Hipotiroidismo, hipertiroidismo o nódulos en la tiroides: ¿son factores de riesgo para el COVID-19?

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Entrevista al doctor Fabián Pitoia, presidente electo de la Sociedad Latinoamericana de Tiroides (LATS) y jefe de la Sección Tiroides del Hospital de Clínicas, para despejar dudas

La tiroides es una glándula en forma de mariposa ubicada en el cuello -arriba de la clavícula- y que produce hormonas. Justamente, son ellas quienes controlan el ritmo de muchas actividades del cuerpo y el metabolismo. Su mal funcionamiento -que por lo general, se manifiesta en hipertiroidismo e hipotiroidismo- puede afectar el ritmo cardíaco, los músculos, los huesos y la función de casi todos los órganos del cuerpo. Por eso, el buen funcionamiento de la tiroides es fundamental y se diagnostica a través de un simple análisis de sangre, el que determinará si los valores son normales o si, por el contrario, se necesita recurrir a la medicación o el tratamiento que la regule.

Con la pandemia de coronavirus, muchas personas consultan a sus médicos acerca de si padecer una patología en la tiroides debe ser considerada un factor de riesgo, al igual que ocurre con la hipertensión o la diabetes, por ejemplo. En una entrevista con Infobae, el Dr. Fabián Pitoia, presidente electo de la Sociedad Latinoamericana de Tiroides (LATS) y jefe de la Sección Tiroides del Hospital de Clínicas, explica todas las dudas al respecto y lleva un manto de tranquilidad.

El Dr Fabián Pitoia

El Dr Fabián Pitoia

-Padecer hipotiroidismo, hipertiroidismo o tener un nódulo en la tiroides, ¿puede poner a un paciente con una vulnerabilidad especial frente al COVID-19?

-No hay más riesgo que en las situaciones habituales para los casos de pacientes con hipotiroidismo, hipertiroidismo o con un nódulo tiroideo, pero hay algunas pequeñas cosas que hay que tener en cuenta. En relación al hipotiroidismo, se recomienda que la persona esté bien tratada para que no tenga un déficit hormonal y eso la pueda llevar a una alteración en la inmunidad, aunque aún no hay nada probado.

En cuanto al hipertiroidismo, hay una medicación que se utiliza y puede provocar alteración de los glóbulos blancos en el 0,3 %, lo que sería una caída de las defensas. Pero esto es tan infrecuente que uno piensa que, si al paciente le pasa, lo más probable es que si tiene una infección sea más severa.

Con relación a los pacientes con tumores tiroideos, es decir en casos de cáncer de tiroides, aquellos que están curados no van a tener ningún impacto, incluso si el diagnóstico se retrasa. Pero hay un grupo de pacientes que tiene enfermedades metastásicas -que por suerte son los menos- y esos son los que se podrían ver afectados por las medicaciones que usan, como fármacos tipo quimioterápicos por vía oral, que pueden alterar las defensas, ya que además pueden tener metástasis pulmonares, las que se sabe que están asociadas con un mayor riesgo de mortalidad y de internaciones en Unidad de Terapia Intensiva por COVID-19. Entonces hay un impacto que tiene que ver con un grupo hiperselecto de pacientes endocrinológicos.

Podemos llevar tranquilidad y no generar una paranoia en una patología que es tan prevalente. En los casos de los pacientes que tienen metástasis, es fundamental que vayan a los controles, que es lo que pasa en la oncología en general y que es lo que vamos a ver dentro de los próximos diez años, cuando se incremente la incidencia de mortalidad por todos los cánceres. Eso sin duda.

La tiroides tiene forma de mariposa y cumple una función fundamental en el organismo

La tiroides tiene forma de mariposa y cumple una función fundamental en el organismo

-¿La postergación de los controles de cualquier tipo de cáncer puede llevar a un elevado aumento de casos?

-El director del National Cancer Institute dijo que por el retraso en el diagnóstico del cáncer de colon y mama se espera un exceso de más de 10 mil muertes en la próxima década, en los Estados Unidos. Son retrasos que se van produciendo en los chequeos de rutina para detectar enfermedades previsibles o que no van a diseminarse, pero que si se diagnostican un año después, obviamente que va a ser diferente.

No es lo mismo que pasa en el caso del cáncer de tiroides, pero lo que vemos ahora es que hay pacientes a quienes tenemos que cambiarles de una línea a otra de quimioterápicos y con todo esto hay retrasos: el paciente progresa igual bajo la medicación, el tema de las obras sociales se complica en este momento con las autorizaciones, aprobaciones de nuevas drogas, etc. Todo eso es un retraso que lo vemos desde el Hospital de Clínicas, más allá de que nuestro Hospital está casi avocado a COVID-19 y sólo está atendiendo las urgencias de todas las especialidades.

-¿Qué pasa con la tiroiditis subaguda y el COVID-19?

-Desde el punto de vista tiroideo, se ha demostrado que -de manera poco frecuente- puede aparecer una tiroiditis subaguda. Es decir, los pacientes se infectan con COVID-19 y, así como sucede con cualquier otro tipo de infección viral, normalmente quince días después lo que ocurre -por un fenómeno de mímica biológica, en donde los anticuerpos interpretan que lo que van a a atacar es tiroideo y en realidad es parte del antígeno del virus- generan una lesión aguda de la glándula tiroidea: es decir, la destruyen y liberan toda la hormona a la sangre.

Ha habido algún reporte en revistas internacionales de casos de tiroiditis subagudas, que son estos episodios en donde se produce la destrucción masiva de la tiroides, se libera hormona a la sangre, se produce un hipertiroidismo y después se resuelve solo: la tiroides se vuelve a rearmar y es algo secundario a la infección por COVID-19.

Esto es lo único certero que podemos decir que tenga un impacto directo hasta ahora reportado y publicado en la bibliografía. El resto es mucha especulación y nada específicamente demostrado.

El Dr Pitoia junto a parte de su equipo en el Hospital de Clínicas

El Dr Pitoia junto a parte de su equipo en el Hospital de Clínicas

-¿El estrés puede influir frente al COVID-19?

-Esta es, sin duda, una situación de estrés pero no hay nada expresamente dicho con respecto al impacto que tiene. Lo que vemos, y esto no es basado en un estudio ni en un dato clínico, es que hay muchos pacientes de tiroides que están desregulados con las dosis. Fundamentalmente, esto tiene que ver con los cambios en los hábitos alimentarios, en el aumento de peso, etc. Todo esto hace que haya que subir las dosis.

También, está el caso de los que descendieron de peso porque cambiaron su alimentación. Todo ese cambio nutricional que trajo este encierro, para un lado o para el otro, también hizo que en el hipotiroidismo tuviéramos que estar ajustando dosis en los casos de muchos pacientes. Creo que tiene que ver más con los cambios en la ingesta, que con el estrés en sí.

El estrés endógeno, que es algo fisiológico, no tiene un impacto en la función de la tiroides. Es algo que nuestro organismo interpreta como una situación de estrés y para eso secreta corticoides de un modo más exagerado, pero eso no tiene un impacto clínico.

Infobae

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