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Lei Z, He Z, Mei Y, Qi X, Yu P, Xu G, Cheng H, Bai R, Deng J. Associations of psychological status and ultrasonic characteristics of thyroid nodules in adults during the COVID-19 pandemic. Front Psychol 2023; 14:1202122. [PMID: 37519348 PMCID: PMC10382619 DOI: 10.3389/fpsyg.2023.1202122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Background The morbidity of thyroid cancer has been increasing in the last decades all over the world. In addition to the more sensitive thyroid nodule screening technology, several social and environmental factors might represent credible candidates for this increase. They include psychological stress, lifestyle-associated risk factors, nutritional deficiencies, and environmental pollutants. Foremost, psychological stress had gained high interest as a possible promoter and a modifiable risk factor for thyroid nodules in recent years. The present study was to investigate the clinical characteristics and psychological status of the population during the peak of coronavirus disease 2019 (COVID-19) and assessed the association of psychosocial determinants and the ultrasonic characteristics of thyroid nodules. Methods In this cross-sectional study, 490 adult subjects who had received at least two doses of COVID-19 vaccine and were not infected with COVID-19, and did not know whether they had thyroid nodules, received thyroid color ultrasound examination and psychological questionnaire survey. Depression, anxiety, and stress were assessed using Depression Anxiety Stress Scales-21 (DASS-21). Sleep quality was rated using the Pittsburgh sleep quality index (PQSI). The characteristics of 243 subjects with thyroid nodules were described and recorded in detail by thyroid color ultrasound, and the correlations between anxiety, depression, sleep quality, clinical indicators, and thyroid nodule ultrasound characteristics were analyzed. Associations between psychological status (mutually adjusted predictors) and ultrasonic characteristics of thyroid nodules (outcome) were modeled using binary logistic regression controlling for sex, age, BMI, TSH, FT3, and FT4. Results Depression was positively correlated with thyroid hypoechoic nodule (OR = 3.720, 95%CI 1.615-8.570), microcalcification of thyroid nodule (OR = 3.638, 95%CI 1.476-8.966), the aspect ratio of thyroid nodule>1 (OR = 3.860, 95%CI 1.052-14.161), the unclear boundary of thyroid nodule (OR = 4.254, 95%CI 1.359-13.312), and the irregular edge of thyroid nodule (OR = 4.134, 95%CI 1.810-9.439). Anxiety was positively correlated with microcalcification of thyroid nodules (OR = 4.319, 95%CI 1.487-11.409). Stress was positively correlated with thyroid hypoechoic nodules (OR = 4.319, 95%CI 1.487-11.409), microcalcification of thyroid nodules (OR = 2.724, 95%CI 1.038-7.151), and the irregular edge of thyroid nodules (OR = 2.478, 95%CI 1.077-5.705). Conclusion This study demonstrates that depression, anxiety, and stress were associated with the morbidity of thyroid nodules and thyroid ultrasound characteristics. During COVID-19, people's negative emotions increased significantly compared to before. Negative emotions might be harmful to thyroid health. Therefore, during periods of high stress, strategies to prevent psychological problems should be implemented to improve thyroid health.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jing Deng
- Health Medical Center, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Atalay A, Besimoglu B, Sinaci S, Kaya E, Ozkavak O, Ocal FD, Ozgu-Erdinc AS, Sahin D. The impact of covid-19 on thyroid function tests in pregnancy. Endocrine 2023; 79:502-511. [PMID: 36367674 PMCID: PMC9650657 DOI: 10.1007/s12020-022-03248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the effects of laboratory-confirmed SARS-CoV-2 infection on thyroid function tests (TFTs) in pregnant women and to evaluate whether TFT changes are related to the severity and prognosis. METHODS Consecutive pregnant women tested for SARS-CoV-2 by RT-PCR at Ankara City Hospital were recruited between January 2021 and September 2021. Thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3), thyroid peroxidase antibody (anti-TPO), and thyroglobulin antibody (anti-TG) were measured on admission. RESULTS Among 747 eligible pregnant women with the same baseline characteristics, 369 RT-PCR-positive women in the patient group and 378 RT-PCR-negative women in the control group were included in the analyses. Pregnant women in the patient group had significantly lower TSH, FT4, FT3, Anti TPO, and Anti TG concentrations compared with those in the control group (p < 0.001). The proportion of patient groups with mild, moderate, severe, and critical diseases were 297 (80.4%), 40 (10.8%), 17 (4.6%), and 15 (4.2%), respectively, among which with the moderate, severe, and critical disease had significantly lower FT3 values (2.5 vs 2.19 pg/mL, p < 0.001) and higher nonthyroidal illness syndrome (NTIS) (29.2 vs. 8.4%, p < 0.001) than those with mild disease. Lower FT3 values increased the risk of ICU admission, NICU admission, and severe disease (p < 0.001). FT3 and TSH correlated positively with lymphocytes (p < 0.001) and negatively correlated with C-reactive protein (CRP) (p < 0.001, p = 0.005). CONCLUSION The SARS-CoV-2 infection seems to have an impact on the TFTs of pregnant women, and particularly FT3 level seems to be correlated with disease severity.
