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COVID-19 and Endocrine Complications
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COVID-19 and Endocrine Complications

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: closed (10 April 2026) | Viewed by 4804

Special Issue Editor

Dr. Kamyar Asadipooya

E-Mail Website
Guest Editor
Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, Barnstable Brown Diabetes and Obesity Center, University of Kentucky, Lexington, KY, USA
Interests: cardiovascular disease; COVID-19; diabetes; osteoporosis

Special Issue Information

Dear Colleagues,

SARS-CoV-2 infection initially causes respiratory problems, but it may also impair the function of endocrine organs, including gonads, pancreas, pituitary, adrenal, and thyroid glands. The rate of death and hospitalization is still remarkable. Furthermore, the long-term complications of acute SARS-CoV-2 infection require more investigation. The current preventive and therapeutic approaches may prevent the complications of acute SARS-CoV-2 infection, such as hospitalization and post-acute sequelae of SARS-CoV-2 infection. However, treating acute SARS-CoV-2 infection with mainly antivirals seems to be inadequate. This is primarily due to the constant changes in the genetic profile of SARS-CoV-2, which are gradually causing resistance to antivirals. In this regard, the therapeutic approaches need to be expanded on steadily, particularly by applying an alternative approach to tackle the ACE2 receptor, mitigate viral entry into the cells, reduce viral proliferation, and thus alleviate organ damages. In this Special Issue, we welcome authors to submit papers on the short- and long-term complications of COVID-19, especially endocrine complications. In addition, new approaches in terms of both the prevention and treatment of acute SARS-CoV-2 infection are welcome to be proposed.

Dr. Kamyar Asadipooya
Guest Editor

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Keywords

  • adrenal
  • ACE2
  • diabetes
  • gonads
  • pituitary
  • SARS-CoV-2
  • thyroid

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Published Papers (4 papers)

