Subacute thyroiditis (SAT) is an inflammatory disorder of the thyroid gland that causes destructive thyrotoxicosis and is attributed to a viral or post-viral response. SARS-CoV-2 is a novel coronavirus that caused a global pandemic in 2020. We present a case that suggests that there may be a relationship between SAT and corona-virus disease 2019 (COVID-19). Methods We describe the clinical findings, thyroid function tests, and neck ultrasound of a patient presenting with anterior neck pain. Results A 47-year-old, Filipino female presented with anterior neck pain associated with neck tenderness and goiter. She did not have fever or respiratory symptoms but had right lower lobe pneumonia on chest radiograph. Thyroid function tests were consistent with subclinical hyperthyroidism with thyroid-stimulating hormone of 0.05 μIU/mL (reference range is 0.47 to 4.68 μIU/mL), free thyroxine of 1.68 pg/mL (reference range is 0.78 to 2.19 pg/mL), and total triiodothyronine of 1.4 ng/mL (reference range is 0.97 to 1.69 ng/mL). Anti-thyroid peroxidase, anti-thyroglobulin, and thyroid-stimulating hormone receptor antibodies were negative. Neck ultrasound showed heterogenous thyroid tissues with normal vascularity. Reverse transcription-polymerase chain reaction for SARS-CoV-2 using nasopharyngeal and oropharyngeal swabs were positive. The patient was diagnosed as having SAT and was treated with mefenamic acid, which was later switched to celecoxib. Ceftriaxone and hydroxychloroquine were started for COVID-19 pneumonia. Complete resolution of symptoms and primary hypothyroidism occurred after 2 months. Conclusion SAT may be a presenting symptom or a sequela of COVID-19. Histopathology studies and definitive documentation of the virus in thyroid tissues may be required to confirm the relationship between SAT and COVID-19.
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202
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Pastor S, Molina Á, De Celis E. Thyrotoxic Crisis and COVID-19 Infection: An Extraordinary Case and Literature Review. Cureus 2020; 12:e11305. [PMID: 33282582 PMCID: PMC7714732 DOI: 10.7759/cureus.11305] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus SARS-CoV-2, which causes the disease commonly known as COVID-19, has spread around the world, associated mostly with respiratory tract symptoms. We report the first case of a thyrotoxic crisis precipitated by COVID-19 and describe its identification, diagnosis, and management in the emergency unit. We also conduct a systematic review of thyrotoxic crisis literature and COVID-19 infection. This case highlights the importance of considering the SARS-CoV2 virus as a potential trigger of a thyroid storm. It also shows the need to maintain extreme contact precautions even after one month of COVID-19 symptom onset.
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Affiliation(s)
- Silvia Pastor
- Neurology Department, La Paz University Hospital, Madrid, ESP
| | - Ángeles Molina
- Emergency Department, La Paz University Hospital, Madrid, ESP
| | - Elena De Celis
- Neurology Department, La Paz University Hospital, Madrid, ESP
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203
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Sen K, Sinha A, Sen S, Chakraborty S, Alam MS. Thyroid Function Test in COVID-19 Patients: A Cross-Sectional Study in a Tertiary Care Hospital. Indian J Endocrinol Metab 2020; 24:532-536. [PMID: 33643870 PMCID: PMC7906107 DOI: 10.4103/ijem.ijem_779_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/06/2020] [Accepted: 12/17/2020] [Indexed: 01/17/2023] Open
Abstract
CONTEXT There is scarcity of data on thyroid function abnormality in COVID-19 patients in world literature. AIMS The objective of this study was to assess thyroid function tests in hospitalized patients of COVID-19. SETTINGS AND DESIGN Sixty (60) patients with COVID-19 detected by RT-PCR admitted in General Medicine isolation ward and COVID block of a tertiary care teaching hospital were selected by semi-purposive sampling. MATERIALS AND METHODS These patients were assessed for thyroid function tests, including total T3, free T3, total T4, free T4, TSH and anti-TPO antibody along with other baseline investigations. Patients with pre-existing thyroid-related ailments, those on levothyroxine or anti-thyroid drugs or other drugs known to interfere with the results were excluded. RESULTS There were 43.3% patients in mild, 26.7% in moderate, and 30% in severe category, according to local COVID-19 severity classification protocol. 35% patients had one or more abnormality in the thyroid function, low TSH being the most common (18.33%). 9.1% patients had characteristic pattern of thyroiditis. In most of the others thyroid function did not match any typical pattern. There was no significant difference in any of the parameters of the thyroid function test between mild, moderate, and severe groups. CONCLUSION Thyroid function may be abnormal in all categories of patients during COVID-19 infection, even in absence of pre-existing thyroid ailments. Although low TSH is the commonest abnormality and typical pattern of thyroiditis can be seen in a subsection of patients, in majority of the patients, thyroid function abnormality does not follow any characteristic pattern and likely represents a combination of thyroiditis and sick euthyroid syndrome in different points of its spectrum.
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Affiliation(s)
- Kaushik Sen
- Department of General Medicine, NRS Medical College and Hospital, Kolkata, West Bengal, India
| | - Arijit Sinha
- Department of General Medicine, NRS Medical College and Hospital, Kolkata, West Bengal, India
| | - Sirsendu Sen
- Department of General Medicine, NRS Medical College and Hospital, Kolkata, West Bengal, India
| | - Sandip Chakraborty
- Biochemistry, NRS Medical College and Hospital, Kolkata, West Bengal, India
| | - Md Sayeef Alam
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, Maharastra, India
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204
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Hazra DK, Neehazra PK, Hazra S, Segal AN. COVID-19 Management in India: Medical Aspects, Current Concepts, and Evolving Directions. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2020. [DOI: 10.1055/s-0040-1718501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractThis review deals with the emerging coronavirus disease 2019 (COVID-19) epidemic summarizing current and evolving medical management in India, and also indicating future directions in the light of possible resurgence of this disease as pandemic as well as prospective biological threats resulting from acts of bioterrorism. Clinical accounts both in published or prepublication reports from the frontline epicenters were used, incorporating the evolving flux in guidelines and current controversies, expressed not only in Print media but also video-webinars and conferences constantly in progress. Rather than presenting hard conclusions from the few randomized controlled trials, less formal clinical impressions have been incorporated in the review as it is felt that at this stage of the COVID-19 battle, such data are relevant! Periodic rewriting on this subject is in our opinion, therefore, eminently desirable (Box format used to allow this). Apart from the respiratory crisis aggravated by cytokine storms, reference is made to the cardiovascular, neurological, renal, gastrointestinal, and cutaneous features, these generalized manifestations being related to the widespread distribution of angiotensin-converting enzyme-2 receptors in the body as well as to the acute inflammatory hypercoagulopathy and disseminated intravascular coagulation typified by hyperacute levels of acute phase reactants as well as the effects of hypoxia-overt or silent!
