Studies of Thyroid Function in Health and Disease

严重急性呼吸综合征冠状病毒-2(SARS-CoV-2)感染与肾上腺和甲状腺功能障碍有关。然而，目前的文献是基于免疫分析测量的，这受到几个干扰因素的影响。在这项初步研究中，我们对在两个第三转诊中心住院的SARS-CoV-2患者(18岁)进行了类固醇和甲状腺激素谱的质谱分析。对肾上腺皮质类固醇激素孕酮、皮质酮、17-羟孕酮、11-脱氧皮质醇、脱氢表雄酮(DHEA)、雄烯二酮、睾酮、总甲状腺素(TT4)、总三碘甲腺原氨酸(TT3)、反三碘甲腺原氨酸(RT3)、促肾上腺皮质激素(ACTH)、促甲状腺激素(TSH)、黄体生成素和卵泡刺激素、醛固酮进行了液-质联用分析。根据体外膜氧合(ECMO)和生存状态对数据进行二分法处理。对10名患者(4名女性；中位年龄：41.5岁)的63个血浆样本的血浆分析显示，与非ECMO患者相比，男性ECMO患者的11-脱氧皮质醇中位数升高了38倍，死于SARS-CoV-2的女性ECMO患者的11-脱氧皮质醇水平比非ECMO存活患者高出20倍。11-脱氧皮质醇升高幅度更大，与相应的皮质醇水平不成比例。死亡男性患者血浆DHEA水平显著升高，严重SARS-CoV-2患者女性患者血浆雄烯二酮、皮质酮和醛固酮水平显著升高。在接受ECMO治疗的患者和死亡患者中，TT4、TT3和RT3的中位数水平显著降低。总之，在急性SARS-CoV-2期间，肾上腺和甲状腺轴可能受到影响，破坏的程度可能与疾病严重程度、性别和ECMO状态有关。

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.