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Research

12 pages, 1742 KB  
Article
Correlation of TSH Levels with Inflammatory Markers in COVID-19 Patients: A Retrospective Study
by Bartosz Krajewski, Martyna Kamińska, Jakub Ligęzka, Mateusz Romek, Agnieszka Żak-Gołąb and Michał Holecki
J. Clin. Med. 2025, 14(23), 8378; https://doi.org/10.3390/jcm14238378 - 26 Nov 2025
Viewed by 930
Abstract
Background: COVID-19 caused by SARS-CoV-2 is an acute disease which may lead to severe systemic inflammation, causing multi-organ dysfunction and death. Studies indicated that thyroid-stimulating hormone (TSH) levels were lower when the infection was more severe. Methods: We conducted a retrospective study of [...] Read more.
Background: COVID-19 caused by SARS-CoV-2 is an acute disease which may lead to severe systemic inflammation, causing multi-organ dysfunction and death. Studies indicated that thyroid-stimulating hormone (TSH) levels were lower when the infection was more severe. Methods: We conducted a retrospective study of 105 patients admitted from 2020 to 2023 to the University Clinical Centre in Katowice with a positive COVID-19 test. TSH levels, white blood cell count (WBC), platelet count (PLT), C-reactive protein (CRP), D-dimers, procalcitonin levels, lymphocyte count and percentage, and neutrophil-to-lymphocyte ratio (NLR) were evaluated. Results: The average age was 69.49 (SD 14.14) and the range was 36–95 years. A total of 53.2% of the population were male. After statistical analysis, lymphocyte count (p = 0.0038) correlated positively and NLR (p = 0.04682) correlated negatively with TSH level in COVID-19 patients, and PLT correlated positively with TSH level in the female population (p = 0.0384), while CRP (p = 0.81320), D-dimers (p = 0.974), WBC (p = 0.6862), Lymphocyte percentage (p = 0.1838), and procalcitonin (p = 0.906) did not reach statistical significance. Conclusions: TSH levels may be associated with lymphocyte count and NLR in patients with confirmed cases of SARS-CoV-2 infection, and with PLT in the female subgroup. Other evaluated inflammatory markers were not significant. These findings suggest that TSH has potential as a biomarker of disease severity, but further studies are needed to investigate this claim, and consideration should be given to other indicators of inflammation. Full article
(This article belongs to the Special Issue COVID-19 and Endocrine Complications)
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11 pages, 648 KB  
Article
Body Mass Index and Hemoglobin A1c Correlate with Clinical Needs After COVID-19 Vaccination in the Veterans Affairs System
by Jay Pendse, Gabriela Jordan, Binhuan Wang, Craig Tenner, Brenda Dorcely, Robert J. Ulrich, Kevin Zhang, Sabrina Felson, Melanie Jay and José O. Alemán
J. Clin. Med. 2025, 14(23), 8271; https://doi.org/10.3390/jcm14238271 - 21 Nov 2025
Viewed by 452
Abstract
Background: Throughout the course of the COVID-19 pandemic, clinicians recognized that individuals with metabolic syndrome, including elevated body mass index (BMI) and type 2 diabetes, have increased clinical care requirements and worsened outcomes during COVID-19 infection. With the availability of COVID-19 vaccines, it [...] Read more.
Background: Throughout the course of the COVID-19 pandemic, clinicians recognized that individuals with metabolic syndrome, including elevated body mass index (BMI) and type 2 diabetes, have increased clinical care requirements and worsened outcomes during COVID-19 infection. With the availability of COVID-19 vaccines, it was unknown whether vaccination could mitigate the clinical outcomes among patients with metabolic syndrome. In this study, we sought to determine whether BMI and hemoglobin A1c are associated with a risk of breakthrough infection and increased clinical needs among patients who have been fully vaccinated against COVID-19. Methods: We conducted a retrospective cohort study of patients in the Veterans Affairs healthcare system who were vaccinated against COVID-19 between 1 December 2020 and 22 August 2021. We sampled a random subset of 549,344 patients from a total of over 1 million de-identified patients greater than age 18 who were vaccinated between 1 December 2020 and 22 August 2021, without a prior positive COVID-19 test in the VA healthcare system data warehouse. The primary study outcomes were breakthrough COVID-19 infections after vaccination and hospitalization due to breakthrough COVID-19 infections. Results: We identified 480,129 patients with available BMI and hemoglobin A1c data; of these, all had data available for the covariates of race, ethnicity, sex, and age, and 467,283 had data available for district as well. Adjusting for those covariates, Cox proportional hazards modeling for time from vaccination until breakthrough infection demonstrated that higher BMI (HR per unit 1.015, p < 0.001) and hemoglobin A1c were associated with an increased risk of infection (HR per unit 1.063, p < 0.001). The number of patients from this set who developed breakthrough infections within the study period was 8903 (9146 if those with missing district data were included). The average age of fully vaccinated patients with breakthrough COVID-19 infection within six months of full vaccination was 64.5. The average BMI was 31.2 ± 6.2 and the average A1c was 6.34 ± 1.5. Adjusting for the above covariates, multivariable logistic regression trends towards significance, with an increased risk of hospitalization due to breakthrough COVID-19 infection with increased BMI (HR per unit 1.010, p = 0.052), and was statistically significant for increased hemoglobin A1c (HR per unit 1.150, p < 0.010). Conclusions: This study identifies BMI and hemoglobin A1c as risk factors for breakthrough COVID-19 infection among fully vaccinated patients in the US veteran population. Full article
