{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:32:16Z","timestamp":1791232336329,"version":"4.1.0"},"reference-count":63,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,28]],"date-time":"2022-10-28T00:00:00Z","timestamp":1666915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>This systematic review and meta-analysis was conducted to evaluate the effect of COVID-19 on thyroid function and the role of thyroid hormones alterations in predicting the severity of COVID-19. Online databases, including Scopus, Medline\/PubMed, EMBASE, Google Scholar, and Cochrane were searched up to August 2, 2022. After screening titles, abstracts, and full manuscripts, respectively, 30 reports were enrolled. The risk of bias (ROB) was evaluated using the QUADAS-2 tool. In addition, odds ratio (OR) and hazard ratio (HR) analysis for assessing the OR of abnormal thyroid function tests (TFT) in predicting the COVID-19 severity and poor outcomes. Among 30 enrolled studies, ROB of the current study is estimated low to moderate. The average number of patients in each study was 325 (range: 40-3,703), with an overall mean age of 57.6, and the female proportion of 40.4%. Overall, the pooled analysis showed that the prevalence of thyroid dysfunction among 9,707 COVID-19 cases was 15%. Among mild to moderate COVID-19 patients, 6.2% had abnormal TFT, and among patients who experienced severe to critical COVID-19, 20.8% had abnormal TFT. The pooled OR for abnormal TFT and the severity of COVID-19 obtained from 3,865 COVID-19 patients was 3.77 (2.03, 6.99). The pooled HR of TSH level of COVID-19 mortality was 1.57 (0.91, 2.72). Our results demonstrate a high prevalence of thyroid dysfunction in COVID-19, and that among patients severe cases had a 3.77-fold higher risk of abnormal TFT compared to mild to moderate COVID-19. Further studies are required to evaluate the longer-term prognostic role of thyroid dysfunction in severe COVID-19, and investigate potential therapeutic strategies.<\/jats:p>","DOI":"10.3389\/fendo.2022.947594","type":"journal-article","created":{"date-parts":[[2022,10,28]],"date-time":"2022-10-28T01:58:20Z","timestamp":1666922300000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":26,"title":["Association of thyroid dysfunction and COVID-19: A systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Mohammad","family":"Darvishi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Reza","family":"Nazer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamze","family":"Shahali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majid","family":"Nouri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,28]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","DOI":"10.1016\/j.compbiomed.2022.105426","article-title":"Decoding clinical biomarker space of COVID-19: Exploring matrix factorization-based feature selection methods","volume-title":"Comput Biol Med","author":"Saberi-Movahed","year":"2022"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2001017","article-title":"A novel coronavirus from patients with pneumonia in China, 2019","volume":"382","author":"Zhu","year":"2020","journal-title":"New Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2020.04.035","article-title":"SARS-CoV-2 receptor ACE2 is an interferon-stimulated gene in human airway epithelial cells and is detected in specific cell subsets across tissues","volume":"181","author":"Ziegler","year":"2020","journal-title":"Cell"},{"key":"B4","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","first-page":"m1295","DOI":"10.1136\/bmj.m1091","article-title":"Clinical characteristics of 113 deceased patients with coronavirus disease 2019: Retrospective study","volume":"368","author":"Chen","year":"2019","journal-title":"Bmj"},{"key":"B6","doi-asserted-by":"crossref","DOI":"10.1089\/ct.2020;32.154-155","volume-title":"COVID-19 and how it is affecting me as a thyroidologist","author":"Hennessey","year":"2020"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2010.0429","article-title":"Thyroid hormones as modulators of immune activities at the cellular level","volume":"21","author":"De Vito","year":"2011","journal-title":"Thyroid"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1210\/edrv-14-1-107","article-title":"Infection, thyroid disease, and autoimmunity","volume":"14","author":"Tomer","year":"1993","journal-title":"Endocrine Rev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1097\/EDE.0b013e3181fe7825","article-title":"PRISMA statement","volume":"22","author":"Moher","year":"2011","journal-title":"Epidemiology"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-8-201110180-00009","article-title":"QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies","volume":"155","author":"Whiting","year":"2011","journal-title":"Ann