The cytokine storm and thyroid hormone changes in COVID-19

L Croce, D Gangemi, G Ancona, F Liboà, G Bendotti, L Minelli, L Chiovato

Research output: Contribution to journalReview articlepeer-review


BACKGROUND: COVID-19 is now a worldwide pandemic. Among the many extra-pulmonary manifestations of COVID-19, recent evidence suggested a possible occurrence of thyroid dysfunction.

PURPOSE: The Aim of the present review is to summarize available studies regarding thyroid function alterations in patients with COVID-19 and to overview the possible physio-pathological explanations.

CONCLUSIONS: The repercussions of the thyroid of COVID-19 seem to be related, in part, with the occurrence of a "cytokine storm" that would, in turn, induce a "non-thyroidal illness". Some specific cytokines and chemokines appear to have a direct role on the hypothalamus-pituitary-thyroid axis. On the other hand, some authors have observed an increased incidence of a destructive thyroiditis, either subacute or painless, in patients with COVID-19. The hypothesis of a direct infection of the thyroid by SARS-Cov-2 stems from the observation that its receptor, ACE2, is strongly expressed in thyroid tissue. Lastly, it is highly probable that some pharmaceutical agents largely used for the treatment of COVID-19 can act as confounding factors in the laboratory evaluation of thyroid function parameters.

Original languageEnglish
Pages (from-to)891-904
Number of pages14
JournalJournal of Endocrinological Investigation
Issue number5
Publication statusPublished - May 2021


  • Antiviral Agents/adverse effects
  • COVID-19/complications
  • Cytokine Release Syndrome/etiology
  • Cytokines/blood
  • Humans
  • Thyroid Hormones/metabolism
  • Thyroiditis/etiology


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