What should patients with thyroid disease do after they are "infected with the new crown"?

With the increase in the number of Omicron new crown infections, patients with thyroid disease will also face the risk of new crown infection and infection, in addition to personal protection to reduce the risk of infection, in case thyroid disease patients are infected with the new crown virus, how to face it?

Can I still take the thyroid medication I was taking? How is the dosage adjusted? Do I need to go to the hospital right away? To answer these questions, we must first understand the right and wrong
between thyroid disease and the new coronavirus.

Thyroid disease and coronavirus infection interact with each other

Although the available clinical research data show that patients with underlying diseases are more likely to be infected with new crowns, these underlying diseases are mainly hypertension, diabetes, coronary heart disease, COPD, etc.
, and thyroid diseases with stable thyroid function control are not risk factors
for infection with new crown and severe pneumonia.
In general, the use of thyroid-related drugs (anti-hyperthyroid drugs, levothyroxine sodium, etc.
), previous history of iodine 131 therapy, and history of thyroid surgery does not increase the risk of
new coronavirus infection and severe pneumonia.

However, for patients with uncontrolled hyperthyroidism and hypothyroidism, new coronavirus infection may lead to aggravation of the original thyroid disease and even induce life-threatening hyperthyroidism or hypothyroid crisis, so regular monitoring, timely review of thyroid function after infection, and assessment and adjustment of medication are necessary
.

➤A small number of hyperthyroid patients treated with antithyroid drugs, granulocytopenia caused by drug side effects can cause fever and sore throat, which need to be distinguished from the symptoms of new coronavirus infection;

➤On the other hand, some patients with new crown infection may have a transient decrease in white blood cells and granulocytes, and if they take anti-hyperthyroid drugs at the same time, they need to monitor the level of white blood cells more closely, and even need to stop the drug for a short time or give leukocyte therapy
if necessary.

Recently, Paxlovid has attracted attention as a treatment drug for new crown infection, and Paxlovid has affected the recommendation and dose
adjustment of the original drug because it can affect the metabolism of drugs for a variety of cardiovascular and cerebrovascular diseases 。 In terms of the effects of thyroid-related medications: existing studies have found that Paxlovid may increase the clearance of levothyroxine sodium in the body, while Paxlovid treatment is shorter and the dose can be adjusted without pre-adjustment, but it is recommended that patients taking levothyroxine sodium monitor thyroid function for one month after treatment with Paxlovid; There are currently no studies
of the interaction of methimazole and propylthiouracil with Paxlovid.

What should I do if a patient with hyperthyroidism is "yang"?

1.
Stabilize emotions and face optimistically

Persistent or strong mental stress is one of the important factors causing hyperthyroidism, and anxiety, tension and psychological pressure for the new crown virus may aggravate hyperthyroidism, so hyperthyroid patients should adjust their mentality, maintain emotional stability, and face it optimistically, which will help stabilize
the condition.

2.
Do not stop the drug without authorization

➤After patients with hyperthyroidism are infected with the new coronavirus, they should drink more water, rest well, and treat uncomfortable symptoms with symptomatic medication;

➤ Patients with hyperthyroidism who are receiving anti-hyperthyroid drugs (such as methimazole, propylthiouracil) should continue to take anti-hyperthyroid drugs after being infected with the new coronavirus, and stopping the drug without authorization may lead to aggravation of the disease;

➤ If leukocytopenia (<3.
0×10^9/L) or neutropenia (<1.
5×10^9/L) occurs after infection with the new coronavirus, you need to temporarily stop antithyroid drugs and seek medical attention
as soon as possible.

3.
Patients with hyperthyroidism need to seek medical attention in time if they encounter the following conditions

➤ If hyperthyroidism is not well controlled, infection with the new coronavirus may cause patients with arrhythmia, myocardial ischemia, increased levels of oxidative stress in the body, and "hyperthyroid crisis" in severe cases, so if there is a high fever that does not subside, increased palpitation, difficulty breathing and other discomfort, you should seek medical attention
in time.

