A Case of Subacute Thyroiditis following COVID-19 Infection

Abstract

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 female presented with neck pain two weeks after resolution of COVID-19 infection. Her thyroid function tests together with ultrasonographic pictures were consistent with SAT. She was treated with three rounds of medrol dose pack without relief. She then required oral prednisone 40 mg per day and ibuprofen 800 mg once daily for another several weeks that eventually resulted in improvement of her symptoms. Discussion. SAT most commonly occurs in females during or after viral infection. The usual course of the disease is hyperthyroidism then hypothyroidism followed by resolution. SAT is clinically diagnosed by lab findings of decreased TSH in the setting of negative thyroid-stimulating and thyroid peroxidase antibodies. All these data are consistent with our case. Conclusion. SAT following COVID-19 infection presents with a similar clinical presentation and course as the classic form of SAT, but we should consider the fact that a high-dose corticosteroid treatment might be necessary for such patients.

Cytodiagnosis of subacute granulomatous thyroiditis (De Quervain's thyroiditis)—A report of four cases

“…Subacute granulomatous thyroiditis (SGT) is most commonly seen in middle aged women and shows a characteristic triad of sudden onset of pain in the anterior cervical region, increased ESR and a history of viral upper respiratory tract infection 2–8 weeks prior to the initiation of symptoms 3 . Viruses commonly linked with SGT include coxsackievirus, adenovirus, Epstein–Barr virus, mumps, measles, and influenza virus 6 . Direct injury by the virus or immunologic response of the host to the virus have both been suggested.…”

“…Direct injury by the virus or immunologic response of the host to the virus have both been suggested. An increase in SGT cases was seen during the COVID‐19 pandemic and attributed to its association with coronavirus infection 6 . The proposed pathogenetic mechanism involves induction of an inflammatory response and interaction with ACE 2 receptors and transmembrane protease serine 2 receptor, which are abundant in the thyroid and for which coronavirus has a high affinity 6 .…”

“…3 Viruses commonly linked with SGT include coxsackievirus, adenovirus, Epstein-Barr virus, mumps, measles, and influenza virus. 6 Direct injury by the virus or immunologic response of the host to the virus have both been suggested. An increase in SGT cases was seen during the COVID-19 pandemic and attributed to its association with coronavirus infection.…”

“…An increase in SGT cases was seen during the COVID-19 pandemic and attributed to its association with coronavirus infection. 6 The proposed pathogenetic mechanism involves induction of an inflammatory response and interaction with ACE 2 receptors and transmembrane protease serine 2 receptor, which are abundant in the thyroid and for which coronavirus has a high affinity. 6 All four of our cases were females who presented with pain in the anterior neck; two patients also complained of dysphagia.…”

“…6 The proposed pathogenetic mechanism involves induction of an inflammatory response and interaction with ACE 2 receptors and transmembrane protease serine 2 receptor, which are abundant in the thyroid and for which coronavirus has a high affinity. 6 All four of our cases were females who presented with pain in the anterior neck; two patients also complained of dysphagia. A history of upper respiratory tract infection was documented in only one of the cases.…”