Endocrine Abstracts

SARS-CoV2 can induce multiple immunological and endocrinological changes. Diabetes and thyroid disorders tend to coexist in patients. Both conditions involve a dysfunction of the endocrine system. Thyroid disorders can have a major impact on glucose control. On one hand, thyroid hormones contribute to the regulation of carbohydrate metabolism and pancreatic function, and on the other hand, diabetes affects thyroid function tests to variable extents. SARS-CoV-2 uses ACE2 receptor combined with the TMPRSS2 as the key molecular complex to infect the host cells. Interestingly, ACE2 and TMPRSS2 expression levels are high in the thyroid gland and more than in the lungs. Physiological concentrations T4 and T3 stimulate the production and release of cytokines, which are also components of “cytokine storm” potentially characterizing systemic viral infections. COVID-19 might also predispose infected individuals to hyperglycemia. In November 2020, a 55 years old chirurg doctor presented the symptoms headache and tachycardia, dyspena, polyuria and polydisia, temperature of 39.0.He had 3 days with this symptoms.Before, he has no history of diabetis mellitus tip 2 or hyperthyrosis. The initial ECG showed a sinus tachycardia with a frequency of up to 120 beats per minute. Laboratory results revealed elevated thyroid hormone levels fT3 6.9 pg/ml; [2.0–4.4]; fT4 26 pg/ml; [9–17) as well as a supressed TSH (0.01 µU/ml; [0.27–4.20]). As thyroid autoantibodies (antithyroid peroxidase (TPO) antibody, anti-thyroglobulin (Tg) antibody and thyroid-stimulating hormone receptor (TSHR) antibody) were negative and thyroid ultrasound was normal. Glycemia 400 mg/dl.HbA1C 5.0%, PCR 10, eritrosedimention rate 30, lymphopenia 1.06G/l.Ct scan of chest pozitiv for COVID 19.The patients was treated with anticovid treatment, no oxygen therapy, amaryl 2 mg 1 tb in the morning and vitagliptin 50 mg 1 tb in dark, unimazol 5 mg 2 tb in morning 2 tb in the dark.After 5 days we had a good improvement of glycemia, tachycardia and dyspnea.The patient was clinically better.After 1 month the patients was stabilized of Covid 19 and had good profile of glycemic control but he had supressed TSH 0.07.The antidiabetic oral and antithyroidien therapy is continued.We assume SARS-CoV-2 infection can induce a destruction of thyroid issue. All patients with COVID-19 should be monitored regarding endocrinological changes, especially diabetes, but also TSH, fT3, fT4 should be assessed. Hyperthyroidism may mimic clinical features of COVID-19 like fever, tachycardia, and diarrhoea. Thyroid dysfunction may be due to coincident primary thyroid disease, but also viral affection of the thyroid should be taken into account.