Post COVID-19 Syndrome: Is Thyroid a reason for “Long hauler”?

During our last festive season, even the best foretellers amongst us would have failed to predict that we would celebrate the 2020 festivals like Deepavali with masks and social distancing. SARS-CoV-2pandemic has changed our regular life in an unprecedented way. Though initially thought as a routine flu like illness which is only an acute infection, health care professionals, researchers and epidemiologists are now recognizing the unique clinical signs and symptoms of COVID-19 infections which differentiate it from other viral infection or flu or ‘common cold’. While we are still fighting the acute stage of the pandemic, our outpatient services are frequented by patients who come witha myriadsigns and symptoms even after they recover from COVID-19 infection. Patients with these symptoms are being addressed by the term “Long Haulers” by lay public and recognised by clinicians as“Post acuteCOVID-19 syndrome”.

The most common symptoms seen in “long haulers” include,

• Tiredness/fatigue
• Breathlessness during their day-to-day activities
• Multiple joint pains/ body ache
• Sleeplessness, palpitation, headache
• Lack of interest in routine work
• Brain fog

Though most of these symptoms can have a psychological basis, we should not ignore the possibility of an underlying organic component. A small percentage of the “Post-acuteCOVID-19 syndrome” can also be attributed to thyroid hormone imbalance. With the increasing COVID-19 tally, physicians might encounter more and more patients whose symptoms would warrant a thyroid function test. Interpretation of the thyroid function test might be a challenge in the aftermath of the COVID-19 infection.

Disorders of the Thyroid gland are the second most common endocrine (hormonal) problems next to diabetes mellitus. Thyroid function tests, which include the measurement of TSH, T4 and T3 hormones in the blood give us an idea about our Thyroid function (normal, high or low). With the increased availability of easily accessible and robust hormone testing methods, many thyroid problems are being diagnosed at an early stage and effectively managed. Thyroid function tests undergo dramatic changes during the acute as well as the recovery stages of any viral infection like SARS COVID-19 infection. This condition is called as “Sick Euthyroid Syndrome” or “Non Thyroid Illness” indicating that the thyroid gland is an innocent bystander in the viral drama.

Alternately, the thyroid gland can also undergo a process called inflammation secondary to the viral infection (thyroiditis) even after months of recovery from an acute phase. A detailed evaluation is required to differentiate between these two conditions as the former needs only a supportive care but thyroid specific medications are needed to treat the latter. With the help of certain special tests like the thyroid scan and measurement of antibody levels, clear-cut diagnosis and management of these conditions is possible when we encounter an abnormal thyroid blood test report. Patients can seek the help of their physician or endocrinologist who can guide them and alleviate their anxiety. With proper medical and psychological support, the “Post-acute COVID-19 syndrome” can easily be overcome by the “Long Haulers”.