Figure - available from: Case Reports in Endocrinology
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Ultrasound of the thyroid gland showing a heterogeneously enlarged thyroid gland with two small 4 mm solid hypoechoic solid nodules in the isthmus.
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Background/Objective. Since the start of the pandemic, COVID-19 has been associated with several postinfection complications. Subacute thyroiditis (SAT) is an inflammatory disorder of the thyroid that has been reported in the literature following COVID-19 infection. We report a case of SAT following COVID-19 infection. Case Report. A 33-year-old fe...
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After the beginning of COVID-19 vaccination campaigns, several reports of thyroid disease possibly related to the COVID-19 vaccination progressively appeared in the literature, raising the question of whether the thyroid disorder might be a SARS-CoV-2 vaccine complication. The aim of this study was to analyze the data about COVID-19 vaccination and...
Citations
... Mumps, enteroviruses (such as Coxsackie viruses), influenza, Epstein-Barr virus and cytomegalovirus are among the viruses that have been implicated in the past. SARS-CoV-2, the cause of COVID-19 infection, has also been reported to cause subacute thyroiditis (8). The literature on the effect of the MPX virus on the thyroid gland is scarce. ...
Mpox (MPX) formerly known as monkeypox was declared a public health emergency of international concern, following an outbreak that commenced in May 2022. We report a case of subacute thyroiditis following MPX infection. To our knowledge, it is the first documented incidence of this complication in humans. A 51-year-old male, with a well-controlled human immunodeficiency virus (HIV) infection on antiretroviral therapy, was reviewed 3 weeks after a positive test for MPX. The acute skin lesions and initial systemic symptoms had resolved, but he described significant neck discomfort, fatigue, weight loss and night sweats. Blood tests showed a raised C-reactive protein, free T4 and suppressed thyroid-stimulating hormone. His thyroid antibodies were negative. He was treated initially with carbimazole and propranolol, pending exclusion of any other intercurrent infection. A chest radiograph was normal; blood cultures and a combined nose and throat swab for respiratory virus PCR testing were negative. Following this, he commenced a 2-week course of prednisolone; his symptoms resolved completely within 24 h of starting. He subsequently developed hypothyroidism, which was treated with levothyroxine. The clinical features, abnormal thyroid function, raised CRP and negative thyroid antibodies 3 weeks post-MPX positive test was consistent with viral subacute thyroiditis. This case demonstrates that, as described following other viral infections, MPX can cause subacute thyroiditis, which follows a similar course to the classic form of subacute thyroiditis. Clinicians should be aware of this potential endocrine complication when attending to patients with MPX.
Learning points
Subacute thyroiditis can present following mpox virus infection.
Its course is similar to the classic form of subacute thyroiditis and steroids are effective.
It is important to exclude other concurrent infections prior to starting steroids, especially for patients who are immunosuppressed or in other high-risk groups.
... Rolę w tym procesie przypisuje się zwiększonym stężeniem cytokin związanych z limfocytami Th1/Th17 -IL17, IL21-IL23, IFNγ oraz TNF-α. Powyższe mechanizmy prowadzą do obserwowanej w badaniach autopsyjnych i histologicznych destrukcji komórek pęcherzykowatych tarczycy, komórek nabłonkowych, zmian w mikrokrążeniu oraz włóknienia tkanek narządu [16]. ...
The SARS-CoV-2 virus is the pathogenic agent of the COVID-19 disease, which pandemic had caused 6.8 million deaths worldwide by February 2023. In the course of the disease, involvement of the thyroid gland is observed. The pathomechanism of damage to the thyroid gland is bidirectional – direct cytotoxicity of the virus and the indirect effect of a cytokine storm. Circulating pro-inflammatory cytokines lead to deiodinase activity dysregulation, resulting in changes in plasma concentrations of TSH, fT3, and fT4. These hormone abnormalities are observed in about 16% of patients during COVID-19 and may also result from the treatment itself – systemic corticosteroids. Dysregulation of the immune system also leads to autoinflammatory thyroid diseases. It seems crucial to monitor thyroid hormones to detect subclinical forms of thyroiditis early. This paper presents the prevalence and potential pathomechanism of thyroid disorders observed during SARS-CoV-2 infection – subacute thyroiditis, low T3 syndrome, Graves-Basedow disease, and Hashimoto’s disease.
... This suggests that thyroid cells could potentially serve as a target for viral entry, providing a possible explanation for the observed association between thyroid dysfunction and COVID-19. [15], [16], [17], [18]. ...
... Some patients may develop permanent hypothyroidism. [15] In our reported cases, the patients exhibited suppressed TSH levels, elevated levels of free thyroxine, and elevated inflammatory markers. The first patient presented with a prolonged febrile syndrome, which was later diagnosed as subacute thyroiditis. ...