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Affiliation(s)
- Daya K. Hazra
- Department of Medicine, Boston Medical Centre, Agra, Uttar Pradesh, India
| | | | - Suratwant Hazra
- Department of Medicine, Boston Medical Centre, Agra, Uttar Pradesh, India
| | - Adarsh N. Segal
- Department of Medicine, Boston Medical Centre, Agra, Uttar Pradesh, India
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205
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Ruano R, Zorzano-Martinez M, Campos A, Rius F, Hernández M. Subacute thyroiditis might be a complication triggered by SARS-CoV-2. ENDOCRINOL DIAB NUTR 2020; 68:S2530-0164(20)30206-8. [PMID: 33139217 PMCID: PMC7553120 DOI: 10.1016/j.endinu.2020.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023]
Affiliation(s)
- R Ruano
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain
| | - M Zorzano-Martinez
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain
| | - A Campos
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain
| | - F Rius
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain; Obesity, Diabetes and Metabolism (ODIM) Research Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain; Medicine Department, University of Lleida (UdL), Lleida, Spain
| | - M Hernández
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain; Obesity, Diabetes and Metabolism (ODIM) Research Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain; Medicine Department, University of Lleida (UdL), Lleida, Spain.
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206
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Barahona San Millán R, Tantinyà Daura M, Hurtado Ganoza A, Recasens Sala M. Painless thyroiditis in SARS-CoV-2 infection. ENDOCRINOL DIAB NUTR 2020; 68:S2530-0164(20)30203-2. [PMID: 33160951 PMCID: PMC7553067 DOI: 10.1016/j.endinu.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Rebeca Barahona San Millán
- Departamento Endocrinología y Nutrición, Hospital Universitario Dr. Josep Trueta de Girona, Girona, España.
| | - Marina Tantinyà Daura
- Departamento de Medicina Familiar y Comunitaria, Hospital Universitario Dr. Josep Trueta de Girona, Girona, España
| | - Abelardo Hurtado Ganoza
- Departamento de Medicina Interna, Hospital Universitario Dr. Josep Trueta de Girona, Girona, España
| | - Mònica Recasens Sala
- Departamento Endocrinología y Nutrición, Hospital Universitario Dr. Josep Trueta de Girona, Girona, España; Departamento de Ciencias Médicas, Escuela de Medicina, Universidad de Girona, Girona, España
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207
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Brancatella A, Ricci D, Cappellani D, Viola N, Sgrò D, Santini F, Latrofa F. Is Subacute Thyroiditis an Underestimated Manifestation of SARS-CoV-2 Infection? Insights From a Case Series. J Clin Endocrinol Metab 2020; 105:5891285. [PMID: 32780854 PMCID: PMC7454668 DOI: 10.1210/clinem/dgaa537] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022]
Abstract
CONTEXT Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 18 million people worldwide and the pandemic is still spreading. After the first case we reported, we observed 4 additional cases of subacute thyroiditis (SAT) related to SARS-CoV-2 infection. OBJECTIVES The objective of this work is to describe additional cases of SAT associated with SARS-CoV-2 infection to alert physicians that SAT may be a manifestation of SARS-CoV-2 infection. METHODS We describe clinical, biochemical, and imaging features of 4 patients with SAT related to SARS-CoV-2 infection. RESULTS All patients were female (age, 29-46 years). SAT developed 16 to 36 days after the resolution of coronavirus disease 2019 (COVID-19). Neck pain radiated to the jaw and palpitations were the main presenting symptoms and were associated with fever and asthenia. One patient was hospitalized because of atrial fibrillation. Thyroid function tests (available for 3 individuals) were suggestive of destructive thyroiditis, and inflammatory markers were high. At neck ultrasound the thyroid was enlarged, with diffuse and bilateral hypoechoic areas and (in 3 patients) absent vascularization at color Doppler. Symptoms disappeared a few days after commencement of treatment (prednisone in 3 patients and ibuprofen in 1). Six weeks after the onset of SAT, all patients were asymptomatic and inflammatory markers had returned to normal range. Two patients were euthyroid, whereas 2 were diagnosed with subclinical hypothyroidism. CONCLUSIONS SAT may be an underestimated manifestation of COVID-19. Clinicians should keep in mind the possible occurrence of SAT during and after SARS-CoV-2 infection.
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Affiliation(s)
- Alessandro Brancatella
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Debora Ricci
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Daniele Cappellani
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Nicola Viola
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Daniele Sgrò
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Ferruccio Santini
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Francesco Latrofa
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
- Corresponding Author: Francesco Latrofa, M.D. Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy. Phone +39050995001; Fax +39050996551; e-mail:
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208
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Lundholm MD, Poku C, Emanuele N, Emanuele MA, Lopez N. SARS-CoV-2 (COVID-19) and the Endocrine System. J Endocr Soc 2020; 4:bvaa144. [PMID: 33145472 PMCID: PMC7543511 DOI: 10.1210/jendso/bvaa144] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/23/2020] [Indexed: 01/08/2023] Open
Abstract
As SARS-CoV-2 (COVID-19) overtakes the world, causing moderate to severe disease in about 15% of infected patients, COVID-19 is also found to have widespread effects throughout the body with a myriad of clinical manifestations including the endocrine system. This manuscript reviews what is known about the impact of COVID-19 on the pathophysiology and management of diabetes (both outpatient and inpatient) as well as pituitary, adrenal, thyroid, bone, and gonadal function. Findings in this area are evolving, and long-term effects of infection remain an active area of further research.
