World Thyroid Day: Here’s all you need to know about Thyroid and its effect on COVID 19

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World Thyroid Day: Here’s all you need to know about Thyroid and its effect on COVID 19

Thyroid disorders are quite common in our community with the prevalence in Kerala being around 10 per cent. We are now during the peak of the covid pandemic and people are often worried regarding the interaction between thyroid diseases and COVID-19. The commonest concern which people have is whether having a thyroid disease puts them at higher risk of COVID-19 or its complications. The answer is generally no. 

The commonest thyroid disease is autoimmune hypothyroidism where the thyroid hormone levels are decreased due to damage to the gland caused by our immune system, and it’s treated by supplementing with thyroid hormones. Since COVID-19 is known to become severe in those with lower immunity, people think having hypothyroidism puts them at risk of severe COVID infection. But both these immunities are different. 

Normally our immune system functions to protect against infections like COVID and when immunity is low, we get COVID easily. But hypothyroidism is due to aberration in our immune systems wherein our immune system destroys our organs due to some reason usually hereditary. So generally having thyroid disease does not put you at higher risk of COVID-19 as far as we know now. The only thing to make sure of is that you do not run out of thyroxine medicines and make sure that you have an adequate supply of the medicines for the next three months because omission of thyroxine tablets is not good for your health. Also, periodic check-ups at least online should not be missed. This is especially true in children who are born with congenital hypothyroidism where treatment and monitoring are very essential for normal growth and development. 

Another common disease affecting the thyroid is goitre which is swelling of the thyroid visible in front of the neck. If the goitre has large nodules in it, you need to rule out cancer in that nodule which we do by doing an ultrasound and needle biopsy. If no cancer is detected, we will have to just follow up the nodule or rarely if it has a cancer surgical removal of the thyroid must be done. 

Having a thyroid nodule even if it is cancerous doesn’t have any bearing on covid because thyroid cancers are relatively indolent and even if you are forced to wait for a few months for the evaluation of the nodule or surgery till the covid peak is over it shouldn’t be a problem in most cases Patients who are on follow up after treatment for thyroid cancer are also generally not predisposed to covid or its complications except for a rare patient who is on chemotherapy for the extensive disease which is extremely rare. If you are not able to physically visit your doctor you can get online consultation and follow up in most cases.

Another rare disease affecting the thyroid is hyperthyroidism which is the opposite of hypothyroidism. In hyperthyroidism thyroid hormone levels are elevated and the doctor will be prescribing you medicines to reduce the levels of thyroid hormones. This again has not much effect on COVID-19. Rarely the medicines taken for hyperthyroidism can cause a side effect called agranulocytosis where the immunity of the body is lowered. This is the only condition that will predispose you to infections including COVID. But this is extremely rare and if at all any patient on medicines for hyperthyroidism develops fever and sore throat, they should consult their doctor immediately.

Now we will see whether COVID affects your thyroid, thyroid has ACE receptors which are the receptors through which sars cov 2 enters the cells. So theoretically COVID can affect your thyroid but a few small studies done in the last year hasn’t shown much effect of COVID on the thyroid the main thyroid abnormalities seen in COVID patients are a lower TSH and lower T3 which can be seen in any serious illness and these abnormalities were more common when infection was more severe, and these abnormalities reversed with recovery from COVID. 

Another thyroid abnormality that can occur during the cytokine storm phase of COVID is thyroiditis where the cytokines can induce inflammation of the thyroid resulting in pain and transient hyperthyroidism. This will respond to steroids and will recover in a few months. 

To conclude having a thyroid disease generally does not predispose you to COVID. Make sure you continue your thyroid medications and regular follow up with your doctor at least online and stay safe. 

About the author: Dr Nisha Bhavani is a Professor of Endocrinology at Amrita Institute of Medical Sciences

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