Features of the pathogenesis of thyroid diseases in COVID-19

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Abstract

The novel coronavirus infection (COVID-19) pandemic has been declared by the WHO as a public health emergency of international concern around the world. The results of numerous studies have convincingly shown that the impact of SARS-CoV-2 extends not only to the respiratory system, but also to other organs and systems, which significantly affects the prognosis of the disease. This review presents research data on the role of SARS-CoV-2 in the development of thyroid diseases, including subacute thyroiditis, diffuse toxic goiter, euthyroid pathology syndrome, chronic thyroiditis with impaired thyroid function. The pathogenesis of endocrine damage in COVID-19 remains unexplored. In addition to the direct cytopathogenic effect of the virus on the thyroid tissue, great importance is attached to the development of an immunoinflammatory syndrome, impaired immune tolerance, and the effect of anticoagulant, antiviral, and anticytokine therapy. Viral damage also affects the central links of endocrine regulation, violating the mechanisms of hypothalamic-pituitary-thyroid regulation. Autoimmune disorders in genetically predisposed persons are considered as one of the main mechanisms of thyroid dysfunction. In addition, a number of thyroid diseases can worsen the course and prognosis of COVID-19. The article discusses the reasons for the development of thyroid dysfunction due to currently known mechanisms of the damaging effect of SARS-CoV-2. The analysis of the accumulated experience in managing patients with COVID-19 presented in the review open the way to develop effective recommendations for the prevention and treatment of thyroid diseases in patients infected with the SARS-CoV-2 virus.

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About the authors

Oksana V. Maksim

S.M. Kirov Military Medical Academy

Author for correspondence.
Email: ovmaks1611@mail.ru
ORCID iD: 0000-0003-0808-3325

Cand. Sci. (Med.), Teaching Assistant at the 1st Department of Therapy (Advanced Medical Education), S.M. Kirov Military Medical Academy, St. Petersburg, Russia

Russian Federation, St. Petersburg

B. V. Romashevsky

S.M. Kirov Military Medical Academy

Email: ovmaks1611@mail.ru
ORCID iD: 0000-0002-6219-5056
Russian Federation, St. Petersburg

N. Y. Demyanenco

S.M. Kirov Military Medical Academy

Email: ovmaks1611@mail.ru
ORCID iD: 0000-0002-8393-0048
Russian Federation, St. Petersburg

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Supplementary files

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2. Fig. 1. Proposed pathogenesis of thyroid dysfunction in COVID-19

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3. Fig. 2. Mechanism of thyroid injury in COVID-19 (adapted from [28])

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4. Fig. 3. Immunological changes leading to thyroid dysfunction in COVID-19 (adapted from [20])

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5. Fig. 4. Dynamics of the appearance of thyroid diseases in COVID-19 (adapted from [20])

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