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Affiliation(s)
- Michelle D Lundholm
- Department of Internal Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Caroline Poku
- Department of Medicine, Division of Endocrinology, Loyola University Health Care System, Maywood, Illinois
| | - Nicholas Emanuele
- Department of Medicine, Division of Endocrinology, Loyola University Health Care System, Maywood, Illinois.,Endocrinology Section, Medical Service, VA Hospital, Hines, Illinois
| | - Mary Ann Emanuele
- Department of Medicine, Division of Endocrinology, Loyola University Health Care System, Maywood, Illinois
| | - Norma Lopez
- Department of Medicine, Division of Endocrinology, Loyola University Health Care System, Maywood, Illinois
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209
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Mateu-Salat M, Urgell E, Chico A. SARS-COV-2 as a trigger for autoimmune disease: report of two cases of Graves' disease after COVID-19. J Endocrinol Invest 2020; 43:1527-1528. [PMID: 32686042 PMCID: PMC7368923 DOI: 10.1007/s40618-020-01366-7] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 11/04/2022]
Affiliation(s)
- M Mateu-Salat
- Endocrinology and Nutrition Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.
| | - E Urgell
- Biochemistry Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - A Chico
- Endocrinology and Nutrition Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER-BBN, Madrid, Spain
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210
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Fiel MI, El Jamal SM, Paniz-Mondolfi A, Gordon RE, Reidy J, Bandovic J, Advani R, Kilaru S, Pourmand K, Ward S, Thung SN, Schiano T. Findings of Hepatic Severe Acute Respiratory Syndrome Coronavirus-2 Infection. Cell Mol Gastroenterol Hepatol 2020; 11:763-770. [PMID: 32992052 PMCID: PMC7521427 DOI: 10.1016/j.jcmgh.2020.09.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Liver injury due to coronavirus disease 2019 (COVID-19) is being increasingly recognized. Abnormal liver chemistry tests of varying severities occur in a majority of patients. However, there is a dearth of accompanying liver histologic studies in these patients. METHODS The current report details the clinical courses of 2 patients having severe COVID-19 hepatitis. Liver biopsies were analyzed under light microscopy, portions of liver tissue were hybridized with a target probe to the severe acute respiratory syndrome coronavirus-2 S gene, and small sections from formalin-fixed paraffin-embedded liver tissue were processed for electron microscopy. RESULTS The liver histology of both cases showed a mixed inflammatory infiltrate with prominent bile duct damage, endotheliitis, and many apoptotic bodies. In situ hybridization and electron microscopy suggest the intrahepatic presence of severe acute respiratory syndrome coronavirus-2, the findings of which may indicate the possibility of direct cell injury. CONCLUSIONS On the basis of the abundant apoptosis and severe cholangiocyte injury, these histopathologic changes suggest a direct cytopathic injury. Furthermore, some of the histopathologic changes may resemble acute cellular rejection occurring after liver transplantation. These 2 cases demonstrate that severe COVID-19 hepatitis can occur even in the absence of significant involvement of other organs.
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Affiliation(s)
- M Isabel Fiel
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Siraj M El Jamal
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alberto Paniz-Mondolfi
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronald E Gordon
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jason Reidy
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jela Bandovic
- Department of Pathology and Division of Gastroenterology, State University of New York, Stony Brook Medical Center, Stony Brook, New York
| | - Rashmi Advani
- Department of Pathology and Division of Gastroenterology, State University of New York, Stony Brook Medical Center, Stony Brook, New York
| | - Saikiran Kilaru
- Division of Liver Diseases and Recanati-Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kamron Pourmand
- Division of Liver Diseases and Recanati-Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephen Ward
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Swan N Thung
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas Schiano
- Division of Liver Diseases and Recanati-Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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211
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Subacute Thyroiditis Associated with COVID-19. Case Rep Endocrinol 2020; 2020:8891539. [PMID: 33005461 PMCID: PMC7522602 DOI: 10.1155/2020/8891539] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/10/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022] Open
Abstract
Subacute thyroiditis is a self-limiting inflammatory disorder, characterized by neck pain or discomfort, a tender diffuse goiter, and sometimes a transient episode of hyperthyroidism followed by euthyroidism and sometimes hypothyroidism. There is usually a normalization of thyroid function within a few weeks. Subacute thyroiditis has a higher incidence in summer and has been linked to a viral or bacterial upper respiratory postinfection inflammatory response. We hereby describe the case of a previously healthy 37-year-old female presenting with subacute thyroiditis associated with a very mild presentation of COVID-19. As most patients with SARS-Cov-2 are asymptomatic, we suggest to rule out SARS-Cov-2 infection in patients presenting with symptoms suggesting SAT.
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212
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Thyroid disorders and SARS-CoV-2 infection: From pathophysiological mechanism to patient management. ANNALES D'ENDOCRINOLOGIE 2020; 81:507-510. [PMID: 32950466 PMCID: PMC7498405 DOI: 10.1016/j.ando.2020.09.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The World Health Organization (WHO) declared the COVID-19 epidemic to be a global pandemic in March 2020. COVID-19 is an infection caused by SARS-CoV-2, a coronavirus that utilizes the angiotensin-2 converting enzyme to penetrate thyroid and pituitary cells, and may result in a “cytokine storm”. Based on the pathophysiological involvement of the pituitary-thyroid axis, the current review discusses the diagnosis of abnormal thyroid function test, and the management of patients presenting with thyrotoxicosis, thyroid-associated orbitopathy and hypothyroidism in the context of SARS-CoV-2 infection.