Internal Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.6.676","article-title":"Comparison of two methods to detect publication bias in meta-analysis","volume":"295","author":"Peters","year":"2006","journal-title":"Jama"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1111\/all.14238","article-title":"Clinical characteristics of 140 patients infected with SARS-CoV-2 in wuhan, China","volume":"75","author":"Zhang","year":"2020","journal-title":"Allergy"},{"key":"B13","doi-asserted-by":"publisher","first-page":"100448","DOI":"10.1016\/j.eclinm.2020.100448","article-title":"Characteristics, risk factors and outcomes among the first consecutive 1096 patients diagnosed with COVID-19 in Kuwait","volume":"24","author":"Almazeedi","year":"2020","journal-title":"EClinicalMedicine"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1101\/2020.03.04.20030395","article-title":"Clinical features of patients infected with the 2019 novel coronavirus (COVID-19) in shanghai, China","author":"Cao","year":"2020","journal-title":"MedRxiv"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2020.0363","article-title":"Thyroid function analysis in 50 patients with COVID-19: A retrospective study","volume":"31","author":"Chen","year":"2020","journal-title":"Thyroid"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-020-01460-w","article-title":"Thyroid hormone concentrations in severely or critically ill patients with COVID-19","volume":"44","author":"Gao","year":"2020","journal-title":"J endocrinological Invest"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ancard.2020.09.030","article-title":"Association of hypertension and antihypertensive agents and the severity of COVID-19 pneumonia. A monocentric French prospective study","volume":"69","author":"Georges","year":"2020","journal-title":"Annales cardiologie d'angeiologie"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-20-0335","article-title":"Thyrotoxicosis in patients with COVID-19: the THYRCOV study","volume":"183","author":"Lania","year":"2020","journal-title":"Eur J Endocrinology."},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-020-03967-9","article-title":"Characteristics of laboratory indexes in COVID-19 patients with non-severe symptoms in hefei city, China: diagnostic value in organ injuries","volume":"39","author":"Li","year":"2020","journal-title":"Eur J Clin Microbiol Infect Diseases."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa813","article-title":"Thyroid dysfunction in relation to immune profile, disease status, and outcome in 191 patients with COVID-19","volume":"106","author":"Lui","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1101\/2020.05.07.20094169","article-title":"Clinical, radiological and therapeutic characteristics of patients with COVID-19 in Saudi Arabia","volume":"15","author":"Shabrawishi","year":"2020","journal-title":"medRxiv"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0237960","article-title":"Prognostic factors in Spanish COVID-19 patients: A case series from Barcelona","volume":"15","author":"Sis\u00f3-Almirall","year":"2020","journal-title":"PloS One"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.00565","article-title":"Outcomes of patients with hypothyroidism and COVID-19: a retrospective cohort study","volume":"11","author":"van Gerwen","year":"2020","journal-title":"Front endocrinology."},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiaa119","article-title":"Clinical outcomes in 55 patients with severe acute respiratory syndrome coronavirus 2 who were asymptomatic at hospital admission in shenzhen, china","volume":"221","author":"Wang","year":"2020","journal-title":"J Infect Diseases."},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1101\/2020.03.19.20038539","article-title":"Clinical characteristics of coronavirus disease 2019 in hainan, China","author":"Yan","year":"2020","journal-title":"medRxiv"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2021.1109","article-title":"Thyroid hormone profile and its prognostic impact on the coronavirus disease 2019 in Korean patients","volume":"36","author":"Ahn","year":"2021","journal-title":"Endocrinol Metab (Seoul)."