➤ In patients with hyperthyroidism in the initial treatment stage (especially within 3 months before treatment), the symptoms of neutropenia caused by anti-hyperthyroid drugs (sore throat, mouth ulcers, fever and influenza-like illness) may overlap with the symptoms of new crown infection (fever, new persistent cough and influenza-like illness), and need to be differentiated
according to medical history, blood routine and the results of new crown antigen/nucleic acid testing.

➤ Patients with Graves eye disease (exophthalmos), if they take glucocorticoids or other immunosuppressive drugs, because they are in a period of decreased immunity, they are also prone to severe pneumonia, it is recommended to receive treatment within 12 weeks to do self-protection to avoid infection with the new coronavirus, if infected with the new coronavirus, you need to closely monitor the changes in the condition, and reduce hormones and other immunosuppressive drugs
if necessary.

What should I do if a patient with hypothyroidism is "positive"?

1.
General treatment

Like hyperthyroid patients, after being infected with the new crown virus, face optimistically, pay attention to rest, drink more water, appropriately increase protein intake, and have symptoms such as fever and cough, and symptomatic treatment can be
provided.

2.
Patients with hypothyroidism are in stable condition and do not need to adjust the treatment plan

A variety of reasons can cause hypothyroidism, such as Hashimoto's thyroiditis, iodine 131 treatment, after thyroidectomy, the above need to take long-term drugs (such as levothyroxine sodium tablets) treatment, if the thyroid function is normal, there is no need to adjust the drug dose after infection with the new coronavirus; However, if there are obvious changes in weight, appetite, mood and other changes after the new coronavirus turns negative, it is necessary to see a doctor in time to review thyroid function
.

In addition, it should be noted that if it is hypothyroidism caused by pituitary disease, hypothyroidism combined with adrenal insufficiency, the dose of glucocorticoids needs to be increased after the new crown virus infection, generally highly suspected or diagnosed symptomatic new crown infection, it is recommended to increase the glucocorticoid dose to 2-4 times the original dose, the original number of doses does not change, increase the amount
of each meal.
With the improvement of infection symptoms and the passage of time, the original dose
can generally be resumed in 5-7 days.

Patients with thyroid diseases are also at risk of contracting the new crown and may be infected with the new crown virus, so patients must not panic too much
.
Control the stability of thyroid function, continue to maintain the treatment of the original thyroid-related drugs, and actively face the new crown infection, if there is difficulty breathing during or after infection, cough and sputum shortness of breath are not relieved, the body temperature after taking the drug is still higher than 38.
5 °C, the heart rate continues to increase and other discomfort manifestations in time
.
Let's work together to overcome the difficulties, fight the new crown, and maintain our thyroid health!

References:

[1] Boelaert K, Visser WE, Taylor PN, Moran C, Léger J, Persani L.
ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of hyperthyroidism and hypothyroidism.
Eur J Endocrinol.
2020 Jul; 183(1):G33-G39.

[2] Taylor PN, Zhang L, Lee RWJ, Muller I, Ezra DG, Dayan CM, Kahaly GJ & Ludgate M.
New insights into the pathogenesis and nonsurgical management of Graves orbitopathy.
Nature Reviews: Endocrinology 2020 16 104–116.
[3] Paxlovid Summary of Product Characteristics, Pfizer Ltd, August 2022.

Written by: Zhao Chenxu, Zhang Yang

Source: Imperial City Great Endocrinology

Disclaimer: This platform is designed to deliver more medical information
to healthcare professionals.
The content published on this platform cannot replace professional medical guidance in any way, nor should it be regarded as diagnosis and treatment advice
.
If such information is used for purposes other than understanding medical information, this platform does not assume relevant responsibilities
.
The content published by this platform does not mean that it agrees with its description and views
.
If copyright issues are involved, please contact us and we will deal with
it as soon as possible.