{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T10:07:13Z","timestamp":1764842833644,"version":"build-2065373602"},"reference-count":72,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T00:00:00Z","timestamp":1706054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Three-year Action Program of Shanghai Municipality for Strengthening the Construction of Public Health System","award":["GWV-10.2-YQ34"],"award-info":[{"award-number":["GWV-10.2-YQ34"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>The association between thyroid function and viral pneumonia has undergone extensive examination, yet the presence of a causal link remains uncertain. The objective of this paper was to employ Two-Sample Mendelian Randomization (MR) analysis to investigate the connections between three thyroid diseases and thyroid hormone indicators with viral pneumonia and COVID-19. We obtained summary statistics datasets from seven genome-wide association studies (GWASs). The primary method used for estimating relationships was inverse-variance weighting (IVW). In addition, we employed weighted median, weighted mode, MR-Egger, and MR-PRESSO as supplementary analytical tools. Sensitivity analyses encompassed Cochran\u2019s Q test, MR-Egger intercept test, and MR-PRESSO. Our study revealed significant causal relationships between having a genetic predisposition to autoimmune thyroid disease (AITD) and an increased susceptibility to viral pneumonia (odds ratio [OR]: 1.096; 95% confidence interval [CI]: 1.022\u20131.176). Moreover, it demonstrated a heightened susceptibility and severity of COVID-19 (OR for COVID-19 susceptibility, COVID-19 hospitalization, and COVID-19 critical illness, with 95% CIs of 1.016, 1.001\u20131.032; 1.058, 1.003\u20131.116; 1.045, 1.010\u20131.081). However, no statistically significant associations were found between TSH, FT4, subclinical hypo- or hyperthyroidism, and the risk of viral pneumonia incidence, or the susceptibility and severity of COVID-19 (all p &gt; 0.05). This study establishes a cause-and-effect relationship between AITD and the development of viral pneumonia, as well as the susceptibility and severity of COVID-19.<\/jats:p>","DOI":"10.3390\/pathogens13020101","type":"journal-article","created":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T04:35:40Z","timestamp":1706070940000},"page":"101","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Influence of Autoimmune Thyroid Diseases on Viral Pneumonia Development, Including COVID-19: A Two-Sample Mendelian Randomization Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Kexin","family":"Yi","sequence":"first","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingjie","family":"Tian","sequence":"additional","affiliation":[{"name":"Shanghai Deji Hospital, Qingdao University, Shanghai 200331, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1585-4888","authenticated-orcid":false,"given":"Xue","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ccm.2016.11.012","article-title":"Epidemiology of Viral Pneumonia","volume":"38","author":"Jain","year":"2017","journal-title":"Clin. Chest Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1007\/s15010-021-01603-y","article-title":"Characteristics of viral pneumonia in the COVID-19 era: An update","volume":"49","author":"Pagliano","year":"2021","journal-title":"Infection"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1016\/S0140-6736(10)61459-6","article-title":"Viral pneumonia","volume":"377","author":"Ruuskanen","year":"2011","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/MCC.0000000000000911","article-title":"Pathophysiology of coronavirus-19 disease acute lung injury","volume":"28","author":"Camporota","year":"2022","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0140-6736(20)30211-7","article-title":"Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study","volume":"395","author":"Chen","year":"2020","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"105951","DOI":"10.1016\/j.ijantimicag.2020.105951","article-title":"Coronavirus disease 2019 (COVID-19): Current status and future perspectives","volume":"55","author":"Li","year":"2020","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"6925296","DOI":"10.34133\/2020\/6925296","article-title":"Combating the Coronavirus Pandemic: Early Detection, Medical Treatment, and a Concerted Effort by the Global Community","volume":"2020","author":"Luo","year":"2020","journal-title":"Research"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention","volume":"323","author":"Wu","year":"2020","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s11154-016-9361-4","article-title":"The role of human parvovirus B19 and hepatitis C virus in the development of thyroid disorders","volume":"17","author":"Fallahi","year":"2016","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1507\/endocrj.EJ20-0443","article-title":"Thyroid complications of SARS and coronavirus disease 2019 (COVID-19)","volume":"68","author":"Speer","year":"2021","journal-title":"Endocr. