Patients with coronavirus disease 2019 (COVID-19) as a result of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may develop subacute thyoriditis (SAT), according to a case series published in the Journal of Clinical Endocrinology & Metabolism.

Researchers previously described a case of SAT associated with SARS-CoV-2 infection and the objective of the current case series was to describe the clinical, biochemical, and radiologic characteristics of additional patients with COVID-19 and SAT.

The case series included 4 women with SAT associated with SARS-CoV-2 infection. The interval between the resolution of COVID-19 and development of SAT ranged between 16 and 36 days.

The main symptoms related to SARS-CoV-2-associated SAT included neck pain with radiation to the jaw and palpitations. Additional symptoms included fever, asthenia, and 1 patient was hospitalized for atrial fibrillation.


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Laboratory findings were suggestive of overt destructive thyrotoxicosis, with both high free thyroxine 4 and free thyroxine 3, as well as elevated C-reactive protein and erythrocyte sedimentation rate. Imaging findings included enlarged thyroid gland on neck ultrasound, with diffuse and multiple hypoechoic areas and absent or low vascularization at color Doppler.

Treatment included prednisone in 3 patients and ibuprofen in the remaining patient. Response to treatment was good and at 6 weeks after onset of SAT symptoms, all patients were asymptomatic and had normal inflammatory markers. As for thyroid function at 6 weeks, 2 women were diagnosed with subclinical hypothyroidism and 2 women were euthyroid.

“[O]ur findings highlight that SAT may be an underestimated manifestation of COVID-19. Clinicians should keep in mind the possible occurrence of SAT during and after SARS-CoV-2 infection,” wrote the researchers.

Reference

Brancatella A, Ricci D, Cappellani D, et al. Is subacute thyroiditis an underestimated manifestation of SARS-CoV-2 infection? Insights from a case series. J Clin Endocrinol Metab.2020;105(10):dgaa537.