(This article belongs to the Special Issue COVID-19 and Endocrine Complications)
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14 pages, 488 KB  
Article
Youth-Onset Type 2 Diabetes Before and After COVID-19 Pandemic-Related Public Health Restrictions: Trends in Incidence, Severity, and Remission
by Jody Beth Grundman, Elizabeth Estrada, Rachel Longendyke and Stephanie T. Chung
J. Clin. Med. 2025, 14(22), 7995; https://doi.org/10.3390/jcm14227995 - 11 Nov 2025
Cited by 1 | Viewed by 1017
Abstract
Background/Objectives: Youth-onset type 2 diabetes (Y-T2D) incidence and severity rose during the COVID-19 pandemic, particularly during periods of widespread public health restrictions—including, but not limited to, virtual learning, stay-at-home orders, closure of recreational facilities, and limitations on in-person healthcare access. This study [...] Read more.
Background/Objectives: Youth-onset type 2 diabetes (Y-T2D) incidence and severity rose during the COVID-19 pandemic, particularly during periods of widespread public health restrictions—including, but not limited to, virtual learning, stay-at-home orders, closure of recreational facilities, and limitations on in-person healthcare access. This study assessed incidence, severity, and remission rates of Y-T2D following the return to in-person education, focusing on cases diagnosed while such restrictions were in place. Methods: A retrospective chart review was conducted at a pediatric tertiary care center (2018–2024) to identify new Y-T2D diagnoses. We compared incidence rates, disease severity at diagnosis, and remission outcomes before and after the period of comprehensive public health restrictions, defined locally as March 2020–August 2021, during which virtual learning was implemented. Results: Incidence declined from 13.2 to 6.3 cases/month after the major restrictions were lifted. Youth diagnosed after the restrictions period had lower rates of diabetic ketoacidosis (7.1% vs. 20.9%, p < 0.001) and severe hyperglycemia (HbA1c 9.1 ± 2.5% vs. 10.1 ± 2.3%, p < 0.001). Among those diagnosed during the restriction period, 11.1% achieved remission within three years. Remission was associated with lower baseline HbA1c (OR = 9.52, 95% CI: 2.2–41.7, p = 0.003), metformin use (OR = 7.0, CI: 1.9–26.3, p = 0.004), GLP-1 receptor agonist use (OR = 5.8, CI: 1.3–24.4, p = 0.018), and lower likelihood of insulin therapy (OR = 19.5, CI: 2.3–166.7, p = 0.007). Conclusions: The reduction in Y-T2D cases after the lifting of pandemic-related restrictions highlights the impact of pandemic-related environmental changes. Low remission rates—especially among underserved youth—underscore the urgency of early screening, prompt intervention, and equitable access to pediatric diabetes care, and highlight the need to consider the metabolic health impacts of future prolonged public health measures. Full article
(This article belongs to the Special Issue COVID-19 and Endocrine Complications)
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14 pages, 664 KB  
Article
Non-Thyroidal Illness Syndrome and Thyroid Autoimmunity in Hospitalized COVID-19 Patients: A Retrospective Study
by Ewa Kozłowska, Milena Małecka-Giełdowska and Olga Ciepiela
J. Clin. Med. 2025, 14(19), 6784; https://doi.org/10.3390/jcm14196784 - 25 Sep 2025
Cited by 1 | Viewed by 1821
Abstract
Background: Thyroid dysfunction, including non-thyroidal illness syndrome (NTIS), is commonly observed in critically ill patients and has been reported in COVID-19, particularly in those with severe disease. NTIS is defined by low free triiodothyronine (fT3) with normal or low thyroid-stimulating hormone (TSH) [...] Read more.
Background: Thyroid dysfunction, including non-thyroidal illness syndrome (NTIS), is commonly observed in critically ill patients and has been reported in COVID-19, particularly in those with severe disease. NTIS is defined by low free triiodothyronine (fT3) with normal or low thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels. Thyroid autoantibodies may also reflect immune system activation. The relationship between thyroid hormone alterations, autoimmunity, and clinical severity in COVID-19 remains incompletely understood. Methods: We conducted a retrospective study of 276 patients hospitalized with COVID-19, including 138 in the intensive care unit (ICU) and 138 in general wards. A control group of 110 hospitalized, non-infected patients was also analyzed. Serum concentrations of TSH, fT3, fT4 and reverse T3 (rT3) were measured. The presence of anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-Tg), and thyrotropin receptor antibodies (TRAb) was assessed. Results: NTIS was observed in 44.2% of ICU patients, 18.1% of non-ICU patients, and 1.8% of controls. The fT3/rT3 ratio was lowest in ICU patients (median 0.11 vs. 0.16 in non-ICU and 0.22 in controls). Thyroid autoantibodies were significantly more prevalent in COVID-19 patients than in controls, with anti-TPO antibodies being the most frequently detected. Their presence, even in patients without known thyroid disease, may reflect immune activation associated with SARS-CoV-2 infection. Conclusions: NTIS and thyroid autoimmunity are frequent in hospitalized COVID-19 patients and may reflect disease severity and immune activation. Our study highlights the prognostic relevance of routine thyroid testing, including the fT3/rT3 ratio and combined autoantibody positivity (notably the triple-positive pattern), by directly comparing ICU and non-ICU patients with a non-COVID control group. Full article
(This article belongs to the Special Issue COVID-19 and Endocrine Complications)
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