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Although disorders of the endocrine glands (including the pancreas and thyroid gland) after COVID-19 are now quite rare, doctors believe that a full assessment of the situation still needs time. For now, specialists are approached by patients with previously diagnosed hormonal problems, whose infection triggered diseases previously regulated by drugs. Most often, these people struggled with diabetes or hypothyroidism.
- The professional literature describes examples of both hyperthyroidism and hypothyroidism after undergoing COVID-19
- Dr. Katarzyna Śleziak-Barglik notes that complications after COVID-19 in her patients most often concern people with pre-existing glucose intolerance
- Disruptions in insulin production and destruction of pancreatic cells are likely
- Dr. Zieleniewski notes that very rarely, but still, new antibodies against the thyroid gland and other tissues may appear
- GPs agree that many of the health-related residues from COVID-19 will manifest over time
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What endocrine disorders do GPs see in convalescents?
The practice of dr. Paweł Lewek, a family doctor from the Le-Med clinic in Łódź, proves that convalescents most often require pulmonological, cardiological and neurological consultations as well as medical rehabilitation doctors. Like many general practitioners, Dr. Lewek is currently not dealing with any patient who would require a referral to an endocrine clinic due to complications after COVID-19.
– According to my observations, currently endocrine problems in the practice of a family doctor are fortunately rare – says. – The main complications relate to the respiratory and nervous systems, while the endocrine system appears to be less affected by complications from COVID-19, though examples of both hyperthyroidism and hypothyroidism in the course of COVID-19 can be found in the professional literature.
Dr. Katarzyna Śleziak-Barglik, head of the primary care clinic in Ruda Śląska, noticed that complications following coronavirus infection in her patients most often concern people with pre-existing glucose intolerance. This condition could be described as a pre-diabetes condition requiring no pharmacotherapy but a proper diet.
– In the case of a severe course of infection, these people tend to disrupt the carbohydrate metabolism, and in some of them there is a so-called iatrogenic diabetes, or steroid diabetes, says Dr. Śleziak-Barglik. “Steroids are used in the course of COVID-19 treatment to reduce the cytokine storm,” he explains. – I have the impression that the greater the obesity, the greater the problems, but I do not keep statistics – he adds.
Healers treated by the doctor report drowsiness, fatigue and an appetite for sweets. They often have blood glucose meters at home and come to the clinic with a ready-made list of measurements. – It happens that they have skin lesions in intimate places – adds Dr. Śleziak-Barglik. – Foci of fungal infection typical of diabetes develop there.
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- Complications after COVID-19. What are the symptoms and what tests should be done after the disease?
Dr. Lewek emphasizes that diabetes, like obesity, increases the risk of complications in the course of COVID-19. In people with diabetes, disorders of insulin production may worsen, as well as an increase in insulin resistance of tissues. The enzyme, which is the entry point of the SARS-CoV-2 virus into cells, is also present in the beta islets of the pancreas that secrete insulin. Therefore, disturbances in insulin production and destruction of pancreatic cells are highly probable. There was also a reduction in insulin secretion. Moreover, hypokalemia (low serum potassium) is common, which further worsens glycemic control in people with diabetes. COVID-19 can also lead to ketoacidosis in both people with and without diabetes.
– Although we do not measure patients’ insulin levels in primary health care, we monitor their blood glucose levels – says Dr. Lewek – and the patient during coronavirus infection, as in the case of other infections, may be significantly disturbed. Fortunately, in most cases it stabilizes after illness.
– If a person developed hyperglycaemia during the infection, after recovery, fasting glucose control or glycated hemoglobin (HbA1c) control may be considered, as this test will reveal possible and previously undiagnosed diabetes – believes Dr. Lewek. – However, in diabetic patients who have contracted COVID-19 and are taking SGLT2 inhibitors, blood ketone testing may be indicated. This examination is not the responsibility of family doctors and requires referral to a diabetologist, for example.
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According to Dr. Śleziak-Barglik, specialist consultation is not required in the initial stage of diabetes, because GPP provides the patient with adequate treatment – it is enough to perform tests such as the sugar curve and glycosylated hemoglobin.
The doctor mentions that the scientific reports also mention hyperthyroidism as a complication after COVID-19, but she has not encountered similar cases. “I tend to have patients with symptoms of hypothyroidism,” he says. – Hair loss is a particularly big problem for women.
