Long Covid: a report from china

Logo of frontendo

Euthyroid Sick Syndrome (Functional Hypothyroidism) in Patients With COVID-19

Runmei Zou,1,†Chenfang Wu,2,†Siye Zhang,2Guyi Wang,2Quan Zhang,3Bo Yu,2Ying Wu,2Haiyun Dong,2Guobao Wu,2Shangjie Wu,4 and Yanjun Zhong2,* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575767/ Published online 2020 Oct 7. doi: 10.3389/fendo.2020.566439PMCID: PMC7575767PMID: 33117282

“Euthyroid Sick Syndrome” (ESS) is Functional Hypothyroidism (see my post on thyroid). It is the physiologic adaptation and pathologic response to stress, particularly to the stress of acute disease. It can be defined as a state in which T3 and T4 are low, without increased TSH.
In the pathophysiological process of ESS, type III deiodinase is activated and type I is suppressed, so there is preferential conversion of T4 to rT3 instead of T3 (9), conversion of free T3 to (inactive) T2 and reduced importation of T4 into the cells.
In addition, there is increased binding of thyroid hormone to plasma protein.
For these reasons, Free T3 plummets.
ESS occurs in infection, trauma, myocardial infarction, malignancy and virtually all other severe diseases (10). Previous studies have suggested that low levels of free T3 (FT3) are associated with severe disease and poor prognosis in critical illness (11, 12).
For example, a study consisting of 503 patients diagnosed with community-acquired pneumonia reported that ESS is an independent risk factor for mortality (19).
Also, in a previous study of 48 SARS patients, 93.7% patients had low T3 (8), high ESR and procalcitonin, but lower lymphocyte count than those without ESS (in this study, Cortisol and rT3 levels unknown).

Herein, Zou et al report studying 149 COVID-19 patients: 41 (27.52%) had ESS (9). 14 of the 41 (34.15%) were male and 65.85, female.
The median age was 58 (IQR: 50–66Yr).
The COVID-19 patients with ESS had stronger inflammatory responses, with higher CRP, ESR and Procalcitonin, but lower lymphocyte count than those without ESS (the levels of Cortisol and rT3 were unknown). ESS patients had more fever [39 (95.12%)], fatigue [18 (43.90%)], cough [36 (87.80%)], shortness of breath [25 (60.98%)], expectoration [20 (48.78%)], and anorexia [21 (51.22%)] than patients without ESS. Hypertension [10 (24.39%)] and diabetes [7 (17.07%)] were the common comorbidities.

Patients with ESS had significantly lower T4 and free T4 (FT4) than non-ESS patients, but the TSH did not differ.

The authors have neatly proven that over 25% of their Covid patients had ESS (Functional Hypothyroidism, “FH”) but evidently they are not familiar with the condition and have not made the obvious connection: the symptoms of “long covid” and ESS/FH are indistinguishable.

In my opinion (please remember that since I am no longer licensed, my opinion does not constitute medical advice or instruction), long covid can be equated with ESS/FH and as such, can be expected to respond to administration of oral Triiodothyronine (dose supervised by a physician and titrated according to response of serum T3, rT3, ESR, CRP & TSH), along with support of other hormones, vitamins and minerals, as necessary.

  • References: (NOTE that these references are from the paper by Zou et al. They are not the product of my research).

1. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol (2020) 92:401–2. 10.1002/jmv.25678 [PMC free article] [PubMed] [CrossRef] [Google Scholar] 2. Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health – The latest 2019 novel coronavirus outbreak in Wuhan. China Int J Infect Dis (2020) 91:264–6. 10.1016/j.ijid.2020.01.009 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
3. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan. China Lancet (2020) 395:497–506. 10.1016/S0140-6736(20)30183-5 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
4. World Health Organization Novel Coronavirus (2019-nCoV) situation reports. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/ (Accessed Assessed on Augest 28th, 2020). 5. Coronaviridae Study Group of the International Committee on Taxonomy of The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol (2020):536–44,0.1038/s41564-020-0695-z [PMC free article] [PubMed] [CrossRef] [Google Scholar]
6. Wadman M, Couzin-Frankel J, Kaiser J, Matacic C. How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes. Science (2020). 10.1126/science.abc3208 [CrossRef]
7. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med (2020) 382:727–33. 10.1056/NEJMoa2001017 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
8. Wang W, Ye Y, Yao H, Li H, Sun L, Wang A, et al. Evaluation and observation of serum thyroid hormone and parathyroid hormone in patients with severe acute respiratory syndrome. J Chin Antituberculous Assoc (2003) 25:232–4. [Google Scholar] 9. Boelen A, Kwakkel J, Fliers E. Beyond low plasma T3: local thyroid hormone metabolism during inflammation and infection. Endocr Rev (2011) 32:670–93. 10.1210/er.2011-0007 [PubMed] [CrossRef] [Google Scholar]
10. Lee S, Farwell AP. Euthyroid Sick Syndrome. Compr Physiol (2016) 6:1071–80. 10.1002/cphy.c150017 [PubMed] [CrossRef] [Google Scholar]
11. Scoscia E, Baglioni S, Eslami A, Iervasi G, Monti S, Todisco T. Low triiodothyronine (T3) state: a predictor of outcome in respiratory failure? Results of a clinical pilot study. Eur J Endocrinol (2004) 151:557–60. 10.1530/eje.0.1510557 [PubMed] [CrossRef] [Google Scholar]
12. Bertoli A, Valentini A, Cianfarani MA, Gasbarra E, Tarantino U, Federici M. Low FT3: a possible marker of frailty in the elderly. Clin Interventions Aging (2017) 12:335–41. 10.2147/CIA.S125934 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

I am a Toronto-trained Urologist. I practiced in downtown Toronto, from 1977 to 1997, when I went to Saudi Arabia as chief of Urology at the Armed Forces (teaching) hospital in Tabuk. Returning to Toronto in Y2000, I switched to family practice. In 2007, began to prescribe Hormone Restoration Therapy and in 2012, I became a member of the American Academy of Antiaging Medicine [A4M]. I successfully wrote the A4M's written examination in December, 2013 and In May, 2016 I passed the oral examination, for accreditation as a BHRT consultant. In 2014 I began BHRT practice in Collingwood, Ontario and in January, 2017, joined the Stone Tree Naturopathic Clinic. Now I am 82 and have retired, but it seems wasteful to jettison my learning and experience: the medical establishment knows nothing of BHRT / Functonal medicine and I feel obliged to offer my knowledge in the interest of those who are willing to think outside the box. MY QUALIFICATIONS: MB, BS, (from UWI), 1964. LMCC 1969. FRCSC (Urology), 1974. ECFMG 1984. Florida license 1998 [inactive], ABAARM Certification [A4M], 2016. I am a Member of CSAMM [the Canadian Society for Aging and Metabolic Medicine], the OMA&CMA, SUSO, CUA, RCP&S/C. PRACTICE TO DATE: Consultation in Functional Medicine, including assessment of Chronic Fatigue Syndrome, Fibromyalgia, Andropause, Menopause, Teenage and Postpartum Depression/Panic Attacks, Thyroid Hormone malfunction, Infertility, Sexual Dysfunction and “the Undiagnosable”. ALL ARE WELCOME to read, comment or question!

2 Comments on “Long Covid: a report from china

Leave a Reply