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213
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Hussain AN, Hussain F, Hashmi SK. Role of testosterone in COVID-19 patients - A double-edged sword? Med Hypotheses 2020; 144:110287. [PMID: 33254589 PMCID: PMC7494488 DOI: 10.1016/j.mehy.2020.110287] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/02/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023]
Abstract
COVID-19 affects males twice as frequently as females with significantly increased severity and mortality. Current data suggest a direct correlation between the lower level of serum testosterone, inflammatory cytokines, disease severity, and poor clinical outcomes among male patients with COVID-19. The gradual decline in total and free testosterone levels has a direct correlation with serious pulmonary complications requiring advanced care (ICU, ventilators, ECMO, etc.). SARS-CoV-2 utilizes Angiotensin-Converting Enzyme II (ACE2) for entry in the host cell, and Transmembrane Protease, Serine 2 (TMPRSS2) to prime spike protein of SARS-CoV-2. Testosterone induces ACE-2 expression, a critical pulmonary protective enzyme. Low testosterone levels in males have a direct correlation with the high probability of ICU admission and the worse disease outcome (ARDS, duration of ICU stay, mortality). On the contrary, however, high testosterone levels can lead to thrombosis which is also one of the fatal manifestations in COVID-19 patients. A critical evaluation of the serum testosterone and its relevance to COVID-19 is warranted to re-evaluate strategies to effectively triage, prioritize, and manage high-risk patients for ICU admission, survival outcomes, targeted solutions, and operational algorithms.
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Affiliation(s)
- Aneela N Hussain
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Fazal Hussain
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
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Patient characteristics and admitting vital signs associated with coronavirus disease 2019 (COVID-19)-related mortality among patients admitted with noncritical illness. Infect Control Hosp Epidemiol 2020; 42:399-405. [PMID: 32928319 PMCID: PMC7520636 DOI: 10.1017/ice.2020.461] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine risk factors for mortality among COVID-19 patients admitted to a system of community hospitals in the United States. DESIGN Retrospective analysis of patient data collected from the routine care of COVID-19 patients. SETTING System of >180 acute-care facilities in the United States. PARTICIPANTS All admitted patients with positive identification of COVID-19 and a documented discharge as of May 12, 2020. METHODS Determination of demographic characteristics, vital signs at admission, patient comorbidities and recorded discharge disposition in this population to construct a logistic regression estimating the odds of mortality, particular for those patients characterized as not being critically ill at admission. RESULTS In total, 6,180 COVID-19+ patients were identified as of May 12, 2020. Most COVID-19+ patients (4,808, 77.8%) were admitted directly to a medical-surgical unit with no documented critical care or mechanical ventilation within 8 hours of admission. After adjusting for demographic characteristics, comorbidities, and vital signs at admission in this subgroup, the largest driver of the odds of mortality was patient age (OR, 1.07; 95% CI, 1.06-1.08; P < .001). Decreased oxygen saturation at admission was associated with increased odds of mortality (OR, 1.09; 95% CI, 1.06-1.12; P < .001) as was diabetes (OR, 1.57; 95% CI, 1.21-2.03; P < .001). CONCLUSIONS The identification of factors observable at admission that are associated with mortality in COVID-19 patients who are initially admitted to non-critical care units may help care providers, hospital epidemiologists, and hospital safety experts better plan for the care of these patients.
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215
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Gorini F, Bianchi F, Iervasi G. COVID-19 and Thyroid: Progress and Prospects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186630. [PMID: 32932954 PMCID: PMC7559547 DOI: 10.3390/ijerph17186630] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 12/13/2022]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide. A number of serious effects on various organs and systems have been reported in humans, and recently emerging evidence on the potential association between the infection and thyroid dysfunction are attracting attention from the scientific community. This editorial critically summarizes the main findings on this topic published so far and defines research lines according to the translational approach from the bench to the bed to epidemiological studies and back again, aimed at patient care and effective public health measures.
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216
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Lazartigues E, Qadir MMF, Mauvais-Jarvis F. Endocrine Significance of SARS-CoV-2's Reliance on ACE2. Endocrinology 2020; 161:5870330. [PMID: 32652001 PMCID: PMC7454499 DOI: 10.1210/endocr/bqaa108] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023]
Abstract
The current COVID-19 pandemic is the most disruptive event in the past 50 years, with a global impact on health care and world economies. It is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a coronavirus that uses angiotensin-converting enzyme 2 (ACE2) as an entry point to the cells. ACE2 is a transmembrane carboxypeptidase and member of the renin-angiotensin system. This mini-review summarizes the main findings regarding ACE2 expression and function in endocrine tissues. We discuss rapidly evolving knowledge on the potential role of ACE2 and SARS coronaviruses in endocrinology and the development of diabetes mellitus, hypogonadism, and pituitary and thyroid diseases.
