Summary of COVID-19 medicines guidance: Endocrine system disorders

This page summarises and signposts to medicine related guidance we’re aware of from professional and government bodies relating to coronavirus and endocrine system disorders.

This page has been put together rapidly in response to the COVID-19 pandemic.

Whilst we have tried to ensure that the information on this page is complete, please report a concern if you feel anything is omitted or inaccurate.

To see our professional guidance summaries for other clinical areas, click here

Advice in this area includes:

 

NHS England/NHS Improvement: After-care needs of inpatients recovering from COVID-19

Last updated 8 June 2020

  • This guidance includes the following therapeutic areas: respiratory, cardiology, neurology, mental health, endocrinology and urology.
  • There is no medication-related information within the neurology, mental health, endocrinology or urology sections.
  • Guidance for management of patients’ physical respiratory needs is given on pages 7-13.
  • Includes recommendations on anticoagulation for patients with pulmonary embolic disease.
  • Reference made to patients requiring cardiac assessment pre-discharge plus plan – with optimisation of medications listed on page 14.

 

Society for Endocrinology: COVID-19 resources for managing endocrine conditions

Our summary

Androgen replacement therapy

Last updated 27th March 2020

  • There is no clinical reason to stop testosterone injections.
  • If clinics are unable to administer testosterone injections, temporary interruption of therapy is not expected to lead to patient harm.
  • Alternatively, patients can be switched from testosterone injections to topical gels. The testosterone gel should be commenced as from the date the next injection would have been due.

Fertility treatment

Nil date of publishing/update specified

  • The decision to suspend routine dispensing of gonadotrophins is one to be made by individual trusts based on clinical circumstances.
  • If routine dispensing is suspended, patient should continue using their current supply of gonadotrophin until they run out.
  • Stopping gonadotrophin is not life-threatening but the fall in testosterone can lead to effects such as tiredness and reduced sex-drive.
  • Use of testosterone gel can help prevent these effects, although it will not help with male infertility.
  • If previous routine monitoring identified a concern with raised blood count, a full blood count should be taken at 3 months after starting testosterone.

Growth hormones

Nil date of publishing/update specified

  • Patients on existing growth hormone therapy can continue on their current dose, even if no recent IGF-1 level available.
  • Patients can safely pause growth hormone therapy for the coming months if they find this preferable.
  • If a patient is admitted to hospital with COVID-19, growth hormone should be held and can be restarted when patient recovers and is asymptomatic of the infection.
  • Patients with newly diagnosed growth hormone sufficiently should not be initiated growth hormone therapy at this current time due to the biomedical monitoring requirements.

Neuroendocrine tumours

Last updated 30th March 2020

  • Somatostatin analogues do increase the risk of patients developing infections, including to COVID-19
  • Approaches to reduce patient exposure to COVID-19 includes teaching them to self-inject, have the injections performed at their GP surgery as opposed to hospital clinic, or have the injections performed by home care delivery teams. Decision needs to be made on an individual basis.
  • For some patients with known stable non-functioning tumours the dose interval may be extended or doses omitted if this means that an at-risk patient would need to travel to have the injection.
  • For patients with newly diagnosed high-functioning tumours, treatment will need to be initiated. Octreotide subcutaneous injections can be used if administration of deep intramuscular injections are not practical.
  • For patients with newly diagnosed low-functioning tumours, treatment initiation can be deferred.
  • The decision to continue chemotherapy agents for neuroendocrine tumours need to be decided on an individual basis following a risk benefit analysis.

Parathyroid conditions

Last updated 24th March 2020

  • Patients should continue to take medication for hypoparathyoidism as usual.
  • If patients are experiencing symptoms of hypocalcaemia, they can take an additional calcium tablet (500 – 1,000 mg) and eat some calcium rich food (e.g. yoghurt)
  • If calcium levels are falling very fast, then patient can take an alfacalcidiol 250 ng tablet, magnesium and an extra calcium tablet whilst awaiting medical advice.

