| Sumario: | Background: COVID-19, caused by SARS-CoV-2, affects multiple organ systems, including the thyroid gland. Non-Thyroidal Illness Syndrome (NTIS) is frequently observed in severe systemic disease. NTIS-like thyroid hormone alterations have previously been reported in COVID-19. However, the relationship between these changes and disease outcomes remains unclear. Objectives: We aimed to evaluate thyroid function and vitamin D concentrations in hospitalized COVID-19 patients, and to analyze the association between hormonal measurements and patient characteristics with COVID-19 mortality. Methods: We conducted a retrospective database search of 846 adult patients hospitalized in a dedicated COVID-19 hospital at the peak of the pandemic. Based on the availability of serum levels of TSH, FT3, FT4, and vitamin D, 137 patients were included in the analysis. Descriptive statistics, comparative analyses, and logistic regression were used to evaluate the associations of laboratory measurements, sex, and age with COVID-19 mortality. Results: Decreased thyroid hormone and vitamin D concentrations were more common than in the general population, although none differed between deceased and COVID-19 survivors. Among the cohort, 63.5% had decreased TSH, 21.2% had decreased FT3, 24.1% had decreased FT4, and 75.9% presented with vitamin D deficiency. Comparative analyses showed no significant differences in TSH (P =.82), FT3 (P =.40), FT4 (P =.81), or vitamin D (P =.78) levels between deceased and surviving patients. Deceased patients were older than survivors (median [IQR]: 75.5 [71.0-80.8] vs 71.0 [61.0-77.0] years; P =.002), with age emerging as the only predictor of mortality (OR = 1.07, 95%CI: 1.02-1.11; P =.001; all other variables P >.33). Conclusions: NTIS-like thyroid hormone alterations and vitamin D deficiency are highly prevalent among hospitalized COVID-19 patients but do not predict in-hospital mortality. Age remains the major risk factor for death in this population. Our findings confirm that COVID-19 frequently affects the endocrine system and highlight the need for further research on long-term thyroid outcomes. Plain Language Summary: Thyroid Hormone and Vitamin D Changes in COVID-19 and Their Impact on Disease Mortality COVID-19 most often affects the lungs, but it can also impact other organs, including the thyroid gland. In severe illness, patients often develop changes in thyroid hormone levels, a condition called Non-Thyroidal Illness Syndrome (NTIS). Hormonal changes have been observed in COVID-19 before, but their impact on disease severity is not well understood. In our study, we analyzed data from a hospital that treated only COVID-19 patients at the peak of the pandemic. We reviewed 846 patient records for measurements of thyroid hormones (TSH, FT3, FT4) and vitamin D at the time of admission. After applying inclusion and exclusion criteria, a total of 137 patients were included in the analysis. We compared their hormone levels, sex, and age against normal ranges and examined their relationship with COVID-19 outcomes. We have found that thyroid hormone changes and vitamin D deficiency were more common than in general population. About 64% of patients had low TSH, 21% had low FT3, 24% had low FT4, and 76% had low vitamin D levels. However, these hormone levels did not differ between patients who survived and those who died in the hospital. The main factor predicting death was age: older patients were more likely to die from COVID-19. Overall, our study highlights that COVID-19 frequently affects the endocrine system. Thyroid hormones and vitamin D levels are often decreased in COVID-19, even in patients without prior thyroid problems. However, these changes do not appear to influence disease outcome, with age remaining the strongest predictor of mortality. Future research should explore whether these changes persist after recovery and if they contribute to long-term complications. Understanding these effects could help improve care for patients recovering from COVID-19.
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