Painless Subacute Thyroiditis in a Patient With Acute COVID-19 Infection: A Transient Event

Dolkar, Tsering; Jitidhar, FNU; Patel, Meet; Hamad, Abubaker M.; Salauddin, Ferdous; Shiferaw-Deribe, Zewge; Dogar, Muhammad H

doi:10.7759/cureus.26924

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…The early cases of COVID-19-associated SAT generally reported suffering from severe neck discomfort. In contrast, the authors of observational studies of COVID-19 patients in intensive care units described uncommon cases of painless SAT with no local symptoms (30,59). Although we discovered heterogeneity among the inpatient cases, it proposed that insufficient lymphocytic infiltration within the thyroid gland due to COVID-19-associated lymphopenia results in the absence of tension of the thyroid capsule and, thus, painless presentations of thyroiditis (59).…”

Section: Discussionmentioning

confidence: 97%

Subacute thyroiditis following COVID-19: A systematic review

et al. 2023

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BackgroundSubacute thyroiditis (SAT) is a self-limiting thyroid inflammatory disease occurring specifically after upper respiratory tract infections. Since COVID-19 is a respiratory disease leading to multi-organ involvements, we aimed to systematically review the literature regarding SAT secondary to COVID-19.MethodsWe searched Scopus, PubMed/MEDLINE, Cochrane, Web of Science, ProQuest, and LitCovid databases using the terms “subacute thyroiditis” and “COVID-19” and their synonyms from inception to November 3, 2022. We included the original articles of the patients with SAT secondary to COVID-19. Studies reporting SAT secondary to COVID-19 vaccination or SAT symptoms’ manifestation before the COVID-19 infection were not included.ResultsTotally, 820 articles were retained. Having removed the duplicates, 250 articles remained, out of which 43 articles (40 case reports and three case series) with a total of 100 patients, were eventually selected. The patients aged 18–85 years (Mean: 42.70, SD: 11.85) and 68 (68%) were women. The time from the onset of COVID-19 to the onset of SAT symptoms varied from zero to 168 days (Mean: 28.31, SD: 36.92). The most common symptoms of SAT were neck pain in 69 patients (69%), fever in 54 (54%), fatigue and weakness in 34 (34%), and persistent palpitations in 31 (31%). The most common ultrasonographic findings were hypoechoic regions in 73 (79%), enlarged thyroid in 46 (50%), and changes in thyroid vascularity in 14 (15%). Thirty-one patients (31%) were hospitalized, and 68 (68%) were treated as outpatients. Corticosteroids were the preferred treatment in both the inpatient and outpatient settings (25 inpatients (81%) and 44 outpatients (65%)). Other preferred treatments were nonsteroidal anti-inflammatory drugs (nine inpatients (29%) and 17 outpatients (25%)) and beta-blockers (four inpatients (13%) and seven outpatients (10%)). After a mean duration of 61.59 days (SD: 67.07), 21 patients (23%) developed hypothyroidism and thus, levothyroxine-based treatment was used in six of these patients and the rest of these patients did not receive levothyroxine.ConclusionSAT secondary to COVID-19 seems to manifest almost similarly to the conventional SAT. However, except for the case reports and case series, lack of studies has limited the quality of the data at hand.

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Section: Discussionmentioning

confidence: 97%

Subacute thyroiditis following COVID-19: A systematic review

et al. 2023

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“…Recently, cases of painless subacute thyroiditis have been reported in relation to COVID-19 infection ( 24 ). However, there have been no reports of painless subacute thyroiditis leading to thyroid storm, and if painless subacute thyroiditis was indeed the cause of the destructive thyroiditis in our case, this would make it the first such report.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Painless Destructive Thyroiditis Resulting in Thyroid Storm

et al. 2023

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Thyroid storm is a life-threatening clinical condition that is usually triggered by untreated or interrupted treatment of Graves' disease, leading to the sudden onset of severe thyrotoxicosis, which requires an immediate diagnosis and treatment based on diagnostic criteria. Cases of thyroid storm caused by painless/painless subacute thyroiditis are very rare. We herein report an 85-year-old man with features of severe thyrotoxicosis caused by painless/painless subacute thyroiditis who had no uptake of 99m TcO4 and was negative for thyroidstimulating hormone receptor antibodies. In thyroid storm patients in whom the findings are inconsistent with Graves' disease, careful follow-up and management are necessary, assuming the possibility of painless or painless subacute thyroiditis.

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New-Onset Paroxysmal Atrial Fibrillation in a Healthy Male With Post-COVID-19 Painless Thyroiditis: A Case Report

Chavez-Flores,

Sharobiem,

Kim

et al. 2024

Cureus

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Painless thyroiditis is a variant of thyroiditis without the typical neck pain and is otherwise similar to subacute thyroiditis, which is a known post-viral condition and has been associated with coronavirus disease 2019 (COVID-19) infections. While it is usually self-limiting, it can lead to thyrotoxicosis that can predispose individuals to cardiac dysrhythmias, including atrial fibrillation. There has been a clear association between COVID-19 and subacute thyroiditis with a few case reports describing atrial fibrillation. We present a case of a healthy patient with new-onset atrial fibrillation secondary to painless thyroiditis. This report highlights the rare entity of painless thyroiditis leading to atrial fibrillation with rapid ventricular response in a patient who recently recovered from COVID-19. Physicians should consider the potential association of painless thyroiditis in patients with new-onset atrial fibrillation who recently recovered from COVID-19.

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Painless Subacute Thyroiditis in a Patient With Acute COVID-19 Infection: A Transient Event

Cited by 3 publications

References 15 publications

Subacute thyroiditis following COVID-19: A systematic review

Subacute thyroiditis following COVID-19: A systematic review

A Rare Case of Painless Destructive Thyroiditis Resulting in Thyroid Storm

New-Onset Paroxysmal Atrial Fibrillation in a Healthy Male With Post-COVID-19 Painless Thyroiditis: A Case Report

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