ACE2 and COVID-19: Assuming that hypothyroidism leads to immune system dysfunctions and that ACE2 is expressed in thyroid gland, one could speculate that hypothyroidism might impact the outcomes in COVID-19 patients.14 Mechanisms that can cause this include an indirect effect of systemic inflammatory immune response, dysfunction of the hypothalamic-pituitary-thyroid (HPT) axis leading to decreased serum TSH or a direct effect of SARS-CoV-2 on target cells.15