Thyroid dysfunction and thyrotoxicosis

  • Anti-thyroid medication does not increase the risk of COVID-19 infection. They can be continued in patients who contract COVID-19, unless neutropenia is present. Anti-thyroid medication does not need to be held if patient develops COVID-19 related leucopenia.
  • The symptoms of neutropenia and COVID-19 are similar (e.g. flu-like symptoms, cough). If patient develops symptoms, anti-thyroid drugs should be stopped and patient should receive an urgent blood test. At the doctor’s discretion a COVID-19 test can also be performed. If a blood test is unable to be performed at onset of symptoms, patients should hold anti-thyroid medication for one week. If symptoms have resolved, they can restart therapy. If symptoms worsen during this period or recur after recommencing the drug, the patient should seek urgent medical attention.
  • Patients taking immunosuppressive therapy (including high dose corticosteroids) for thyroid eye disease,should be shielded for 12 weeks as per government advice.
  • Patients who have recently undergone radioiodine treatment for hyperthyroidism, with a low threshold for commencing thyroxine therapy if hypothyroid symptoms develop should be identified. Monitor thyroid function in those who have not been started on levothyroxine if possible.
  • For patients with newly diagnosed thyrotoxicosis, suggested therapy is as follows:
    • FT4 between upper limit of normal and 30 picomol/L: initiate carbimazole 20mg daily. After 6 weeks, increase dose to 40mg daily and add levothyroxine (75mcg if body weight 55Kg or below; 100mcg if body weight above 55Kg)
    • FT4 between 30 – 60 picomol/L: Initiate carbimazole 40mg daily. After 6 weeks, add levothyroxine (dose above)
    • FT4 above 60 picomol/L: Initiate carbimazole 40mg daily. After 8 weeks, add levothyroxine (dose above)

Thyroid cancer

Last updated 7th April 2020

  • Radioactive iodine therapy is not urgent and can safely be delayed.
  • Patients on suppressive doses of thyroxine (i.e have a thyroid stimulating hormone target of below 0.1mU/l) should continue on their current dose.
  • Being on suppressive dose of levothyroxine does not increase the risk of COVID-19 infection.
  • Patients receiving multikinase inhibitors (such as Lenvatinib or Sorafenib) or chemotherapy for thyroid cancer are at increased risk of severe illness from coronavirus and should follow government advice regarding shielding.

Thyroid eye disease (TED)

Last updated 9th April 2020

  • Intravenous methylprednisolone therapy is generally not recommended for treating moderate to severe TED during the COVID19 pandemic due to risk of immunosuppression.
  • Patients who, under normal circumstances, would have had intravenous methylprednisolone should be switched to oral prednisolone. The recommended dose of oral prednisolone is greater than 20mg/day for longer than 4 weeks in unilateral / bilateral sight threatening disease. Whilst it may be required, that oral prednisolone is less effective and more likely to cause side effects and should only be considered for severe (e.g. severe constant diplopia) or sight threatening disease.
  • Steroid therapy for moderate TED should be delayed by commencing second line treatment as per local protocols and patients followed up by regular virtual review.
  • Patients already on second line immunosuppressants for moderate TED should continue on their current dose, as long as there are no concurrent symptoms of infection.
  • If a patient develops COVID-19 symptoms, second line immunosuppressants should be stopped with immediate effect.

 

Society for Endocrinology: Adrenal Crisis Information

Our summary:

  • If patient develops a fever or infection, their daily dose of steroids should be doubled.
  • If adrenal crisis in a patient is suspected, hydrocortisone 100mg needs to be administered via intravenous or intramuscular injection, along with intravenous fluids.
  • Patient should be maintained on parenteral hydrocortisone 200mg over 24 hours (preferably by continuous intravenous infusion) until clinical recovery and further guidance by an endocrinologist.
  • This advice applies to pregnant women. The risk to the baby of hydrocortisone use in this situation is far lower than uncontrolled adrenal insufficiency.
  • Infants up to 1 year may be given 25mg hydrocortisone intravenously; children 1 to 5 years, 50mg; 6 to 12 years, 100mg. This dose can be repeated three or four times in 24 hours depending upon the condition being treated and the patient’s response.

 

European Journal of Endocrinology (Hosted by European Society of Endocrinology): Endocrinology in the time of COVID-19

Our summary:

This contains links to in-depth guidelines on the diagnosis, treatment and monitoring of the following endocrine disorders

 

Changes made on last update (13th July 2020)

Minor amendments of dates of last updates on resources. Nil information regarding medication has changed