},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-021-01599-0","article-title":"Thyroid dysfunction in COVID-19 patients","volume":"44","author":"Baldelli","year":"2021","journal-title":"J Endocrinol Invest"},{"key":"B28","doi-asserted-by":"publisher","first-page":"5057","DOI":"10.3390\/jcm10215057","article-title":"Thyroid disfunction in critically ill COVID-19 patients. relationship with in-hospital mortality","volume":"10","author":"Ballesteros Vizoso","year":"2021","journal-title":"J Clin Med"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2021.0225","article-title":"Thyroid hormone levels during hospital admission inform disease severity and mortality in COVID-19 patients","volume":"31","author":"Beltr\u00e3o","year":"2021","journal-title":"Thyroid"},{"key":"B30","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1530\/EJE-20-1391","article-title":"The spectrum of thyroid function tests during hospitalization for SARS COV-2 infection","volume":"184","author":"Campi","year":"2021","journal-title":"Eur J Endocrinol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1530\/EC-21-0362","article-title":"Low FT3 is an independent marker of disease severity in patients hospitalized for COVID-19","volume":"10","author":"Dutta","year":"2021","journal-title":"Endocrine Connections"},{"key":"B32","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1186\/s12902-021-00766-x","article-title":"Prognostic significance of low TSH concentration in patients with COVID-19 presenting with non-thyroidal illness syndrome","volume":"21","author":"Gong","year":"2021","journal-title":"BMC Endocr Disord"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.14129","article-title":"The prognostic impact of thyroid disorders on the clinical severity of COVID-19: Results of single-centre pandemic hospital","volume":"75","author":"G\u00fcven","year":"2021","journal-title":"Int J Clin Pract"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa830","article-title":"Thyroid function before, during, and after COVID-19","volume":"106","author":"Khoo","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14476","article-title":"Role of non-thyroidal illness syndrome in predicting adverse outcomes in COVID-19 patients predominantly of mild-to-moderate severity","volume":"95","author":"Lui","year":"2021","journal-title":"Clin Endocrinol (Oxf)."},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(20)30266-7","article-title":"SARS-CoV-2-related atypical thyroiditis","author":"Muller","year":"2020","journal-title":"Lancet Publishing Group"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1530\/EC-21-0029","article-title":"Thyroid hormone alterations in critically and non-critically ill patients with SARS-CoV-2 infection","volume":"10","author":"Vassiliadi","year":"2021","journal-title":"Endocrine Connections"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.623792","article-title":"Thyroid function abnormalities in COVID-19 patients","volume":"11","author":"Wang","year":"2020","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B39","doi-asserted-by":"publisher","first-page":"111097","DOI":"10.1016\/j.mce.2020.111097","article-title":"Thyroid dysfunction may be associated with poor outcomes in patients with COVID-19","volume":"521","author":"Zhang","year":"2021","journal-title":"Mol Cell Endocrinol"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.566439","article-title":"Euthyroid sick syndrome in patients with COVID-19","volume":"11","author":"Zou","year":"2020","journal-title":"Front Endocrinol (Lausanne)."},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1139\/O10-022","article-title":"Endocrine cells of the adenohypophysis in severe acute respiratory syndrome (SARS)","volume":"88","author":"Wei","year":"2010","journal-title":"Biochem Cell Biol"},{"key":"B42","article-title":"Histopathological study of new coronavirus pneumonia (COVID-19) in three patients","volume":"49","author":"Yao X","year":"2020","journal-title":"Chin J Pathol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/S2666-5247(20)30115-4","article-title":"Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study","volume":"1","author":"Hanley","year":"2020","journal-title":"Lancet Microbe"},{"key":"B44","article-title":"Evaluation and observation of serum thyroid hormone and parathyroid hormone in patients with severe acute respiratory syndrome","volume":"25","author":"Wang","year":"2003","journal-title":"J Chin Antituberculous Assoc"},{"key":"B45","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1111\/j.1365-2265.2005.02325.x","article-title":"Hypocortisolism in survivors of severe acute respiratory syndrome (SARS)","volume":"63","author":"Leow","year":"2005","journal-title":"Clin Endocrinol"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20050828","article-title":"Multiple organ infection and the pathogenesis of SARS","volume":"202","author":"Gu","year":"2005","journal-title":"J Exp Med"},{"key":"B47","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.humpath.2006.06.011","article-title":"Pathology of the thyroid in severe acute respiratory syndrome","volume":"38","author":"Wei","year":"2007","journal-title":"Hum Pathol"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30749-2","article-title":"Caution against corticosteroid-based