Management Of Thyroid Diseases During The COVID-19 Pandemic

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.

The effects of COVID -19  on patients with thyroid disease are still unknown. Because the prevalence of thyroid disease ranges from 1 to 2% for spontaneous hypothyroidism, 0.5 to 2% for hyperthyroidism in women, and 1% and 5% for clinically detectable thyroid nodules in men and women, respectively, it may assume that patients with the disease will be affected both directly and indirectly by the pandemic. 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 hypothyroidism 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) who are 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 thyroid cancer cases are low risk and have a good prognosis, surgical procedures could and should be postponed safely during the pandemic period. Additionally, radioiodine therapy could be safely postponed for as long as possible when indicated.

Glucocorticoids and Heparin, frequently administered to COVID-19 patients, may act as confounding factors due to their effect on the HPT axis (glucocorticoids) and their interference (heparin) in the assays for free thyroid hormones

Keywords: Coronavirus disease 2019 (COVID-19),  Graves’Ophthalmopathy (GO), Antithyroid Drugs (ATDs), Graves’ Disease (GD), total thyroidectomy (TT).


Prof., Ph.D. Nguyen Hai Thuy

University of Medicine and Pharmacy, Hue University