Abstract

Coronavirus disease 2019 (COVID-19) is now a worldwide pandemic. Among the many extra-pulmonary manifestations of COVID-19 recent evidence suggested a possible occurrence of thyroid dysfunction. COVID-19 effects on patients with thyroid disease are not yet known. The most frequent thyroid hormonal findings in COVID-19 patients with severe disease, are similar to those present in the non-thyroidal illness syndrome (NTIS) and require no intervention. Subacute thyroiditis has also been reported during COVID-19 infection. Well-controlled hypothỷroidism and hyperthyroidism are not associated with an increased risk of COVID-19 infection or severity. Newly diagnosed hyperthyroidism during the pandemic should be preferably treated with antithyroid drugs (ATDs). In the patients with moderate Graves’ ophthalmopathy (GO) not at risk of visual loss, glucocorticoids at immunosuppressive doses should be avoided, while in those with severe GO without COVID-19 and at risk of vision loss, intravenous glucocorticoid is the therapeutic choice. Hyperthyroidism treatment by radioiodine therapy or surgery may be considered in those cases that protective protocols can be followed to avoid COVID-19 contamination or once the pandemic is over. Considering that most of the thyroid cancer cases are low risk and associated with an excellent prognosis, surgical procedures could and should be postponed safely during the pandemic period. Additionally, when indicated, radioiodine therapy could also be safely postponed as long as it is possible. Glucocorticoids and Heparin, frequently administered to COVID-19 patients, may act as confounding factors due to their effect on the HPT axis (glucocorticoids) and to their interference (heparin) in the assays for free thyroid hormones.