Summary: Background: The outbreak of coronavirus disease 2019 (COVID-19) has become a world-wide emergency. Fangcang shelter hospitals have been applied in COVID-19 to ease ongoing shortage of medical resources in Wuhan since February 2020. Method: This study enrolled all cases (no=1848) with mild or moderate type of COVID-19 in Fangcang shelter hospital of Jianghan in Wuhan from Feb 5th to Mar 9th, 2020. Diagnosis of COVID-19 was based on the National health commission of China. Epidemiological history, comorbidity, vital signs, symptoms and signs were recorded in detail. Laboratory tests included biochemical indicators and nucleic acid tests by throat swabs have been performed as well. Finding: A total of 1327 patients reached the criteria of isolation release. Meanwhile, 521 patients have been transferred to the designated hospitals for further treatment, including severe type, fever more than 3 days, and severe comorbidity. The case-severity rate (rate of mild or moderate type transforming to severe type) was 3.0% in the shelter hospital. The patients from mild or moderate type to severe type showed the following clinical characteristics: the median incubation (onset to shelter) period was 10 days; they were all symptomatic at admission; fever, cough, and fatigue were the most common symptoms; hypertension, diabetes and coronary heart diseases were common co-morbidities; most of the patients had elevated levels of CRP at ill onset with 33.3% over 10 mg per L; bilateral distribution and ground-glass opacity were the most common manifestations in chest CT. Interpretation: The potential risk factors of fever, fatigue, high level of C-reactive protein were the risk factors to identify the progression of COVID-19 patients with mild or moderate type. Fangcang shelter hospitals have substantially reduced the time from the onset of severe symptoms transfer to a designated hospital. Early application of the Fangcang shelter hospital may contribute to decrease the ratio of mild transforming to severe patients. Funding: No specific grant from any funding was applied to this research. Research in context: Evidence before this study: We searched PubMed from Nov 1, 2019, to Apr 8, 2020, for studies published in any language using the terms “COVID-19”, “coronavirus disease 2019”, “novel coronavirus”, “cabin hospital”, “shelter hospital”. Five studies have been found about coronavirus disease 2019 (COVID-19) in shelter hospital or cabin hospital. Fangcang shelter hospital of Jianghan received the largest number of patients among Fangcang shelter hospitals in Wuhan. These studies were related to development of Fangcang shelter hospitals, explaining three key characteristics (rapid construction, massive scale, and low cost) and five essential functions (isolation, triage, basic medical care, frequent monitoring and rapid referral, and essential living and social engagement). To our knowledge, there are no studies to comprehensively investigate a cohort of mild COVID-19 patients transfer to designated hospital from shelter hospital and their distinctive clinical features. Since Fangcang shelter hospital is a novel public health strategy, we aimed to investigate the clinical characteristics and risk factors for developed COVID-19 patients transfer to the designated hospital in Jianghan Fangcang shelter Hospital. Added value of this study: From Feb 5th to Mar 9th, a total of 1848 cases of mild or moderate type of COVID-19 were enrolled in Fangcang shelter hospital of Jianghan (Wuhan, China). Of these cases, 521 patients were transferred to designated hospitals. Rate of mild or moderate type transforming to severe type was 3.0 % (56/1848) in the Fangcang shelter hospital. The median incubation (onset to shelter) period was 10 days (IQR 8.0-16.0). Patients with fever on cabin admission, high level C-reactive protein were also associated with mild-to-severe. Early application of the shelter hospital may contribute to alleviate the shortage of medical resources and decrease the ratio of severe patients. Furthermore, Fangcang shelter hospitals are likely to have substantially reduced the time from the onset of severe symptoms to admission to a designated hospital. The clinical characteristics of patients transferred to the designated hospital were important for the revision of admission criteria of COVID patients in Fangcang shelter hospitals. Dynamic observation the risk factors of mild to severe patients is contribute to great value for early prognosis and treatment. Implications of all the available evidence: Keep vigilance of those mild patients whose had a fever over 38.0°C, cough and fatigue when they isolated at home. Fangcang shelter hospital could provide the rational strategy for isolation and triage of infected patients and decrease the family or community transmission cases.

Background: While elevated thyroid-stimulating hormone (TSH) is a known risk factor for differentiated thyroid cancer (DTC), it remains unclear whether autoimmune thyroiditis (AT) modifies this association. Clarifying this interaction is critical for personalized risk assessment and TSH suppression therapy. Methods: This study performed a retrospective analysis including 2425 participants who underwent thyroidectomy for thyroid nodules. Participants were categorized based on histological AT diagnosis and thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels. Multivariable logistic regression models were used to assess the association between thyroid parameters and DTC risk, stratified by AT and autoantibody status. Results: The prevalence of histological diagnosed AT, TgAb-positivity, and TPOAb-positivity among DTC patients was 31.58%, 13.68%, and 18.76%, respectively. An increase in one standard deviation in TSH, thyrotrophic thyroxine resistance index (TT4RI), and TSH index (TSHI) was associated with an elevated risk of DTC in euthyroid individuals without AT or positive thyroid autoantibodies. A positive and nonlinear association between TSH and DTC risk in euthyroid patients without AT was identified, with inflection points at TSH levels of 1.32 mIU/L. In subgroups characterized by concurrent AT, TgAb-positivity, or TPOAb-positivity, these thyroid parameters showed no statistically significant correlation with DTC risk. Conclusions: The association between TSH and DTC risk varies according to autoimmune thyroiditis status. These findings highlight the importance of considering thyroid autoimmunity in thyroid cancer risk assessment and warrant prospective evaluation to determine its potential implications for TSH suppressive therapy.