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1038\/s41586-022-05542-y","article-title":"SARS-CoV-2 infection and persistence in the human body and brain at autopsy","volume":"612","author":"Stein","year":"2022","journal-title":"Nature"},{"key":"ref_12","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. Endocr. Soc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3614","DOI":"10.1210\/jc.2010-1245","article-title":"Thyroid and Obesity: An Intriguing Relationship","volume":"95","author":"Biondi","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1152\/physrev.00030.2013","article-title":"Thyroid hormone Regulation of Metabolism","volume":"94","author":"Mullur","year":"2014","journal-title":"Physiol. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3190","DOI":"10.1210\/clinem\/dgad371","article-title":"Thyroid Function and Metabolic Syndrome: A Two-Sample Bidirectional Mendelian Randomization Study","volume":"108","author":"Zemunik","year":"2023","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1002\/cphy.c200003","article-title":"The Role of Thyroid Hormone in the Innate and Adaptive Immune Response during Infection","volume":"10","author":"Rubingh","year":"2020","journal-title":"Compr. Physiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.jaut.2015.07.009","article-title":"Immunogenetics of autoimmune thyroid diseases: A comprehensive review","volume":"64","author":"Lee","year":"2015","journal-title":"J. Autoimmun."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1093\/infdis\/174.3.456","article-title":"Respiratory Syncytial Virus Is an Important Cause of Community-Acquired Lower Respiratory Infection among Hospitalized Adults","volume":"174","author":"Dowell","year":"1996","journal-title":"J. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Gorini, F., and Vassalle, C. (2023). A Literature Review on SARS-CoV-2 and Other Viruses in Thyroid Disorders: Environmental Triggers or No-Guilty Bystanders?. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20032389"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Fallahi, P., Elia, G., Ragusa, F., Paparo, S.R., Patrizio, A., Balestri, E., Mazzi, V., Benvenga, S., Varricchi, G., and Gragnani, L. (2023). Thyroid Autoimmunity and SARS-CoV-2 Infection. J. Clin. Med., 12.","DOI":"10.3390\/jcm12196365"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"bqab004","DOI":"10.1210\/endocr\/bqab004","article-title":"Potential Interaction Between SARS-CoV-2 and Thyroid: A Review","volume":"162","author":"Chen","year":"2021","journal-title":"Endocrinology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"708333","DOI":"10.3389\/fendo.2021.708333","article-title":"Coronavirus Disease 2019 and the Thyroid\u2014Progress and Perspectives","volume":"12","author":"Inaba","year":"2021","journal-title":"Front. Endocrinol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1007\/s12020-022-03129-1","article-title":"Thyroid function changes and COVID-19 severity: Egg or chicken?","volume":"78","author":"Chen","year":"2022","journal-title":"Endocrine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"947594","DOI":"10.3389\/fendo.2022.947594","article-title":"Association of thyroid dysfunction and COVID-19: A systematic review and meta-analysis","volume":"13","author":"Darvishi","year":"2022","journal-title":"Front. Endocrinol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"03000605221082898","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":"ref_26","doi-asserted-by":"crossref","first-page":"1041676","DOI":"10.3389\/fendo.2022.1041676","article-title":"COVID-19 and thyroid function: What do we know so far?","volume":"13","author":"Rossetti","year":"2022","journal-title":"Front. Endocrinol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clnesp.2022.02.116","article-title":"Severe acute respiratory syndrome and thyroid: A molecular point of view","volume":"48","author":"Sadoughi","year":"2022","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1001\/jama.2017.17219","article-title":"Mendelian randomization","volume":"318","author":"Emdin","year":"2017","journal-title":"JAMA"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1146\/annurev-genom-083117-021731","article-title":"Inferring Causal Relationships Between Risk Factors and Outcomes from Genome-Wide Association Study Data","volume":"19","author":"Burgess","year":"2018","journal-title":"Annu. Rev. Genom. Hum. Genet."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"k601","DOI":"10.1136\/bmj.k601","article-title":"Reading Mendelian randomisation studies: A guide, glossary, and checklist for clinicians","volume":"362","author":"Davies","year":"2018","journal-title":"BMJ"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"bqac139","DOI":"10.1210\/endocr\/bqac139","article-title":"Thyroid Function and COVID-19 Susceptibility and Its Severity: A Two-Sample Mendelian Randomization Study","volume":"163","author":"Zhang","year":"2022","journal-title":"Endocrinology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1038\/s41586-020-2436-0","article-title":"FLT3 stop mutation increases FLT3 ligand level and risk of autoimmune thyroid disease","volume":"584","author":"Saevarsdottir","year":"2020","journal-title":"Nature"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1038\/s41586-022-05473-8","article-title":"FinnGen provides genetic insights from a well-phenotyped isolated population","volume":"613","author":"Kurki","year":"2023","journal-title":"Nature"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.1038\/s41586-023-06355-3","article-title":"A second update on mapping the human genetic architecture of COVID-19","volume":"621","author":"Kanai","year":"2023","journal-title":"Nature"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"4455","DOI":"10.1038\/s41467-018-06356-1","article-title":"Genome-wide analyses identify a role for SLC17A4 and AADAT in thyroid hormone regulation","volume":"9","author":"Teumer","year":"2018","journal-title":"Nat. Commun."