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Affiliation(s)
- Eric Lazartigues
- Department of Pharmacology & Experimental Therapeutics, New
Orleans, Louisiana
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences
Center, New Orleans, Louisiana
- Southeast Louisiana Veterans Health Care Systems, New Orleans,
Louisiana
- Correspondence: Eric Lazartigues, PhD, Department of Pharmacology & Experimental Therapeutics,
Louisiana State University Health Sciences Center, New Orleans, LA 70112. E-mail:
| | - Mirza Muhammad Fahd Qadir
- Southeast Louisiana Veterans Health Care Systems, New Orleans,
Louisiana
- Division of Endocrinology & Metabolism, Department of Medicine, Tulane
University School of Medicine, New Orleans, Louisiana
| | - Franck Mauvais-Jarvis
- Southeast Louisiana Veterans Health Care Systems, New Orleans,
Louisiana
- Division of Endocrinology & Metabolism, Department of Medicine, Tulane
University School of Medicine, New Orleans, Louisiana
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217
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Rachel JB, Gururaj N, Smitha T, Daniel TD, Harishini BS, Rosaian AS. Innovative diagnostic approach and investigation trends in COVID19-A systematic review. J Oral Maxillofac Pathol 2020; 24:421-436. [PMID: 33967476 PMCID: PMC8083432 DOI: 10.4103/jomfp.jomfp_395_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/14/2020] [Accepted: 10/20/2020] [Indexed: 01/19/2023] Open
Abstract
A highly contagious viral infection emerged in Wuhan city; China had increased mortality with uncertain pathogenesis spreads throughout the world to become a pandemic. It is reported to be caused by a member of β coronaviruses and named it as COVID-19 by the World Health Organization (WHO). The disease is caused by a mutant strain of coronavirus SARS-COV-2 that affects the respiratory tract causing mild to severe respiratory tract illness. The clinical manifestation ranges from mild, moderate, severe and very severe signs and symptoms result in death due to severe hypoxia or multi-organ dysfunction. Also, the affected persons were capable of infecting others through various modes of transmission through respiratory droplets (aerosol spread). A definite investigation protocol has followed to diagnose COVID 19 disease but mainly confirmed with reverse transcription polymerase chain reaction. Computerized tomography scan plays a significant role in the diagnosis and prognosis of affected individuals. The major problem with COVID-19 is due to its novelty and lack of vaccination or treatment. This review focuses on the mutation, pathogenesis, various diagnostic tests adopted and autopsy findings in patients affected with COVID-19.
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Affiliation(s)
- J Beryl Rachel
- Department of Oral Pathology and Microbiology, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - N Gururaj
- Department of Oral Pathology and Microbiology, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - T Smitha
- Department of Oral Pathology and Microbiology, Vokkaligara Sangha Dental College and Hosipital, Bengaluru, Karnataka, India
| | - T Divyna Daniel
- Department of Oral Pathology and Microbiology, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - B S Harishini
- Department of Oral Pathology and Microbiology, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - Adlin Saroja Rosaian
- Department of Oral Pathology and Microbiology, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
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218
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Garg MK, Gopalakrishnan M, Yadav P, Misra S. Endocrine Involvement in COVID-19: Mechanisms, Clinical Features, and Implications for Care. Indian J Endocrinol Metab 2020; 24:381-386. [PMID: 33489841 PMCID: PMC7810055 DOI: 10.4103/ijem.ijem_440_20] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/06/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023] Open
Abstract
Coronavirus 2019 (COVID -19) has rapidly emerged as a global pandemic with multi-system involvement. Involvement of the endocrine system is expected in COVID-19 as the interplay between severe acute respiratory syndrome corona virus-2 (SARS CoV-2) and the endocrine system occurs at multiple levels. The widespread presence of ACE-2 receptors on various tissues suggests scope for direct viral infection. The interactions via the activation of inflammatory mediators and indirect immune-mediated damage are also postulated. Evidence so far suggests that COVID-19 can cause functional hypopituitarism by direct and indirect effects on the hypothalamo-pituitary axis resulting in inappropriate adrenal response to stress. Several reports highlight possible immune-mediated damage to thyroid glands resulting in subacute thyroiditis. COVID-19 is implicated in precipitating hyperglycemia in known diabetics and uncovering insulin resistance in those previously undiagnosed. COVID-19 has also been shown to trigger Type 1 Diabetes with ketosis. Various mechanisms including direct virus-induced beta cell apoptosis and immune-mediated beta-cell damage have been demonstrated. The presence of virus in semen has unclear clinical significance at present. In this mini-review summarize the endocrine manifestations reported so far in COVID-19 disease and explore mechanisms to decipher how SARS CoV-2 may affect various endocrine organs.
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Affiliation(s)
- Mahendra K. Garg
- Professor, Department of Medicine and Endocrinology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Maya Gopalakrishnan
- Assistant Professor, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prakrati Yadav
- Resident Doctor, Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sanjeev Misra
- Director and Chief Executive Officer, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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219
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Muller I, Cannavaro D, Dazzi D, Covelli D, Mantovani G, Muscatello A, Ferrante E, Orsi E, Resi V, Longari V, Cuzzocrea M, Bandera A, Lazzaroni E, Dolci A, Ceriotti F, Re TE, Gori A, Arosio M, Salvi M. SARS-CoV-2-related atypical thyroiditis. Lancet Diabetes Endocrinol 2020; 8:739-741. [PMID: 32738929 PMCID: PMC7392564 DOI: 10.1016/s2213-8587(20)30266-7] [Citation(s) in RCA: 188] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Ilaria Muller
- Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy; Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK.
| | - Daniele Cannavaro
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Davide Dazzi
- Internal Medicine, Ospedale di Vaio, Fidenza, Italy
| | - Danila Covelli
- Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Giovanna Mantovani
- Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Antonio Muscatello
- Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Emanuele Ferrante
- Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Emanuela Orsi
- Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Veronica Resi
- Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Virgilio Longari
- Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Marco Cuzzocrea
- Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Alessandra Bandera
- Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Elisa Lazzaroni
- Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Alessia Dolci
- Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Ferruccio Ceriotti
- Clinical Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Tiziana E Re
- Medicine-Acute Medical Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Andrea Gori
- Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Maura Arosio
- Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mario Salvi
- Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
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220
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Dixit NM, Truong KP, Rabadia SV, Li D, Srivastava PK, Mosaferi T, Calfon Press MA, Donangelo I, Kelesidis T. Sudden Cardiac Arrest in a Patient With Myxedema Coma and COVID-19. J Endocr Soc 2020; 4:bvaa130. [PMID: 32984743 PMCID: PMC7499619 DOI: 10.1210/jendso/bvaa130] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Indexed: 12/13/2022] Open
Abstract
SARS-CoV-2 infection is associated with significant lung and cardiac morbidity but there is a limited understanding of the endocrine manifestations of coronavirus disease 2019 (COVID-19). Although thyrotoxicosis due to subacute thyroiditis has been reported in COVID-19, it is unknown whether SARS-CoV-2 infection can also lead to decompensated hypothyroidism. We present the first case of myxedema coma (MC) in COVID-19 and we discuss how SARS-CoV-2 may have precipitated multiorgan damage and sudden cardiac arrest in our patient. A 69-year-old woman with a history of small cell lung cancer presented with hypothermia, hypotension, decreased respiratory rate, and a Glasgow Coma Scale score of 5. The patient was intubated and administered vasopressors. Laboratory investigation showed elevated thyrotropin, very low free thyroxine, elevated thyroid peroxidase antibody, and markedly elevated inflammatory markers. SARS-CoV-2 test was positive. Computed tomography showed pulmonary embolism and peripheral ground-glass opacities in the lungs. The patient was diagnosed with myxedema coma with concomitant COVID-19. While treatment with intravenous hydrocortisone and levothyroxine were begun the patient developed a junctional escape rhythm. Eight minutes later, the patient became pulseless and was eventually resuscitated. Echocardiogram following the arrest showed evidence of right heart dysfunction. She died 2 days later of multiorgan failure. This is the first report of SARS-CoV-2 infection with MC. Sudden cardiac arrest likely resulted from the presence of viral pneumonia, cardiac arrhythmia, pulmonary emboli, and MC-all of which were associated with the patient's SARS-CoV-2 infection.
