Studies of Thyroid Function in Health and Disease

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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is associated with adrenal and thyroid dysfunction. However, the current literature is based on immunoassay measurements, which are subject to several interfering factors. In this preliminary study, we performed mass spectrometry analysis of steroid and thyroid hormone profiles in patients (18 years) hospitalized with SARS-CoV-2 at two tertiary referral centers. Liquid chromatography-mass spectrometry analysis of adrenocortical steroids progesterone, corticosterone, 17-hydroxyprogesterone, 11-deoxycortisol, cortisol, cortisone, dehydroepiandrosterone (DHEA), androstenedione, testosterone, total thyroxine (TT4), total triiodothyronine (TT3), reverse triiodothyronine (rT3), and immunoassay analysis of adrenocorticotropic hormone (ACTH), thyroid stimulating hormone (TSH), luteinizing and follicle-stimulating hormones, and aldosterone were performed. Data were dichotomized based on extracorporeal membrane oxygenation (ECMO) and survival status. Plasma analysis of a total of 63 plasma samples from ten patients (four females; median age: 41.5 years) revealed a median 11-deoxycortisol elevation up to 38-fold in male ECMO patients compared to non-ECMO patients, and up to 20-fold among female ECMO patients who died from SARS-CoV-2 compared to non-ECMO surviving patients. The 11-deoxycortisol elevations were more profound and out of proportion to corresponding cortisol levels. Significantly higher levels were noted in plasma DHEA in male non-survivors, androstenedione in females with severe SARS-CoV-2, corticosterone, and aldosterone in male/female non-survivors. Median TT4, TT3, and rT3 levels were significantly lower in patients on ECMO and among non-survivors. In conclusion, the adrenal and thyroid axes can be affected during acute SARS-CoV-2 and the degree of disruption may be associated with disease severity, sex, and ECMO status.