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3981","DOI":"10.1038\/s41467-020-17718-z","article-title":"GWAS of thyroid stimulating hormone highlights pleiotropic effects and inverse association with thyroid cancer","volume":"11","author":"Zhou","year":"2020","journal-title":"Nat. Commun."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2548","DOI":"10.1093\/hmg\/ddac052","article-title":"Thyroid function, pernicious anemia and erythropoiesis: A two-sample Mendelian randomization study","volume":"31","author":"Kjaergaard","year":"2022","journal-title":"Hum. Mol. Genet."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"4851","DOI":"10.1093\/bioinformatics\/btz469","article-title":"PhenoScanner V2: An expanded tool for searching human genotype\u2013phenotype associations","volume":"35","author":"Kamat","year":"2019","journal-title":"Bioinformatics"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1093\/ije\/dyr036","article-title":"Avoiding bias from weak instruments in Mendelian randomization studies","volume":"40","author":"Burgess","year":"2011","journal-title":"Int. J. Epidemiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e4251","DOI":"10.1210\/clinem\/dgab183","article-title":"Causal Association Between Serum Thyrotropin and Obesity: A Bidirectional, Mendelian Randomization Study","volume":"106","author":"Wang","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1093\/ije\/dyx034","article-title":"MendelianRandomization: An R package for performing Mendelian randomization analyses using summarized data","volume":"46","author":"Yavorska","year":"2017","journal-title":"Int. J. Epidemiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1093\/ije\/dyx102","article-title":"Robust inference in summary data Mendelian randomization via the zero modal pleiotropy assumption","volume":"46","author":"Hartwig","year":"2017","journal-title":"Int. J. Epidemiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1002\/gepi.21965","article-title":"Consistent Estimation in Mendelian Randomization with Some Invalid Instruments Using a Weighted Median Estimator","volume":"40","author":"Bowden","year":"2016","journal-title":"Genet. Epidemiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1007\/s10654-017-0255-x","article-title":"Interpreting findings from Mendelian randomization using the MR-Egger method","volume":"32","author":"Burgess","year":"2017","journal-title":"Eur. J. Epidemiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1038\/s41588-018-0099-7","article-title":"Detection of widespread horizontal pleiotropy in causal relationships inferred from Mendelian randomization between complex traits and diseases","volume":"50","author":"Verbanck","year":"2018","journal-title":"Nat. Genet."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1093\/ije\/dyq151","article-title":"Power and instrument strength requirements for Mendelian randomization studies using multiple genetic variants","volume":"40","author":"Pierce","year":"2011","journal-title":"Int. J. Epidemiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1093\/ije\/dyt179","article-title":"Calculating statistical power in Mendelian randomization studies","volume":"42","author":"Brion","year":"2013","journal-title":"Int. J. Epidemiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1002\/gepi.21998","article-title":"Bias due to participant overlap in two-sample Mendelian randomization","volume":"40","author":"Burgess","year":"2016","journal-title":"Genet Epidemiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"4120","DOI":"10.1016\/j.clnu.2021.01.047","article-title":"Causal relationship between dietary macronutrient composition and anthropometric measures: A bidirectional two-sample Mendelian randomization analysis","volume":"40","author":"Freuer","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e13511","DOI":"10.1111\/ctr.13511","article-title":"RNA respiratory viral infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice","volume":"33","author":"Manuel","year":"2019","journal-title":"Clin. Transplant."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2682","DOI":"10.1182\/blood-2016-01-634873","article-title":"How I treat respiratory viral infections in the setting of intensive chemotherapy or hematopoietic cell transplantation","volume":"127","author":"Waghmare","year":"2016","journal-title":"Blood"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1093\/cid\/ciaa863","article-title":"COVID-19 in Immunocompromised Hosts: What We Know So Far","volume":"72","author":"Fung","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.autrev.2014.10.016","article-title":"Autoimmune thyroid disorders","volume":"14","author":"Antonelli","year":"2015","journal-title":"Autoimmun. Rev."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"688066","DOI":"10.3389\/fimmu.2021.688066","article-title":"Role of Th22 Cells in the Pathogenesis of Autoimmune Diseases","volume":"12","author":"Jiang","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_55","first-page":"e210024","article-title":"Cellular and molecular basis of thyroid autoimmunity","volume":"11","author":"Godlewska","year":"2022","journal-title":"Eur. Thyroid J."