SARS-CoV-2 and thyroid disease: a nationwide study on hyperthyroidism and hypothyroidism using Oracle EHR Real-World Data

Abstract We investigate the risk of new-onset hyperthyroidism and hypothyroidism following COVID-19 in patients with no history of thyroid disease. Retrospective data consisting of 5 543 496 patients ≥18 years old, 1 847 832 patients with COVID-19 from December 2019 to August 2024 and 3 695 664 matched (2 to 1) patients without COVID-19 from January 2018 to August 2024, from the Oracle EHR Real-World Data, comprising all United States, were utilized. Incidence rates, incidence rate ratios, and adjusted hazard ratios (aHRs) for hyperthyroidism and hypothyroidism among those with COVID-19 compared to those without COVID-19 were calculated. COVID-19 was associated with a significantly higher risk of hyperthyroidism (aHR: 1.41; 95% CI: 1.36, 1.47) and hypothyroidism (aHR: 1.22; 95% CI: 1.20, 1.24). Patients with COVID-19 from outpatient encounters (hyper aHR: 1.32; hypo aHR: 1.18), non-hospitalized (hyper aHR: 1.45; hypo aHR: 1.29), hospitalized (hyper aHR: 1.55; hypo aHR: 1.31), transfered to the intensive care unit (hyper aHR: 1.57; hypo aHR: 1.49), ventilator dependent (hyper aHR: 3.05; hypo aHR: 2.19), and extracorporeal membrane oxygenation dependent (hyper aHR: 9.87; hypo aHR: 5.15) all had significantly higher risks of hyper/hypothyroidism than non-COVID-19 patients. Those with COVID-19 reinfection and long COVID-19 additionally had significantly higher risks of hyper/hypothyrdisim than COVID-19 patients without conditions and non-COVID-19 patients. Our findings identify, in the largest study to date, the impact of COVID-19 on the risk of thyroid disorders, and identify that COVID-19 severity and extended COVID-19 confer a particularly high thyroid disease risk.