Subacute thyroiditis (SAT) is an inflammatory condition affecting the thyroid gland, usually triggered by a viral infection or occurring after a viral illness. It is characterized by neck tenderness, along with the typical symptoms of thyrotoxicosis and an elevated erythrocyte sedimentation rate. SAT has been identified as a potential complication associated with SARS-CoV-2 infection. The aim of this study is to present and discuss two cases of subacute thyroiditis that occurred following a viral infection, potentially linked to SARS-CoV-2 infection. We describe the clinical, biochemical, and imaging features of two cases of SAT that manifested six weeks after the onset of COVID-19-associated symptoms. Both cases involved female patients, aged 58 and 39, who developed subacute thyroiditis, characterized by neck pain, fever, and fatigue. These symptoms emerged three weeks after recovering from a viral episode marked by acute coryza, cough, and anosmia. Due to a persistent fever lasting three weeks, one of the patients required hospitalization to rule out other infectious causes of prolonged febrile syndrome. Laboratory analyses revealed elevated inflammatory markers, positive serology for SARS-CoV-2 infection, thyroid function tests showed thyroid over-activity and thyroid ultrasound confirmed the diagnosis of SAT. The patients received corticosteroid treatments and beta-blockers, resulting in the complete resolution of symptoms and normalization of inflammatory markers, within three weeks after the SAT diagnosis. Post-COVID-19 thyroiditis can emerge as a potential complication of SARS-CoV-2 infection. It is crucial for clinicians to be aware of this possibility, highlighting the importance of considering post-COVID-19 thyroiditis in patients presenting with relevant symptoms.
Subacute granulomatous thyroiditis (SGT)/De Quervain's thyroiditis is a rare self‐limiting inflammatory disease, accounting for 3% of all thyroid disorders. Most commonly seen in middle aged women, it shows a characteristic triad of pain in the anterior cervical region, increased ESR and recent history of viral upper respiratory tract infection. The cytomorphological features are not pathognomonic and can also be seen in Hashimoto's thyroiditis, granulomatous infections, sarcoidosis, and papillary thyroid carcinoma. We report four cases of SGT, diagnosed on fine needle aspiration cytology (FNAC). Familiarity with cytomorphology of SGT and awareness of the clinical setting is essential for making an accurate diagnosis.
Background: Subacute thyroiditis (SAT) is a self-limiting thyroid inflammatory disease occurring specifically after upper respiratory tract infections. Since COVID-19 is a respiratory disease leading to multi-organ involvements, we aimed to systematically review the literature regarding SAT secondary to COVID-19.
Methods: We searched Scopus, PubMed/MEDLINE, Cochrane, Web of Science, ProQuest, and LitCovid databases using the terms “subacute thyroiditis” and “COVID-19” and their synonyms from inception to November 3, 2022. We included the original articles of the patients with SAT secondary to COVID-19. Studies reporting SAT secondary to COVID-19 vaccination or SAT symptoms’ manifestation before the COVID-19 infection were not included.
Results: Totally, 820 articles were retained. Having removed the duplicates, 250 articles remained, out of which 43 articles (40 case reports and three case series) with a total of 100 patients, were eventually selected. The patients aged 18–85 years (Mean: 42.70, SD: 11.85) and 68 (68%) were women. The time from the onset of COVID-19 to the onset of SAT symptoms varied from zero to 168 days (Mean: 28.31, SD: 36.92). The most common symptoms of SAT were neck pain in 69 patients (69%), fever in 54 (54%), fatigue and weakness in 34 (34%), and persistent palpitations in 31 (31%). The most common ultrasonographic findings were hypoechoic regions in 73 (79%), enlarged thyroid in 46 (50%), and changes in thyroid vascularity in 14 (15%). Thirty-one patients (31%) were hospitalized, and 68 (68%) were treated as outpatients. Corticosteroids were the preferred treatment in both the inpatient and outpatient settings (25 inpatients (81%) and 44 outpatients (65%)). Other preferred treatments were nonsteroidal anti-inflammatory drugs (nine inpatients (29%) and 17 outpatients (25%)) and beta-blockers (four inpatients (13%) and seven outpatients (10%)). After a mean duration of 61.59 days (SD: 67.07), 21 patients (23%) developed hypothyroidism and thus, levothyroxine-based treatment was used in six of these patients and the rest of these patients did not receive levothyroxine.
Conclusion: SAT secondary to COVID-19 seems to manifest almost similarly to the conventional SAT. However, except for the case reports and case series, lack of studies has limited the quality of the data at hand.
Introduction
SARS CoV-2 infection involves many organs and systems, including the thyroid, in which it manifests itself as subacute thyroiditis (SAT). After our first description of SAT due to SARS-CoV2 infection, other reports have confirmed the correlation between SARS-CoV-2 and SAT. We review the cases of SAT associated with COVID-19 to highlight its peculiar clinical and biochemical features, including its outcome and what it has added to our understanding of SAT.
Results
We have reviewed 24 articles, for a total of 69 cases of SAT related to SARS-CoV2 infection. All had neck pain, whereas thyrotoxicosis was documented in 68/68 who had their thyroid function checked. Ultrasound, performed in 67 patients, was typical of SAT in 65 and low uptake at scintigraphy was demonstrated in all 12 evaluated patients. Patients had a prompt response to the anti-inflammatory and/or glucocorticoid therapy, as expected in SAT. The rate of hypothyroidism was higher (36.5%) in COVID-19-related SAT compared to that observed in the pre-COVID era (10%).
Conclusions
Clinical, biochemical, and instrumental features of SAT related to SARS-CoV2 are like those observed in SAT cases reported prior to COVID-19 pandemic, but it appears more severe.