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Affiliation(s)
- Aysegul Atalay
- University of Health Sciences Ankara City Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey.
| | - Berhan Besimoglu
- University of Health Sciences Ankara City Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
| | - Selcan Sinaci
- University of Health Sciences Ankara City Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
| | - Ecem Kaya
- University of Health Sciences Ankara City Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
| | - Onur Ozkavak
- University of Health Sciences Ankara City Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
| | - Fatma Doga Ocal
- University of Health Sciences Ankara City Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
| | - Ayse Seval Ozgu-Erdinc
- University of Health Sciences Ankara City Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
| | - Dilek Sahin
- University of Health Sciences Ankara City Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
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Ilias I, Milionis C, Koukkou E. Further understanding of thyroid function in pregnant women. Expert Rev Endocrinol Metab 2022; 17:365-374. [PMID: 35831988 DOI: 10.1080/17446651.2022.2099372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Normal thyroid status throughout pregnancy is important for both maternal and fetal health. Despite the bulk of contemporary research honing on thyroid function in gestation and the relevant disorders, there are still gaps in our current knowledge about the etiology and treatment of thyroid diseases in pregnant women. AREAS COVERED This article analyzes the adaptation of the thyroid gland to gestational physiological changes and attempts to explain the effect of several factors on thyroid function in pregnancy. It also stresses proper utilization and interpretation of thyroid tests during pregnancy and underlines the significance of proper screening and treatment of pregnant women aiming at favorable health outcomes. EXPERT OPINION Appropriate strategies for diagnosing and treating thyroid disease in pregnancy are important. Laboratory thyroid testing plays a leading role, but test results should be interpreted with caution. Given the possible serious maternal and fetal/neonatal complications of thyroid disease in pregnancy, we recommend universal screening with TSH measurements of all pregnant women. Additional assessment with determination of the levels of free thyroid hormones and thyroid antibodies may be necessary under certain conditions. The economic burden of such interventions should be considered.
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Affiliation(s)
- Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
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Miao Y, Xu Y, Teng P, Wang A, Zhang Y, Zhou Y, Liu W. Efficacy of propylthiouracil in the treatment of pregnancy with hyperthyroidism and its effect on pregnancy outcomes: A meta-analysis. PLoS One 2022; 17:e0265085. [PMID: 35271661 PMCID: PMC8912150 DOI: 10.1371/journal.pone.0265085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background Hyperthyroidism affects about 0.2%-2.7% of all pregnancies, and is generally treated with propylthiouracil (PTU). However, previous studies about the effects of propylthiouracil on maternal or foetal are contentious. Objective This meta-analysis was carried out to investigate the safety and efficacy of propylthiouracil during pregnancy. Materials and methods PubMed, EBSCO, Embase, Scopus, Web of Science, Cochrane, CNKI, Wanfang and VIP database were searched from inception until August 31, 2021 for all available randomized controlled trials (RCTs) or cohort studies that evaluated the efficacy of propylthiouracil and its effects on pregnancy outcomes. Odds ratio (OR) and 95% confidence interval (CI) were used for binary variables, weighted mean difference (WMD) and 95% confidence interval (CI) were used for continuous variables. RevMan5.4 and Stata 16.0 were used for performing the meta-analysis. Results The researchers examined data from 13 randomized controlled trials and cohort studies involving 18948 infants. Congenital anomalies were not significantly associated with PTU in the pooled results (OR = 1.03, 95%CI: 0.84–1.25, P = 0.80, I2 = 40.3%). There were no statistically significant differences in neonatal hypothyroidism (OR = 0.55, 95%CI: 0.06–4.92, P = 0.593, I2 = 57.0%) or hepatotoxicity (OR = 0.34, 95%CI: 0.08–1.48, P = 0.151, I2 = 0.0%) exposed to PTU compared to the control group. The serum levels of FT3, FT4, TT3, and TT4 were significantly lower in the propylthiouracil group compared to the control group. Conclusion This meta-analysis confirmed the beneficial effects of propylthiouracil treatment, namely the risks of adverse pregnancy outcomes were not increased, and it also proved PTU’s efficacy in the treatment of pregnant women with hyperthyroidism. The findings supported the use of propylthiouracil during pregnancy with hyperthyroidism in order to improve clinical pregnancy outcomes in patients with thyroid dysfunction.
