Matt Kelly explains how COVID and long COVID can trigger thyroid problems through immune activation and new autoimmunity. The video covers specific thyroid antibodies like TPO and antithyroglobulin, how reverse T3 blocks active T3, and symptoms including fatigue, dry skin, and hair loss. He recommends screening labs: TSH, free T3, free T4, thyroid antibodies, and ANA.
We've done a lot of long COVID, COVID content here on the channel. And in, I think, a number of those, I had mentioned that long COVID or COVID proper can change thyroid status, thyroid function. And so we should probably break down specifically how does long COVID alter your thyroid function, or at least potentially alter your thyroid function. So we're going to break that down into a few chunks here as I describe what's going on with COVID long COVID, and then thyroid dysfunction that goes on. And this particular video, we're just keeping it to thyroid as opposed to all the other things that can go on in a patient who has long COVID. So let's break this down. One of the things that can happen when you have a patient with COVID and then they derive long COVID is the generation of new autoimmune activity. So autoimmune activity is just what it says. Your immune system is attacking you instead of a foreign invader. So the immune system is supposed to attack foreign bacteria, viruses, all that stuff. But in autoimmunity, it picks a part of you and attacks you. One of the things in the research that you see with COVID and long COVID, et cetera, from the spike protein damage is that we wind up with increased autoimmunity that people never had before. One thing that will rise in people who didn't ever have it before is the group of autoimmune markers called the antinuclear antibody or ANA family. Now, ANA is a global measurement, and then there's a whole bunch of sub-ANA parts, and that's beyond the scope of what we're talking about here. But one of the things that has come out in research is if you look at long COVID patients, a lot of them who didn't have positive ANAs before, in their long COVID experience, they have positive ANAs. Well, that means your body is having some kind of problem with you and you now have an autoimmune or pre-autoimmune condition you didn't have before. That then can also more specifically affect the thyroid. Now, the thyroid has 3 primary ways it can have autoimmune activity, and those can be at 3 different sort of points of the thyroid substance. Now, that might be the thyroglobulin, that is the synthetic base upon which you make your thyroid, and they call that antithyroglobulin antibody. It might be at the peroxidase enzyme step, which helps you in adding iodine onto your thyroid, and they call that in modern times the thyroid peroxidase antibody, TPO, et cetera. It's also known as other things as well. Your lab may call it that, but TPO is pretty common. And then there's also a thyrotrophin antibody, which can cause actually a hyperthyroid condition. The other 2 tend to cause a hypothyroid condition. So you can, number one, have autoimmune triggering, which affects your thyroid directly, and that can be totally new since COVID The next thing is a blocking thyroid your body makes called reverse T3. Now, reverse T3 is something that we've been able to test in labs for decades, but only reliably really for probably the last 20 years or so, maybe less. And what I've noticed with reverse T3 both in the research and in clinical practices. If you have a healthy person, you don't really need to test reverse T3. If you have a chronically ill person like a long COVID patient, you really do need to be testing reverse T3 because what reverse T3 does is— so the thyroid hormones are T4 and T3. There's also T1 and T2, but we don't need to talk about them. T4 is the major kind of thyroid hormone you make from your thyroid gland, and then it gets converted through an enzyme to T3, which is the active form that binds at mitochondria and runs your metabolic rate and stuff. So it's called T3. What would reverse T3 be? It's a reverse isomer of regular T3 that blocks T3. I used to tell students it's evil T3 because it doesn't allow the T3 to bind. Why would your body make something that blocks the most important thyroid hormone? It does that when it is under stress or has danger. Chronic stress, chronic danger to the body is perceived as a need to slow the mitochondria down, slow down your metabolic rate. And so the body will increase the production of reverse T3 to slow down the stimulation of the thyroid on your mitochondria. So it is both a cause of the problem and an effect of the problem at the same time. If all you do is look for reverse T3 and treat that, and you then you don't treat all the other problems, you're going to have an issue. But because we're limiting this particular talk to just stuff about the thyroid, just know that in people with long COVID, Reverse T3 blocking T3 often rises over time. Then people with hypothyroidism can just naturally create a long COVID hypothyroid combo. So by that I mean if you came into COVID with hypothyroid, your thyroid might work even worse than it did before you had COVID. But then there's the other side of the coin, which is why often people don't get tested for these things. Somebody's lived their whole life with no thyroid problems at all, and now. They have long COVID and they develop a de novo or brand new hypothyroid problem. And so sometimes their doctor might not test them for a thyroid problem because they'll say, well, you never had that before. But just like thyroid autoimmunity and reverse T3 elevation could come on in long COVID because of the immune dysregulation, so can just plain old non-autoimmune hypothyroidism, which is also shown in the literature as well. So what thyroid problems tend to feel like are fatigue. Because it runs your mitochondrial rate, there is a slowdown in turnover of cells. So you can get digestive problems, constipation. You can get dry skin. Your hair will fall out. Your nails will get brittle. Anything where your body needs to be turning over cells can have a problem. As I said, core and centralized fatigue is a huge problem with thyroid issues, and obviously it's not the only reason for long COVID, but it is an extremely important thing to sort out. But we want to. Sort out all the possibilities. So in regard to thyroid, what would we want to test? Well, we do want to do our standard labs, chemistries, blood counts, stuff like that. We want to add the ANA because that could go up. We want to add all the thyroid antibodies because those could be there from— weren't there before. We want to test the T3 and T4, usually free T3, free T4. Want to test the TSH, which is the usual test they do. And then also now you can add on reverse T3. So if you can do those things, at least you can screen and say thyroid is part of Long COVID problem, or no, those are fine. Thyroid's probably not part of my long COVID problem. All right. Well, I hope that cleared up those questions around long COVID and thyroid. 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