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Affiliation(s)
- Neal M Dixit
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Katie P Truong
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Soniya V Rabadia
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David Li
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Pratyaksh K Srivastava
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Tina Mosaferi
- Division of Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Ines Donangelo
- Division of Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Theodoros Kelesidis
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California
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221
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Abstract
We report a case of a hospitalised patient with COVID-19 who developed subacute thyroiditis in association with SARS-COV-2 infection. The patient presented with tachycardia, anterior neck pain and thyroid function tests revealing hyperthyroidism together with consistent ultrasonographic evidence suggesting subacute thyroiditis. Treatment with corticosteroids resulted in rapid clinical resolution. This case illustrates that subacute thyroiditis associated with viruses such as SARS-CoV-2 should be recognised as a complication of COVID-19 and considered as a differential diagnosis when infected patients present with tachycardia without evidence of progression of COVID-19 illness.
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222
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Ippolito S, Dentali F, Tanda ML. SARS-CoV-2: a potential trigger for subacute thyroiditis? Insights from a case report. J Endocrinol Invest 2020; 43:1171-1172. [PMID: 32488726 PMCID: PMC7266411 DOI: 10.1007/s40618-020-01312-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/26/2020] [Indexed: 01/21/2023]
Affiliation(s)
- S Ippolito
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria-Ospedale Di Circolo Di Varese, ASST Dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy.
| | - F Dentali
- Internal Medicine Unit, Department of Medicine and Surgery, University of Insubria-Ospedale Di Circolo Di Varese, ASST Dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
| | - M L Tanda
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria-Ospedale Di Circolo Di Varese, ASST Dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
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Abstract
Coronavirus disease 2019 caused by SARS-CoV-2 originated from China and spread across every corner of the world. The scientific interest on COVID-19 increased after WHO declared it a pandemic in the early February of 2020. In fact, this pandemic has had a worldwide impact on economy, health, and lifestyle like no other in the last 100 years. SARS-CoV-2 belongs to Coronaviridae family and causes the deadliest clinical manifestations when compared to other viruses in the family. COVID-19 is an emerging zoonotic disease that has resulted in over 383,000 deaths around the world. Scientists are scrambling for ideas to develop treatment and prevention strategies to thwart the disease condition. In this review, we have attempted to summarize the latest information on the virus, disease, prevention, and treatment strategies. The future looks promising.
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224
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Zhao W, Qiu H, Gong Y, Han C, Ruan S, Wang C, Chen J, Ke S, Shi W, Wang J, Xu Q, Li Y, Shi Y, Chen Q, Chen Y. Clinical considerations for the management of cancer patients in the mitigation stage of the COVID-19 pandemic. Am J Cancer Res 2020; 10:2282-2292. [PMID: 32905504 PMCID: PMC7471365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/19/2020] [Indexed: 06/11/2023] Open
Abstract
The ongoing outbreak of the coronavirus disease 2019 (COVID-19) has become an unprecedented threat to public health around the world. The crisis has also brought great challenges to the routine diagnosis and treatment of cancer patients, especially given the urgency and continuity of cancer care. Cancer patients need to be more prudently and individually managed to combat COVID-19. At present, the COVID-19 epidemic in some countries has moved from the outbreak phase to the remission phase. How to preserve high-quality anti-tumor therapy for cancer patients while maintaining strict prevention and control of COVID-19 is a matter of concern. Here, we summarized essential data about COVID-19 and cancer and provided the clinical recommendations for the management of cancer patients during the COVID-19 pandemic based on our practical experience and relevant literatures.
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Affiliation(s)
- Wensi Zhao
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
| | - Hu Qiu
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
| | - Yi Gong
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
| | - Chen Han
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
| | - Shasha Ruan
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
| | - Chenyu Wang
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
| | - Jiamei Chen
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
| | - Shaobo Ke
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
| | - Wei Shi
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
| | - Jing Wang
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
| | - Qiuni Xu
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
| | - Yan Li
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
| | - Yuxia Shi
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
| | - Qian Chen
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
| | - Yongshun Chen
- Department of Clinical Oncology, Renmin Hospital of Wuhan University Wuhan 430060, China
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225
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Somasundaram NP, Ranathunga I, Ratnasamy V, Wijewickrama PSA, Dissanayake HA, Yogendranathan N, Gamage KKK, de Silva NL, Sumanatilleke M, Katulanda P, Grossman AB. The Impact of SARS-Cov-2 Virus Infection on the Endocrine System. J Endocr Soc 2020; 4:bvaa082. [PMID: 32728654 PMCID: PMC7337839 DOI: 10.1210/jendso/bvaa082] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has spread across the globe rapidly causing an unprecedented pandemic. Because of the novelty of the disease, the possible impact on the endocrine system is not clear. To compile a mini-review describing possible endocrine consequences of SARS-CoV-2 infection, we performed a literature survey using the key words Covid-19, Coronavirus, SARS CoV-1, SARS Cov-2, Endocrine, and related terms in medical databases including PubMed, Google Scholar, and MedARXiv from the year 2000. Additional references were identified through manual screening of bibliographies and via citations in the selected articles. The literature review is current until April 28, 2020. In light of the literature, we discuss SARS-CoV-2 and explore the endocrine consequences based on the experience with structurally-similar SARS-CoV-1. Studies from the SARS -CoV-1 epidemic have reported variable changes in the endocrine organs. SARS-CoV-2 attaches to the ACE2 system in the pancreas causing perturbation of insulin production resulting in hyperglycemic emergencies. In patients with preexisting endocrine disorders who develop COVID-19, several factors warrant management decisions. Hydrocortisone dose adjustments are required in patients with adrenal insufficiency. Identification and management of critical illness-related corticosteroid insufficiency is crucial. Patients with Cushing syndrome may have poorer outcomes because of the associated immunodeficiency and coagulopathy. Vitamin D deficiency appears to be associated with increased susceptibility or severity to SARS-CoV-2 infection, and replacement may improve outcomes. Robust strategies required for the optimal management of endocrinopathies in COVID-19 are discussed extensively in this mini-review.