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Shi Q, Wu M, Chen P, Wei B, Tan H, Huang P, Chang S. Criminal of Adverse Pregnant Outcomes: A Perspective From Thyroid Hormone Disturbance Caused by SARS-CoV-2. Front Cell Infect Microbiol 2022; 11:791654. [PMID: 35047419 PMCID: PMC8761741 DOI: 10.3389/fcimb.2021.791654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/06/2021] [Indexed: 01/11/2023] Open
Abstract
Nowadays, emerging evidence has shown adverse pregnancy outcomes, including preterm birth, preeclampsia, cesarean, and perinatal death, occurring in pregnant women after getting infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the underlying mechanisms remain elusive. Thyroid hormone disturbance has been unveiled consistently in various studies. As commonly known, thyroid hormone is vital for promoting pregnancy and optimal fetal growth and development. Even mild thyroid dysfunction can cause adverse pregnancy outcomes. We explored and summarized possible mechanisms of thyroid hormone abnormality in pregnant women after coronavirus disease 2019 (COVID-19) infection and made a scientific thypothesis that adverse pregnancy outcomes can be the result of thyroid hormone disorder during COVID-19. In which case, we accentuate the importance of thyroid hormone surveillance for COVID-19-infected pregnant women.
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Affiliation(s)
- Qiman Shi
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Min Wu
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Pei Chen
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Bo Wei
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Hailong Tan
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Peng Huang
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Shi Chang
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, China.,Clinical Research Center for Thyroid Disease in Hunan Province, Changsha, China.,Hunan Provincial Engineering Research Center for Thyroid and Related Diseases Treatment Technology, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
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Weiwei D, Bei W, Hong W, Cailan W, Hailin S, Donghong X, Xiaolai W, Zhaohu H, Shijun L, Jian T, Qiang J. Thyroid Hormone Changes in the Northern Area of Tianjin during the COVID-19 Pandemic. Int J Endocrinol 2022; 2022:5720875. [PMID: 35013681 PMCID: PMC8742148 DOI: 10.1155/2022/5720875] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study aimed to determine whether and how stress-induced thyroid hormone changes occur during the COVID-19 pandemic in the northern area of Tianjin. METHODS This study comprised two groups of study subjects in Tianjin: before (2019) and during (2020) the COVID-19 outbreak. Subjects were included if they had FT3, FT4, and TSH concentrations and thyroid TPOAb or TgAb information available. People who were pregnant, were lactating, or had mental illness were excluded. We used propensity score matching to form a cohort in which patients had similar baseline characteristics, and their anxiety level was measured by the Hamilton Anxiety Rating Scale (HAMA). RESULTS Among the 1395 eligible people, 224 in Group A and 224 in Group B had similar propensity scores and were included in the analyses. The detection rate of abnormal thyroid function was decreased in pandemic Group B (69.2% vs. 93.3%, χ 2 = 42.725, p < 0.01), especially for hypothyroidism (14.29% vs. 35.71%, χ 2 = 27.429, p < 0.01) and isolated thyroid-related antibodies (25.89% vs. 38.39%, χ 2 = 8.023, p < 0.01). The level of FT4 (z = -2.821, p < 0.01) and HAMA score (7.63 ± 2.07 vs. 5.40 ± 1.65, t = 16.873, p < 0.01) went up in Group B; however, TSH (z = -5.238, p < 0.01), FT3 (z = -3.089, p=0.002), TgAb (z = -11.814, p < 0.01), and TPOAb (z = -9.299, p < 0.01) were lower, and HAMA was positive with FT3 (r = 0.208, p < 0.01) and FT4 (r = 0.247, p < 0.01). CONCLUSION People in the northern area of Tianjin during the COVID-19 outbreak were at an increased risk of higher FT4, lower FT3, and lower TSH. The HAMA scores increased in emergency situations and were positively correlated with the levels of FT3 and FT4.
