Thyroid Incidentalomas in Hospitalized Patients with COVID-19: Prevalence and Associated Factors

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Thyroid incidentaloma refers to the unexpected discovery of an asymptomatic thyroid nodule during the investigation of an unrelated condition.

With the widespread use of high-resolution imaging studies, such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), the incidence of thyroid incidentalomas has been on the rise. In the context of the global COVID-19 pandemic caused by the SARS-CoV-2 virus, there is a growing interest in understanding the prevalence of thyroid incidentalomas among hospitalized patients with COVID-19 and exploring potential associated factors.

Prevalence of Thyroid Incidentalomas

The prevalence of thyroid incidentalomas varies depending on the imaging methods used. In adults, the reported prevalence ranges from 5% to 67%. Ultrasound (US) studies have reported a prevalence of up to 67%, while contrast-enhanced chest CT examinations have reported up to 25% prevalence.

Neck CT and MRI scans have shown a prevalence of 16% to 18%, while fluorine-18 fluorodeoxyglucose (18F-FDG) PET scans have reported a prevalence of 1% to 2%. Factors such as female gender, increasing age, and possibly obesity have been associated with a higher prevalence of thyroid nodules.

SARS-CoV-2 and Thyroid Gland Vulnerability

SARS-CoV-2 utilizes the angiotensin-converting enzyme 2 (ACE2) receptor, present on the surface of host cells, for viral entry and replication. Studies have shown extensive ACE2 expression in various endocrine tissues, including the thyroid gland. Thyroid tissue has a high mRNA expression of ACE2 and TMPRSS2, which are essential for SARS-CoV-2 infection.

This evidence suggests that the thyroid gland may be susceptible to SARS-CoV-2 infection. COVID-19 infection can induce systemic inflammatory immune responses in the thyroid gland, leading to various thyroid-related conditions such as euthyroid sick syndrome, subacute thyroiditis, Graves disease, Hashimoto thyroiditis, postpartum thyroiditis, and silent thyroiditis. However, the oncogenic potential of SARS-CoV-2 in the thyroid gland remains poorly understood.

Thyroid Incidentalomas in COVID-19 Patients

The COVID-19 pandemic has affected individuals of all ages, and patients with COVID-19 exhibit a wide spectrum of symptoms. Initially, most hospitalized patients with COVID-19 primarily exhibited pulmonary involvement and underwent chest CT scans. However, there is a lack of literature regarding the prevalence of thyroid incidentalomas in the younger population.

While thyroid cancer screening is not recommended in asymptomatic individuals, thyroid ultrasonography is frequently performed in health check-up programs. Previous studies have reported a prevalence of thyroid incidentalomas identified by 18F-FDG PET in healthy subjects, but there is a paucity of data on thyroid incidentalomas identified by chest CT in healthy individuals.

Objective

The objective of this study was to investigate the prevalence of thyroid incidentalomas and associated factors among hospitalized patients with COVID-19. By examining the presence of thyroid nodules in this specific population, we aim to contribute to the understanding of the impact of COVID-19 on thyroid health and shed light on potential factors associated with the development of thyroid incidentalomas.

Conclusion

Thyroid incidentalomas, asymptomatic thyroid nodules discovered incidentally during the investigation of unrelated conditions, are becoming increasingly common due to the widespread use of high-resolution imaging studies. In the context of the COVID-19 pandemic caused by SARS-CoV-2, the vulnerability of the thyroid gland to viral infection has been a topic of interest.

Understanding the prevalence of thyroid incidentalomas and associated factors among hospitalized patients with COVID-19 can provide valuable insights into the relationship between COVID-19 and thyroid health. Further research is needed to explore the long-term implications of SARS-CoV-2 infection on thyroid function and the potential oncogenic effects of the virus in the thyroid gland.


reference link :https://academic.oup.com/jes/article/7/6/bvad060/7159860?login=false

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