Abstract #1001450: A Case of Thyroiditis Following Severe COVID-19 Infection

Abstract

Introduction:The ongoing COVID-19 pandemic has been devastating the United States since early 2020. As time went on, its extrapulmonary manifestations became further elucidated. Here we present a case of suspected thyroiditis from COVID-19 or intravenous (IV) contrast. Case Description: 34 year old man with schizoaffective disorder, bowel obstruction with subsequent colectomy and colostomy, and recent COVID-19 ICU admission in May 2020 presents in July with fevers and chills from group home. Patient had no history of lithium or amiodarone use. He did have a CT abdomen with IV contrast in May. He had symptoms of increased output from the colostomy and abdominal discomfort but denied any symptoms of neck pain, dysphagia, dysphonia, heat intolerance, palpitations, or tremors. On admission, the patient received an abdominal CT scan with intravenous contrast for his gastrointestinal symptoms which was unremarkable. Lab studies showed TSH < 0.10 mU/L(0.27 e 42 mU/L), TT3 108 ng/dl(80-200 ng/dl), and FT4 3.21 ng/ dl(0.7-1.8 ng/dl). Thyroid ultrasound found no evidence of nodules. Burch Wartofsky score was 60 from temperature of 102.9 ºF, sinus tachycardia to 130 beats/min and mild abdominal discomfort with increased output from colostomy. Though the Burch Wartofsky score was suggestive of thyroid storm, his FT4 was not severely elevated, therefore he was started on methimazole 20 mg daily with metoprolol tartrate 12.5 mg twice a day. TSH receptor antibody and thyroid stimulating immunoglobulin came back negative. Given high suspicion for thyroiditis from either COVID-19 or IV contrast, methimazole was discontinued. Patient was subsequently discharged on metoprolol tartrate 12.5 mg twice a day. His follow up labs in September during an admission for aspiration pneumonia revealed TSH < 0.10 mU/L(0.27 e 4.2 mU/L), TT3 67.9 ng/dl(80-200 ng/dl), and FT4 1.28 ng/dl(0.7-1.8 ng/dl) suggesting resolving thyroiditis. Discussion: There are a handful of cases of subacute thyroiditis caused by COVID-19 viral infection described in literature. Our patient's thyroiditis is further complicated by recent IV contrast use, which is commonly used. Both IV contrast and COVID-19 can cause thyroiditis, though post-viral thyroiditis typically presents with anterior neck pain. Treatment options have beta blockers in common but painless thyroiditis from IV contrast usually does not require prednisone or nonsteroidal anti-inflammatory drugs. Our case helps raise the awareness of COVID-19 and IV contrast as possible causes of thyrotoxicosis during this pandemic. Thyroiditis should always be part of the differential in the workup of thyrotoxicosis in a patient recently diagnosed with COVID-19 in the last couple of months.