Subacute thyroiditis following COVID-19: A systematic review

Abstract

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.

High Diagnostic Accuracy of Thyroid-Stimulating Hormone (TSH) Receptor Antibodies in Distinguishing Graves’ Disease and Subacute Thyrotoxicosis in the Indian Population

“…A recent study has reported a large amount of thyroiditis in Bengaluru, India, based on a nuclear medicine centers-based study, although the proportion of thyroiditis among thyrotoxicosis was not reported, which may indicate a higher prevalence of subacute thyroiditis in the city [ 12 ]. The coronavirus disease 2019 (COVID-19) epidemic in 2020-2021 and vaccination for COVID-19 might have also contributed to a slightly higher proportion of subacute thyroiditis in the current study [ 13 , 14 ].…”

Occult endocrine disorders newly diagnosed in patients with post-COVID-19 symptoms

“…Regarding thyroid diseases, subacute thyroiditis has been reported to have a twofold increased risk of onset in the first 6 months after onset of COVID-19, and subacute thyroiditis after COVID-19 appears to have the same characteristics as those of conventional subacute thyroiditis 21 , 22 . No cases of subacute thyroiditis were found in this study, probably because subacute thyroiditis is a relatively acute condition and is diagnosed and treated by primary care physicians and internists before referral to the outpatient clinic for long COVID at our university hospital.…”

Comparison of treatment outcome between glucocorticoids and non-steroidal anti-inflammatory drugs in subacute thyroiditis patients—a systematic review and meta-analysis

“…Subacute thyroiditis (SAT) is a self-limiting and inflammatory thyroid disease, accounting for approximately 5% of all thyroid diseases. SAT often occurs after an upper respiratory tract infection and is probably caused by a viral infection (1)(2)(3)(4). The potentially causative viruses include Coxsackie virus, Echovirus, adenovirus, influenza virus, mumps and rubella virus, parvovirus B19, orthomyxovirus, HIV, Epstein-Barr virus, hepatitis E, measles virus, and the pandemic-spreading severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) since the outbreak of novel coronavirus (COVID-19) in 2019 (5)(6)(7).…”