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1089\/thy.2018.0065","article-title":"Sphk1\/S1P\/S1PR1 Signaling is Involved in the Development of Autoimmune Thyroiditis in Patients and NOD.H-2h4 Mice","volume":"29","author":"Han","year":"2019","journal-title":"Thyroid"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1016\/j.kint.2022.01.022","article-title":"COVID-19 in dialysis: Clinical impact, immune response, prevention, and treatment","volume":"101","year":"2022","journal-title":"Kidney Int."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Zhao, X., Cao, Y., Zhao, E., Li, T., Cong, T., Gao, Y., and Zhang, J. (2022). The Expression Levels of SARS-CoV-2 Infection-Mediating Molecules Promoted by Interferon-\u03b3 and Tumor Necrosis Factor-\u03b1 Are Downregulated by Hydrogen Sulfide. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms232113624"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1038\/s41586-020-2180-5","article-title":"Structure of the SARS-CoV-2 spike receptor-binding domain bound to the ACE2 receptor","volume":"581","author":"Lan","year":"2020","journal-title":"Nature"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1126\/science.abd3072","article-title":"Neuropilin-1 is a host factor for SARS-CoV-2 infection","volume":"370","author":"Daly","year":"2020","journal-title":"Science"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1126\/science.abd2985","article-title":"Neuropilin-1 facilitates SARS-CoV-2 cell entry and infectivity","volume":"370","author":"Ojha","year":"2020","journal-title":"Science"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"G33","DOI":"10.1530\/EJE-20-0445","article-title":"ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of hyperthyroidism and hypothyroidism","volume":"183","author":"Boelaert","year":"2020","journal-title":"Eur. J. Endocrinol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.ando.2020.09.001","article-title":"Thyroid disorders and SARS-CoV-2 infection: From pathophysiological mechanism to patient management","volume":"81","author":"Caron","year":"2020","journal-title":"Ann. d\u2019Endocrinologie"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"565","DOI":"10.3389\/fendo.2020.00565","article-title":"Outcomes of Patients With Hypothyroidism and COVID-19: A Retrospective Cohort Study","volume":"11","author":"Alsen","year":"2020","journal-title":"Front. Endocrinol."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Sun, Y., Ding, Z., Guo, Y., Yuan, J., Zhu, C., Pan, Y., and Sun, R. (2023). Causal Inference of Central Nervous System-Regulated Hormones in COVID-19: A Bidirectional Two-Sample Mendelian Randomization Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12041681"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"961717","DOI":"10.3389\/fendo.2022.961717","article-title":"Causal associations between thyroid dysfunction and COVID-19 susceptibility and severity: A bidirectional Mendelian randomization study","volume":"13","author":"Zhang","year":"2022","journal-title":"Front. Endocrinol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1089\/thy.2022.0243","article-title":"COVID-19 and Thyroid Function: A Bi-Directional Two-Sample Mendelian Randomization Study","volume":"32","author":"Li","year":"2022","journal-title":"Thyroid"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s10194-023-01612-2","article-title":"Exploring the bidirectional relationship between pain and mental disorders: A comprehensive Mendelian randomization study","volume":"24","author":"Yao","year":"2023","journal-title":"J. Headache Pain"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1093\/ije\/dyt093","article-title":"Use of allele scores as instrumental variables for Mendelian randomization","volume":"42","author":"Burgess","year":"2013","journal-title":"Int. J. Epidemiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"4913","DOI":"10.1093\/eurheartj\/ehad736","article-title":"Mendelian randomization for cardiovascular diseases: Principles and applications","volume":"44","author":"Larsson","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Smith, G.D., Lawlor, D.A., Harbord, R., Timpson, N., Day, I., and Ebrahim, S. (2007). Clustered Environments and Randomized Genes: A Fundamental Distinction between Conventional and Genetic Epidemiology. PLoS Med., 4.","DOI":"10.1371\/journal.pmed.0040352"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"a038984","DOI":"10.1101\/cshperspect.a038984","article-title":"Multivariable Mendelian Randomization and Mediation","volume":"11","author":"Sanderson","year":"2021","journal-title":"Cold Spring Harb. Perspect. Med."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/13\/2\/101\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:48:17Z","timestamp":1760104097000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/13\/2\/101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,24]]},"references-count":72,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["pathogens13020101"],"URL":"https:\/\/doi.org\/10.3390\/pathogens13020101","relation":{},"ISSN":["2076-0817"],"issn-type":[{"type":"electronic","value":"2076-0817"}],"subject":[],"published":{"date-parts":[[2024,1,24]]}}}