Detection of Sars-Cov-2 antigens in thyroid gland showing histopathological features of subacute thyroiditis

Jakovac, Hrvoje; Ferenčić, Antun; Štemberger, Christophe; Mohar, Bojana; Cuculić, Dražen

doi:10.1530/etj-22-0005

Cited by 13 publications

(11 citation statements)

References 5 publications

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“…Furthermore, many patients with painless SAT were in intensive care unit and/or were suffering from severe forms; it is conceivable that many of them were unable to report pain because of their general condition and treatment. The recent finding of a copious mononuclear infiltrate forming granuloma-like structures with giant multinucleated cells, resembling those observed in previous cases of SAT, in the thyroid tissue obtained from a patient deceased from COVID-19 is against the hypothesis of a reduced lymphocytic and plasmocytic infiltration of the thyroid, resulting from lymphopenia [45]. Among patients described in this paper, most were treated with glucocorticoids, with an excellent symptomatic response, a result similar to that reported in SAT described in the pre-COVID period.…”

Section: Discussionsupporting

confidence: 61%

Clinical, biochemical features and functional outcome of patients with SARS-CoV-2-related subacute thyroiditis: a review

et al. 2022

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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.

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Section: Discussionsupporting

confidence: 61%

Clinical, biochemical features and functional outcome of patients with SARS-CoV-2-related subacute thyroiditis: a review

et al. 2022

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“…Importantly, histopathological studies have suggested that virus infiltration in endocrine glands can be observed in severe cases of COVID-19. Such studies have detected the viral genome and proteins inside endocrine tissues and have identified signs of apoptosis as a result of this viral invasion ( 54 , 55 ), which signifies the potential for direct damage to the thyroid gland in severe COVID-19 cases.…”

Section: Discussionmentioning

confidence: 99%

Association of thyroid dysfunction and COVID-19: A systematic review and meta-analysis

Darvishi

Nazer²,

Shahali³

et al. 2022

Front. Endocrinol.

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This systematic review and meta-analysis was conducted to evaluate the effect of COVID-19 on thyroid function and the role of thyroid hormones alterations in predicting the severity of COVID-19. Online databases, including Scopus, Medline/PubMed, EMBASE, Google Scholar, and Cochrane were searched up to August 2, 2022. After screening titles, abstracts, and full manuscripts, respectively, 30 reports were enrolled. The risk of bias (ROB) was evaluated using the QUADAS-2 tool. In addition, odds ratio (OR) and hazard ratio (HR) analysis for assessing the OR of abnormal thyroid function tests (TFT) in predicting the COVID-19 severity and poor outcomes. Among 30 enrolled studies, ROB of the current study is estimated low to moderate. The average number of patients in each study was 325 (range: 40-3,703), with an overall mean age of 57.6, and the female proportion of 40.4%. Overall, the pooled analysis showed that the prevalence of thyroid dysfunction among 9,707 COVID-19 cases was 15%. Among mild to moderate COVID-19 patients, 6.2% had abnormal TFT, and among patients who experienced severe to critical COVID-19, 20.8% had abnormal TFT. The pooled OR for abnormal TFT and the severity of COVID-19 obtained from 3,865 COVID-19 patients was 3.77 (2.03, 6.99). The pooled HR of TSH level of COVID-19 mortality was 1.57 (0.91, 2.72). Our results demonstrate a high prevalence of thyroid dysfunction in COVID-19, and that among patients severe cases had a 3.77-fold higher risk of abnormal TFT compared to mild to moderate COVID-19. Further studies are required to evaluate the longer-term prognostic role of thyroid dysfunction in severe COVID-19, and investigate potential therapeutic strategies.

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“…The high expression of the angiotensin-converting enzyme-2 (ACE2) receptor used by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to enter the cell in thyroid follicular cells suggests that COVID-19 may directly cause inflammation in thyroid cells [19][20][21]. The finding of SARS-CoV-2 antigens in the thyroid gland showing the histopathological features of SAT in a post-mortem examination also strengthens this hypothesis [22]. However, considering that SAT often develops following viral infections, the molecular mimicry hypothesis also comes to the fore.…”

Section: Discussionmentioning

confidence: 86%

Impact of the COVID-19 pandemic on the incidence, seasonal distribution, and characteristics of subacute thyroiditis

et al. 2022

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Purpose An increasing number of cases of subacute thyroiditis (SAT) related to the coronavirus disease 2019 (COVID-19) and its vaccines continue to be published. The aim of this study was to investigate any change in the incidence and characteristics of SAT by comparing the pre-pandemic and pandemic periods. Methods This retrospective, single-center study included 432 newly-diagnosed SAT patients between January 2018 and December 2021. The annual frequency of SAT was calculated as the number of newly-diagnosed SAT cases divided by the total number of outpatients that year. Results The frequencies of newly-diagnosed SAT were 0.136% in 2018, 0.127% in 2019, 0.157% in 2020, and 0.114% in 2021 ( p = 0.19). While SAT patients were clustered in the autumn (35.1%) in 2018 and 2019, it was found that this cluster shifted to the winter (33.0%) in 2020 and 2021, in parallel with COVID-19 case peaks ( p = 0.017). The patients were separated into two groups as pre-COVID-19 pandemic SAT ( n = 272) and COVID-19 pandemic SAT ( n = 160). The mean ages of the groups were similar. There were more male patients in the COVID-19 pandemic SAT group than in the pre-pandemic group (30.6% vs. 18.7%, p = 0.005). Frequencies of overt hyperthyroidism and median free-thyroxine levels were significantly higher in the COVID-19 pandemic SAT group ( p = 0.029, p = 0.001). Treatment modalities, recurrence rates, and permanent hypothyroidism were similar in both groups. Conclusion With the COVID-19 pandemic, although there was a change in seasonal variation of SAT and an increase in the number of male patients, there was no change in the incidence and clinical course of SAT.

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Detection of Sars-Cov-2 antigens in thyroid gland showing histopathological features of subacute thyroiditis

Cited by 13 publications

References 5 publications

Clinical, biochemical features and functional outcome of patients with SARS-CoV-2-related subacute thyroiditis: a review

Clinical, biochemical features and functional outcome of patients with SARS-CoV-2-related subacute thyroiditis: a review

Association of thyroid dysfunction and COVID-19: A systematic review and meta-analysis

Impact of the COVID-19 pandemic on the incidence, seasonal distribution, and characteristics of subacute thyroiditis

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