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Affiliation(s)
| | - Ishara Ranathunga
- Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Vithiya Ratnasamy
- University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | | | | | | | - Nipun Lakshitha de Silva
- Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.,Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Sri Lanka, Rathmalana, Sri Lanka
| | | | - Prasad Katulanda
- University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.,Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka, Colombo, Sri Lanka
| | - Ashley Barry Grossman
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, London, UK.,Centre for Endocrinology, Barts and the London School of Medicine, Queen Mary University of London, Oxford, UK
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226
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Jasul G, Paz-Pacheco E, Jimeno C, Suastika K, Hussein Z, Mustafa N, Aung AA, Robles J, Leow MKS, Deerochanawong C, Khue NT, Dang TH. AFES A.S.-O.N.E.: ASEAN Survey Of Needs in Endocrinology in the Time of the COVID-19 Pandemic. J ASEAN Fed Endocr Soc 2020; 35:5-13. [PMID: 33790494 PMCID: PMC7992306 DOI: 10.15605/jafes.035.01.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/23/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has made a major impact on hospital services globally, including the care of persons with diabetes and endocrine disorders. The aim of this study is to describe the epidemiology of COVID-19 in the ASEAN Federation of Endocrine Societies (AFES) member countries; to describe challenges, changes and opportunities in caring for patients with endocrine diseases, as well as in fellowship training programs, and endocrinerelated research in the AFES countries. METHODOLOGY The AFES ASEAN Survey Of Needs in Endocrinology (AFES A.S.-O.N.E.) was an open-ended questionnaire that was sent to the presidents and representatives of the AFES member countries by email. Responses from Societies were collated and synthesized to obtain perspectives on the emergent issues in endocrinology in the Southeast Asian region during this pandemic. RESULTS The burden of COVID-19 cases varied widely across the AFES member countries, with the least number of cases in Vietnam and Myanmar, and the greatest number of cases in either the most populous countries (Indonesia and the Philippines), or a country with the highest capability for testing (Singapore). The case fatality rate was also the highest for Indonesia and the Philippines at around 6%, and lowest for Vietnam at no fatalities. The percentage with diabetes among patients with COVID-19 ranged from 5% in Indonesia to 20% in Singapore, approximating the reported percentages in China and the United States. The major challenges in managing patients with endocrine diseases involved inaccessibility of health care providers, clinics and hospitals due to the implementation of lockdowns, community quarantines or movement control among the member countries. This led to disruptions in the continuity of care, testing and monitoring, and for some, provision of both preventive care and active management including surgery for thyroid cancer or pituitary and adrenal tumors, and radioactive iodine therapy. Major disruptions in the endocrine fellowship training programs were also noted across the region, so that some countries have had to freeze hiring of new trainees or to revise both program requirements and approaches to training due to the closure of outpatient endocrine clinics. The same observations are seen for endocrine-related researches, as most research papers have focused on the pandemic. Finally, the report ends by describing innovative approaches to fill in the gap in training and in improving patient access to endocrine services by Telemedicine. CONCLUSION The burden of COVID-19 cases and its case fatality rate varies across the AFES member countries but its impact is almost uniform: it has disrupted the provision of care for patients with endocrine diseases, and has also disrupted endocrine fellowship training and endocrine-related research across the region. Telemedicine and innovations in training have been operationalized across the AFES countries in an attempt to cope with the disruptions from COVID-19, but its over-all impact on the practice of endocrinology across the region will only become apparent once we conquer this pandemic.
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Affiliation(s)
- Gabriel Jasul
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines College of Medicine (UPCM)-Philippine General Hospital
- Diabetes, Thyroid and Endocrine Center, St. Luke's Medical Center, Quezon City, Philippines
| | - Elizabeth Paz-Pacheco
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines College of Medicine (UPCM)-Philippine General Hospital
- The Medical City, Pasig City, Philippines
| | - Cecilia Jimeno
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines College of Medicine (UPCM)-Philippine General Hospital
- UPCM Department of Pharmacology and Toxicology, Manila, Philippines
| | | | | | | | - Aye Aye Aung
- Myanmar Society of Endocrinology and Metabolism (MSEM)
| | | | | | | | | | - Tran Huu Dang
- Vietnam Association of Diabetes and Endocrinology (VADE)
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227
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Vojdani A, Vojdani E, Kharrazian D. Reaction of Human Monoclonal Antibodies to SARS-CoV-2 Proteins With Tissue Antigens: Implications for Autoimmune Diseases. Front Immunol 2020; 11:617089. [PMID: 33584709 DOI: 10.3389/fimmu.2020.617089/full] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/14/2020] [Indexed: 05/20/2023] Open
Abstract
We sought to determine whether immune reactivity occurs between anti-SARS-CoV-2 protein antibodies and human tissue antigens, and whether molecular mimicry between COVID-19 viral proteins and human tissues could be the cause. We applied both human monoclonal anti-SARS-Cov-2 antibodies (spike protein, nucleoprotein) and rabbit polyclonal anti-SARS-Cov-2 antibodies (envelope protein, membrane protein) to 55 different tissue antigens. We found that SARS-CoV-2 antibodies had reactions with 28 out of 55 tissue antigens, representing a diversity of tissue groups that included barrier proteins, gastrointestinal, thyroid and neural tissues, and more. We also did selective epitope mapping using BLAST and showed similarities and homology between spike, nucleoprotein, and many other SARS-CoV-2 proteins with the human tissue antigens mitochondria M2, F-actin and TPO. This extensive immune cross-reactivity between SARS-CoV-2 antibodies and different antigen groups may play a role in the multi-system disease process of COVID-19, influence the severity of the disease, precipitate the onset of autoimmunity in susceptible subgroups, and potentially exacerbate autoimmunity in subjects that have pre-existing autoimmune diseases. Very recently, human monoclonal antibodies were approved for use on patients with COVID-19. The human monoclonal antibodies used in this study are almost identical with these approved antibodies. Thus, our results can establish the potential risk for autoimmunity and multi-system disorders with COVID-19 that may come from cross-reactivity between our own human tissues and this dreaded virus, and thus ensure that the badly-needed vaccines and treatments being developed for it are truly safe to use against this disease.
