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Background/Aim The aims of the study are to compare characteristics of subacute thyroiditis (SAT) related to different aetiologies, and to identify predictors of recurrence of SAT and incident hypothyroidism. Methods This nationwide multicenter retrospective cohort study included 53 endocrinology centers in Turkey. The study participants were divided into either coronavirus disease-2019 (COVID-19)-related SAT (Cov-SAT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine-related SAT (Vac-SAT), or control SAT (Cont-SAT). Results Of the 811 patients, 258 (31·8%) were included in the Vac-SAT group, 98 (12·1%) in the Cov-SAT group, and 455 (56·1%) in the Cont-SAT group. No difference was found between the groups with regard to laboratory and imaging findings. The aetiology of SAT was not an independent predictor of recurrence or hypothyroidism. In the entire cohort, steroid therapy requirement and younger age were statistically significant predictors for SAT recurrence. C-reactive protein (CRP) measured during SAT onset, female gender, absence of anti-thyroid peroxidase (TPO) positivity, and absence of steroid therapy were statistically significant predictors of incident (early) hypothyroidism, irrespective of SAT aetiology. On the other hand, probable predictors of established hypothyroidism differed from that of incident hypothyroidism. Conclusion Since there is no difference in terms of follow-up parameters and outcomes, COVID-19- and SARS-CoV-2- vaccine related SATs can be treated and followed up like classical SATs. The recurrence was determined by the younger age and steroid therapy requirement. Steroid therapy independently predict incident hypothyroidism that may sometimes be transient in overall SATs and is also associated with lower risk of established hypothyroidism.

Dilated cardiomyopathy (DCM) is characterized by systolic dysfunction and is usually idiopathic. A rare cause of reversible DCM is hypocalcemia. Calcium plays a key role in myocardial contraction. Hypocalcemia can lead to a decrease in contraction, left ventricular systolic dysfunction, and heart failure with reduced ejection fraction (EF). Hypocalcemia-related reversible DCM reports are rare. Herein, we present two cases with heart failure caused by hypocalcemia developed due to hypoparathyroidism. The first case presented with severe heart failure and an extremely low serum calcium level (4.4 mg/dL) due to idiopathic hypoparathyroidism. The second case, which was also admitted with heart failure due to hypocalcemia, had iatrogenic hypoparathyroidism due to a subtotal thyroidectomy. In both cases, patients had reduced left ventricular systolic functions (EF was 33% and 42%, respectively). After calcium replacement and heart failure treatment, calcium levels were normalized. A significant and rapid improvement in heart failure was achieved in both cases (EF 60% and 50%, respectively). Serum calcium levels should always be measured in patients with heart failure, and the etiology of hypocalcemia should be sought. In addition to the standard pharmacotherapy of heart failure with reduced EF, calcium supplementation is essential for treating these patients.

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