ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of hyperthyroidism and hypothyroidism.
ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of hyperthyroidism and hypothyroidism.
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DOI：
10.1530/eje-20-0445
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发表时间：
2020-07
影响因子：
5.8
通讯作者：
Persani L
中科院分区：
文献类型：
--
作者：
Boelaert K;Visser WE;Taylor PN;Moran C;Léger J;Persani L
本手稿为2019冠状病毒病大流行期间甲状腺功能障碍的管理提供指导。自身免疫性甲状腺疾病与COVID-19风险增加无关。不受控制的甲状腺毒症可能导致SARS-CoV-2感染的更严重并发症，包括甲状腺风暴。由于有限的生化检测可用性，新诊断为甲状腺功能亢进症的患者的管理最好采用阻断和替代方案。抗甲状腺药物（ATD）诱导的中性粒细胞减少症可能有利于COVID-19的进展，感染症状可能与SARS-CoV-2感染混淆。如果在治疗的最初几个月出现流感样表现，应考虑停用ATD并紧急测量中性粒细胞。紧急手术或131-I可以在选定的情况下进行控制甲状腺毒症。感染COVID-19的患者可能会出现结膜炎，这可能会对新发或现有Graves眼病患者造成诊断困难。正在接受甲状腺激素替代治疗的患者应确保有足够的药物供应。通常的建议，以增加剂量的左旋甲状腺素在怀孕期间应坚持。许多新出现的和以前诊断的甲状腺功能障碍患者可以通过虚拟电话或视频诊所进行管理，并根据现有设施提供专门的护士主导服务。
This manuscript provides guidance on the management of thyroid dysfunction during the COVID-19 pandemic. Autoimmune thyroid diseases are not linked to increased risks of COVID-19. Uncontrolled thyrotoxicosis may result in more severe complications from SARS-CoV-2 infection, including thyroid storm. The management of patients with a new diagnosis of hyperthyroidism is best undertaken with a block-and-replace regimen due to limited biochemical testing availability. Antithyroid drug (ATD)-induced neutropenia may favour the progression of COVID-19 and symptoms of infection may be confused with SARS-CoV-2 infection. The withdrawal of ATDs and urgent measurement of neutrophils should be considered in case of flu-like manifestations occurring in the initial months of treatment. Urgent surgery or 131-I may be undertaken in selected cases of uncontrolled thyrotoxicosis. Patients with COVID-19 infection may present with conjunctivitis, which could cause diagnostic difficulties in patients with new or existing Graves' ophthalmopathy. Patients who are on replacement treatment with thyroid hormones should ensure they have sufficient supply of medication. The usual advice to increase dosage of levothyroxine during pregnancy should be adhered to. Many newly presenting and previously diagnosed patients with thyroid dysfunction can be managed through virtual telephone or video clinics supported by a dedicated nurse-led service, depending on available facilities.