The effect of the Covid-19 virus, which affects the whole world, on chronic diseases is among the most curious topics.
Although it is known that Covid-19 infection is more severe in the elderly and male sex in general, the increasing number of cases worries especially those with chronic diseases. Stating that the Covid-19 virus also shows different effects in chronic diseases such as diabetes, obesity, thyroid and hypertension, Assoc.Prof. From the Department of Endocrinology and Metabolic Diseases at Memorial Ankara Hospital. Dr. Ethem Turgay Cerit answered 19 important questions about the effects of the Covid-4 virus and what to do in these ailments:
1-Do endocrinological diseases increase the risk of Covid-19 infection?
DIABETES: One of the most curious issues of diabetes patients is whether diabetes increases the risk of getting coronavirus. Although the first articles that appeared at the beginning of the pandemic revealed data in this direction, in the light of reliable scientific data published later, it shows that the risk of getting Covid-19 infection in diabetic patients is not more than non-diabetic individuals.
OBESITY: In the light of current data, it can be said that individuals with obesity have a higher risk of getting Covid-19 than normal weight individuals. As it is known, Covid-19 virus enters the body through ACE2 receptors. ACE2 level increasing in parallel with the increase in adipose tissue in obesity and due to Covid-19's affinity for ACE2, it can be said that obese patients are exposed to more intense viral load than normal weight patients. The fact that individuals with obesity often have other accompanying diseases and their immune response capacity is low compared to individuals with normal weight pose an additional risk in terms of getting Covid 19. In addition, the fact that vitamin D levels, which are known to have a very important role in the immune system, are widely seen in individuals with obesity can be considered as an additional risk factor for obese individuals in terms of Covid-19.
HYPERTENSION: In the light of the researches, we can say that being a hypertensive patient or the antihypertensive drugs used do not increase the risk of getting Covid-19.
THYROID: There is no data on an increased risk of Covid-19 infection in people with thyroid disease.
KIDNEY GAP OR HYPOPHYSIS DISEASES: There is no data that patients with adrenal gland or pituitary disease are more likely to get Covid-19 infection than the general population. However, it should be kept in mind that, for example, cushing's disease and cushing syndrome with excess cortisol have the potential to make the individual more susceptible to infections by suppressing the immune system.
2-How do endocrinological diseases affect the course of Covid-19 infection?
DIABETES: All kinds of infections are more severe in diabetic patients. While the immune system balance is impaired in diabetic patients, it has been observed that the inflammatory cytokine response increases. It is possible for these increased signals to exacerbate virus-related lung disease and increase the risk of multiple organ failure. Studies have shown that uncontrolled diabetes has a more severe course and Covid-19 infections have higher mortality rates.
OBESITY: In studies conducted in different countries during the pandemic, it has been shown that the course of the disease is worse in the presence of obesity, the need for intensive care and mortality rates are higher than those of normal weight.
HYPERTENSION: Covid-19 infection may have a more severe course in patients with hypertension.
THYROID: There is no data that having thyroid disease adversely affects the course of Covid-19 infection.
KIDNEY GAP OR HYPOPHYSIS DISEASES:Covid-19 infection may be more severe in patients with adrenal gland or pituitary diseases, especially when the disease is not under control.
3-Covid-19 infection increases the risk of developing endocrine diseases?
DIABETES: Any infection that arises impairs metabolic control. Therefore, in cases of prediabetes (individuals with high risk of diabetes) whose metabolic control is not good at the beginning, blood glucose levels may deteriorate further and overt diabetes may occur due to Covid-19 infection. During Covid-19 infection, it may be possible to have a sudden increase in blood sugar and temporary or permanent diabetes.
OBESITY: It is an inevitable fact that inactivity caused by quarantine and pandemic living conditions increases the risk of obesity.
HYPERTENSION: During the course of Covid-19 infection, uncontrolled high blood pressure may be encountered.
THYROID: During or after Covid-19 infection, the likelihood of subacute thyroiditis-like inflammation, pain and thyroid dysfunction increases in the thyroid gland.
KIDNEY GAP OR HYPOPHYSIS DISEASES:Since the pituitary gland can express ACE2, it can become a direct target organ for the virus. Covid-19 infection has the potential to cause impairment in pituitary and adrenal gland functions.
4-What should those with endocrinological disease pay attention to during the Covid-19 process?
DIABETES: In the Covid-19 process, it is recommended that diabetic patients use their medications regularly, monitor their blood sugar more often at home, consume enough fluids, comply with healthy eating recommendations, and walk 5 thousand steps a day at home if possible. Thanks to these recommendations, blood sugar regulation on the one hand, weight control on the other hand, and people feel better psychologically. Diabetic individuals should be careful about symptoms that can cause serious problems if neglected, such as blood glucose constantly above 250-300 mg / dl, newly developing standing wounds, feeling of severe pressure or pain in the chest, uncontrollable blood pressure, and should not hesitate to go to the hospital. .
OBESITY: It is recommended that patients with obesity avoid high-calorie diet during the pandemic process, and try to achieve a slight weight loss with calorie restriction. In addition, approaches such as avoiding sedentary lifestyle with mild-moderate exercise can contribute to the body's immune system being more resistant to the virus.
HYPERTENSION: In the light of the available data, we can say that none of the blood pressure medications used increase the risk of getting Covid-19 infection or cause the disease to progress more severely. For this reason, patients using hypertension medication should continue in the same way without stopping their medication. It is also extremely important that they follow the usual salt-free healthy eating recommendations.
THYROID: Medicines used for thyroid diseases do not weaken the immune system. General recommendations for Covid-19 apply to all thyroid patients.
Patients who take thyroid hormone (levothyroxine) in hypothyroidism, a condition in which the thyroid gland is less working, may postpone their routine controls to a later date without changing their drug doses, if there has not been a recent change in drug doses. Patients with dose changes should determine their control times by consulting their physicians.
In cases where the thyroid gland is overworked (graves disease, hyperthyroidism) and those who use antithyroid drugs (methimazole, propylthiouracil), timely thyroid function tests should be performed and the drug dose should be adjusted. Although it is not correct to use antithyroid drugs without testing for a long time, patients should not change the doses of their medication themselves and leave the decision of dose change to the physicians who follow them.
Patients using antithyroid drugs (methimazole, propylthiouracil) for hyperthyroidism; If symptoms such as sore throat, fever, and flu infection occur, they should stop their medication, apply to the nearest healthcare institution, have blood count (especially neutrophil) tests done and contact the physicians who follow them.
Patients who have undergone thyroid surgery for the treatment of thyroid cancer (may or may not have received radioactive iodine afterwards) do not carry an additional risk in terms of Covid-19 infection. Chemotherapy and radiotherapy (irradiation) are very rarely needed in thyroid cancers. Patients who have received radiation therapy for thyroid cancer metastasis and still receive chemotherapy may increase the risk of Covid-19 infection. These patients need to apply protective measures more stringently.
KIDNEY GAP OR HYPOPHYSIS DISEASES:Patients with Addison's (renal milk gland insufficiency) and pituitary insufficiency should not discontinue vital steroid treatments and other medications they are taking, and should continue to use them regularly.In case of a possible Covid-19 infection or suspected, the doses of steroid medications they take should be increased. For this reason, it is extremely important that they share their disease diagnosis with the healthcare team who will definitely make the Covid-19 treatment plan.