COVID-19 treatment","volume":"395","author":"Tang","year":"2020","journal-title":"Lancet"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.14310\/horm.2002.1301","article-title":"Thyroid function during critical illness","volume":"10","author":"Economidou","year":"2011","journal-title":"Hormones (Athens)"},{"key":"B50","doi-asserted-by":"publisher","first-page":"58","DOI":"10.4103\/trp.trp_16_16","article-title":"Thyroid dysfunction in critically ill patients in a tertiary care hospital in sikkim, India","volume":"14","author":"Suresh","year":"2017","journal-title":"Thyroid Res Pract"},{"key":"B51","doi-asserted-by":"crossref","first-page":"bvab076","DOI":"10.1210\/jendso\/bvab076","article-title":"COVID-19 and thyroid diseases: A bidirectional impact","volume":"5","author":"Duntas","year":"2021","journal-title":"J Endocrine Soc"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-021-09653-1","article-title":"Thyroid sequelae of COVID-19: A systematic review of reviews","volume":"22","author":"Trimboli","year":"2021","journal-title":"Rev Endocrine Metab Disord"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-020-01436-w","article-title":"Detection of SARS-COV-2 receptor ACE-2 mRNA in thyroid cells: a clue for COVID-19-related subacute thyroiditis","volume":"44","author":"Rotondi","year":"2021","journal-title":"J Endocrinological Invest"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-021-01628-y","article-title":"COVID-19 autopsy cases: detection of virus in endocrine tissues","volume":"45","author":"Poma","year":"2022","journal-title":"J Endocrinological Invest"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1530\/ETJ-22-0005","article-title":"Detection of sars-Cov-2 antigens in thyroid gland showing histopathological features of subacute thyroiditis","volume":"11","author":"Jakovac","year":"2022","journal-title":"Eur Thyroid J"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14699","article-title":"Association of hypothyroidism with outcomes in hospitalized adults with COVID-19: Results from the international SCCM discovery viral infection and respiratory illness universal study (VIRUS): COVID-19 registry","author":"Bogojevic","year":"2022","journal-title":"Clin Endocrinol"},{"key":"B57","doi-asserted-by":"publisher","first-page":"030006052210828","DOI":"10.1177\/03000605221082898","article-title":"Potential relationships between COVID-19 and the thyroid gland: an update","volume":"50","author":"Naguib","year":"2022","journal-title":"J Int Med Res"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.22541\/au.159414506.65558424","article-title":"Bnormal thyroid test results in euthyroid state: An appraisal of the role of drugs","author":"Krishnamurthy","year":"2020"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2021.01.001","article-title":"Sick euthyroid syndrome on presentation of patients with COVID-19: A potential marker for disease severity","volume":"27","author":"Schwarz","year":"2021","journal-title":"Endocrine Pract"},{"key":"B60","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1016\/j.eprac.2022.02.006","article-title":"Euthyroid sick syndrome as a prognostic indicator of COVID-19 pulmonary involvement, associated with poorer disease prognosis and increased mortality","volume":"28","author":"\u015awistek","year":"2022","journal-title":"Endocrine Pract"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1007\/s42399-021-00912-5","article-title":"The association of subacute thyroiditis with COVID-19: A systematic review","volume":"3","author":"Aemaz Ur Rehman","year":"2021","journal-title":"SN Compr Clin Med"},{"key":"B62","doi-asserted-by":"publisher","first-page":"postgradmedj\u20132021-141429","DOI":"10.1136\/postgradmedj-2021-141429","article-title":"Subacute thyroiditis following recovery from COVID-19 infection: novel clinical findings from an Eastern Indian cohort","author":"Mondal","year":"2022","journal-title":"Postgraduate Med J"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-022-01854-y","article-title":"Development of a prediction score (ThyroCOVID) for identifying abnormal thyroid function in COVID-19 patients","volume":"45","author":"Lui","year":"2022","journal-title":"J Endocrinological Invest"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2022.947594\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,28]],"date-time":"2022-10-28T01:58:31Z","timestamp":1666922311000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2022.947594\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,28]]},"references-count":63,"alternative-id":["10.3389\/fendo.2022.947594"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2022.947594","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,28]]},"article-number":"947594"}}