Medicina | Free Full-Text | Thyroid Stimulating Hormone as a Possible Additional COVID-19 Outcome Marker
It is crucial to gain a deeper understanding of the pathophysiology of the disease and promptly identify the phenotypes of vulnerable patients who are at the highest risk of immediate and prolonged unfavorable outcomes.
Our study aims to investigate the predictive value of serum Thyroid Stimulating Hormone (TSH) in patients with no known thyroid disorder concerning short-term and middle-term COVID-19 outcomes.
One of the main shortcomings of this study, owing to the retrospective analysis, was that fT3 and fT4 were not assessed during the hospitalization. In addition, the serum TSH was tested while patients were receiving glucocorticoids. Furthermore, the patients included in this study were hospitalized patients with moderate–severe disease. Thus, we lack data from patients with milder disease forms. In addition, chest MSCT was not available both during hospitalization and in the post-COVID-19 follow-up for all patients. Nevertheless, to our knowledge, this is the first study investigating the serum TSH and the COVID-19-associated outcomes of patients in a population drawn from the first and largest COVID-19 hospital in Croatia, with a follow-up to assess post-COVID-19 pulmonary involvement. The results of our research may indicate that lower TSH might be a predictor of worse immediate and middle-term outcomes.
Other considerations and limitations requiring clinicians’ attention are related to high sensitivity and low specificity associated with the cut-off value of TSH 0.5 mIU/L. The set specific threshold exhibits a predisposition toward yielding positives and false positives, emphasizing the importance of identifying patients at risk and the potential need for mechanical ventilation. Lower specificity implies a compromised ability of the test to accurately discern patients devoid of risk. However, in our opinion, designating a patient as at risk and providing additional observation is probably less harmful as opposed to the converse scenario. It is imperative to emphasize that TSH provides only supplementary laboratory aid, which should be utilized with caution and only in an adjunct to established standard procedures employed for evaluating the severity of the condition. As there is no current gold-standard test identifying COVID-19 patients at risk for worse outcomes at an early stage of the disease, any additional cheap and easily available tool, such as TSH, might be useful.
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