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Affiliation(s)
- Dong Weiwei
- Department of Nuclear Medicine, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin 300052, China
| | - Wu Bei
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin 300052, China
- Department of Nuclear Medicine, Tianjin Hospital, Tianjin 300211, China
| | - Wang Hong
- Rehabilitation Medical Department, Tianjin Union Medical Center, Tianjin 300121, China
| | - Wu Cailan
- Department of Nuclear Medicine, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
| | - Shao Hailin
- Department of Endocrinology Medicine, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
| | - Xu Donghong
- Department of Endocrinology Medicine, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
| | - Wang Xiaolai
- Department of Endocrinology Medicine, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
| | - Hao Zhaohu
- Department of Endocrinology Medicine, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
| | - Li Shijun
- Department of Hematology, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
| | - Tan Jian
- Department of Nuclear Medicine, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
| | - Jia Qiang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin 300052, China
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Venkateswaran V, Parida R, Khanna P, Bhoi D, Singh AK, Mathur P, Sahoo D, Dass C, Gupta A, Aravindan A, Trikha A. Maternal and neonatal characteristics, operative details and outcomes in COVID-19 positive parturients undergoing cesarean sections: A retrospective observational study. J Anaesthesiol Clin Pharmacol 2022; 38:S52-S57. [PMID: 36060190 PMCID: PMC9438814 DOI: 10.4103/joacp.joacp_358_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 11/04/2022] Open
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Gajbhiye RK, Sawant MS, Kuppusamy P, Surve S, Pasi A, Prusty RK, Mahale SD, Modi DN. Differential impact of COVID-19 in pregnant women from high-income countries and low- to middle-income countries: A systematic review and meta-analysis. Int J Gynaecol Obstet 2021; 155:48-56. [PMID: 34160059 PMCID: PMC7612435 DOI: 10.1002/ijgo.13793] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/22/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND SARS-CoV-2 has infected a large number of pregnant women. OBJECTIVE To compare clinical, perinatal outcomes of women with COVID-19 from high-income countries (HICs) and low- to middle-income countries (LMICs). SEARCH STRATEGY Online databases were searched. SELECTION CRITERIA Original studies on pregnant women with COVID-19 were included. DATA COLLECTION AND ANALYSIS Information on clinical presentation, co-morbidities, pregnancy outcomes, neonatal outcomes, and SARS-CoV-2 infection in neonates was extracted. MAIN RESULTS The pooled estimate of SARS-CoV-2 positive neonates is 3.7%. Symptomatic presentations are less common in LMICs compared to HICs (odds ratio [OR] 0.38). Diabetes (OR 0.5), hypertension (OR 0.5), and asthma (OR 0.14) are commonly reported from HICs; hypothyroidism (OR 2.2), anemia (OR 3.2), and co-infections (OR 6.0) are commonly reported in LMICs. The overall risk of adverse pregnancy outcomes is higher in LMICs compared to HICs (OR 2.4). Abortion (OR 6.2), stillbirths (OR 2.0), and maternal death (OR 7.8) are more common in LMICs. Preterm births and premature rupture of membranes are comparable in both groups. Neonatal deaths (OR 3.7), pneumonia (OR 7.5), and neonatal SARS-CoV-2 infection (OR 1.8) are commonly reported in LMICs. CONCLUSIONS In LMICs, pregnant women and neonates are more vulnerable to adverse outcomes due to COVID-19. PROSPERO registration no: CRD42020198743.
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Affiliation(s)
- Rahul K. Gajbhiye
- Clinical Research LabICMR‐National Institute for Research in Reproductive HealthMumbaiIndia
| | - Mamta S. Sawant
- Molecular and Cellular Biology LaboratoryICMR‐National Institute for Research in Reproductive HealthMumbaiIndia
| | - Periyasamy Kuppusamy
- Clinical Research LabICMR‐National Institute for Research in Reproductive HealthMumbaiIndia
| | - Suchitra Surve
- Department of Clinical ResearchICMR‐National Institute for Research in Reproductive HealthMumbaiIndia
| | - Achhelal Pasi
- Airport Health OrganizationMinistry of Health and Family WelfareGovernment of IndiaMumbaiIndia
| | - Ranjan K. Prusty
- Department of BiostatisticsICMR‐National Institute for Research in Reproductive HealthMumbaiIndia
| | - Smita D. Mahale
- Emeritus Scientist, ICMR‐National Institute for Research in Reproductive HealthMumbaiIndia
| | - Deepak N. Modi
- Molecular and Cellular Biology LaboratoryICMR‐National Institute for Research in Reproductive HealthMumbaiIndia
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