The team led by prof. Przemysław Kardas from the Department of Family Medicine, Medical University of Łódź, carried out almost 4,4 thousand Polish convalescents, a questionnaire survey (available at www.objawyCovid.pl). The respondents mention excessive sweating, which may be included as an endocrine symptom of COVID-19, although it is most likely associated, for example, with fever in the course of an infection. This symptom was present in 16,4 percent. respondents. Therefore, it is not a dominant symptom, but it may appear in about 1-2 patients out of 10.
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GPs agree that much of the COVID-19 residue will show up over time. For now, their temporal relationship with SARS-CoV-2 infection is visible.
– I talk to each patient I refer for a coronavirus test and arrange a personal visit after the isolation is completed – says Dr. Śleziak-Barglik. – Then there is also time to dispel doubts. We must also take into account that patients may develop late symptoms after infection, so I enter the condition after COVID-19 on the list of diagnoses, so that the patient does not constantly ask when and how he suffered the disease.
How do the complications after COVID-19 see the endocrinologist?
Any viral infection, regardless of the type of virus, strongly stimulates our immune system, causing excessive production of inflammatory substances. In this process, both substances are created that are supposed to counteract infection, i.e. eliminate the virus, and substances that can damage one’s own tissues and organs. Any stimulation of the immune system may be associated with the intensification of autoimmune effects in the form of multiplication of autoantibodies. In other words, self-harm can develop against one’s own tissues.
– Severe inflammation is sometimes referred to as cytokine storm, then the body produces large amounts of pro-and anti-inflammatory substances acting on its own organs – says Dr. n. med. Wojciech Zieleniewski, specialist in internal diseases and endocrinologist. – As for the endocrine system, i.e. the endocrine glands, certain diseases, such as type 1 diabetes, hypothyroidism in the course of Hashimoto’s disease, or hyperthyroidism in the course of Graves-Basedow’s disease and even other rarer endocrine diseases, also depend on the production of autoantibodies, that is, antibodies against your own organs.
Endocrinologists note that people who have already been diagnosed with, for example, hypothyroidism, after suffering from SARS-CoV-2 virus infection, require modification of the dosage of substitution (replacement) treatment with L-thyroxine. As a rule, in these patients hypothyroidism worsens and the dose of this hormone should be increased.
– Very rarely, but still, there are situations when new antibodies against the thyroid gland and other tissues appearwhich exacerbate hyperthyroidism in the course of Graves’ disease, says Dr. Zieleniewski. – There are even eye changes, i.e. exophthalmia with double vision.
Treatment of this type of complications after COVID-19 requires control of thyroid function parameters, control of an ophthalmologist and possible imaging tests to check what is happening in the orbits. The applied treatment should be two-pronged. On the one hand, it is aimed at anti-inflammatory actions and controlling excessive immune reaction – it will be the so-called immunosuppressive therapy. Additionally, we combine them with the treatment of the thyroid gland.
– I had a patient who underwent COVID-19 really lightly – says Dr. Zieleniewski. – Later she decided to check thyroid function, although it was working perfectly before the infection. She came to me because after the checkup it turned out that she developed hypothyroidism.
Another example of the effects of COVID-19 on thyroid function is in the family case: mother and daughter have Hashimoto’s disease. After the end of the infection, only the mother required an increase in the dosage of drugs, the daughter’s level of thyroid hormones did not change, but she developed the so-called brain fog.
- Where does ‘brain fog’ come from in COVID-19 patients?
– When it comes to the regulation of insulin secretion, each viral infection, and especially COVID-19, increases insulin resistance, i.e. disturbing the target effect of insulin – explains Dr. Zieleniewski. – This condition requires an increase in insulin dosage, more frequent blood glucose control, and possibly the addition of other medications that will sensitize tissues to insulin. This is what happens with every infection – he emphasizes.
Interestingly, Dr. Zieleniewski did not notice that the ailments described by his patients were related to the severity of the course of the coronavirus infection.
– Yesterday I read an interesting publication about the effects of COVID-19 on the adrenal glands – adds Dr. Zieleniewski. – It shows that the infected have lower levels of renin and angiotensin, substances responsible for the secretion of aldosterone, the main hormone regulating the concentration of sodium and potassium in humans, and thus maintaining proper blood pressure. Hence, possible disturbances in blood pressure values in people with a history of coornavirus infection.
People who received endocrine treatment before contracting coronavirus, as the infection may require supervision and modification of treatment, should pay particular attention to the function of the endocrine glands (especially the thyroid gland and pancreas).
– With a diagnosed thyroid disease, a past infection usually requires some modification of treatment – says Dr. Zieleniewski. Virtually all convalescents who have ever had endocrine problems should have their health checked for this.
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