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Affiliation(s)
- Aristo Vojdani
- Department of Immunology, Immunosciences Laboratory, Inc., Los Angeles, CA, United States
- Department of Preventive Medicine, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | | | - Datis Kharrazian
- Department of Preventive Medicine, Loma Linda University School of Medicine, Loma Linda, CA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, United States
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Wang W, Su X, Ding Y, Fan W, Zhou W, Su J, Chen Z, Zhao H, Xu K, Ni Q, Xu X, Qiu Y, Teng L. Thyroid Function Abnormalities in COVID-19 Patients. Front Endocrinol (Lausanne) 2020; 11:623792. [PMID: 33679608 PMCID: PMC7933556 DOI: 10.3389/fendo.2020.623792] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/24/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The novel coronavirus COVID-19, has caused a worldwide pandemic, impairing several human organs and systems. Whether COVID-19 affects human thyroid function remains unknown. METHODS Eighty-four hospitalized COVID-19 patients in the First Affiliated Hospital, Zhejiang University School of Medicine (Hangzhou, China) were retrospectively enrolled in this study, among which 22 cases had complete records of thyroid hormones. In addition, 91 other patients with pneumonia and 807 healthy subjects were included as controls. RESULTS We found that levels of total triiodothyronine (TT3) and thyroid stimulating hormone (TSH) were lower in COVID-19 patients than healthy group (p < 0.001). Besides, TSH level in COVID-19 patients was obviously lower than non-COVID-19 patients (p < 0.001). Within the group of COVID-19, 61.9% (52/84) patients presented with thyroid function abnormalities and the proportion of thyroid dysfunction was higher in severe cases than mild/moderate cases (74.6 vs. 23.8%, p < 0.001). Patients with thyroid dysfunction tended to have longer viral nucleic acid cleaning time (14.1 ± 9.4 vs. 10.6 ± 8.3 days, p = 0.088). To note, thyroid dysfunction was also associated with decreased lymphocytes (p < 0.001) and increased CRP (p = 0.002). The correlation between TT3 and TSH level seemed to be positive rather than negative in the early stage, and gradually turned to be negatively related over time. CONCLUSION Thyroid function abnormalities are common in COVID-19 patients, especially in severe cases. This might be partially explained by nonthyroidal illness syndrome.
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Affiliation(s)
- Weibin Wang
- Department of Surgical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xingyun Su
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongfeng Ding
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weina Fan
- Department of Intensive Care Unit (ICU), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weibin Zhou
- Department of Endocrinology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junwei Su
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhendong Chen
- Department of Surgical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Zhao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Kaijin Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qin Ni
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaowei Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yunqing Qiu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Lisong Teng, ; Yunqing Qiu,
| | - Lisong Teng
- Department of Surgical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Lisong Teng, ; Yunqing Qiu,
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Wangnoo S, Jindal R, Siddiqui M. COVID-19 and endocrinopathies. APOLLO MEDICINE 2020. [DOI: 10.4103/am.am_59_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Moroti R, Badiu C. ENDOCRINE EFFECTS OF COVID 19: DIFFICULTIES IN THE MANAGEMENT OF ENDOCRINE DISORDERS FROM INDIVIDUAL TO SOCIETIES. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:74-77. [PMID: 32685042 DOI: 10.4183/aeb.2020.74] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Development of Covid-19 pandemic infection which started in December 2019 from Wuhan, China, impacted all medical specialities and societies. Endocrine professionals are involved in this battle, as far as many patients with endocrine co-morbidities (diabetes, metabolic syndrome, pituitary, thyroid, adrenal disorders) are most affected by the disease. Specific recommendations for the management of endocrine disorders were released by European experts. Most rely on the same principles of epidemiological safety measures, delaying non emergency admissions and transforming the routine follow-up in telemedicine clinics. Special attention is required to adrenal disorders, either central in the context of pituitary patients or primary. Corticosteroids are a mainstay of treatment in Covid-19 infection, therefore it is important to consider all aspects involved by high doses, including metabolic adverse reactions especially in diabetic patients. Other endocrine disorders, thyroid dysfunctions or nodules, parathyroid, adrenal, and pituitary diseases should follow specific recommendations for management. Surgery is postponed for non-emergency situations, restricting most planned surgeries, either thyroid, pituitary or adrenal. Laparoscopic surgery, if required in emergency, is including a supplementary risk, therefore all involved in the operating theater should wear PPE. In conclusion, a coordinated response should be organized in the multidisciplinary management of endocrine patients.
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Affiliation(s)
- R Moroti
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Matei Bals" National Institute for Infectious Diseases, Bucharest, Romania
| | - C Badiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
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