Subacute Thyroiditis from COVID-19 Infection: A Case Report and Review of Literature

Abstract

<b><i>Introduction:</i></b> The novel severe-acute-respiratory-syndrome-coronavirus-2 (SARS-CoV-2) virus has led to the ongoing Coronavirus disease 2019 (COVID-19) disease pandemic. There are increasing reports of extrapulmonary clinical features of COVID-19, either as initial presentations or sequelae of disease. We report a patient diagnosed with subacute thyroiditis precipitated by COVID-19 infection, as well as review the literature of similar cases. <b><i>Case Presentation:</i></b> A 41-year-old female with no significant personal or family history of endocrinologic disorders presented with clinical features of thyroiditis that began after COVID-19 infection. Clinical, laboratory, and radiologic findings were indicative of subacute thyroiditis. Workup for potential triggers other than SARS-CoV-2 was negative. <b><i>Discussion/Conclusion:</i></b> We compared the clinical and diagnostic findings of our patient with other well-documented cases of subacute thyroiditis presumed to be triggered by SARS-CoV-2 viral infection. We also reviewed the literature related to the potential mechanisms leading to thyroiditis. Clinicians must be aware of the possibility of thyroid dysfunction after COVID-19 infection. Early recognition and timely anti-inflammatory therapy help in successful management.

The Association of Subacute Thyroiditis with COVID-19: a Systematic Review

“…Our search identified 30 articles; 9 were excluded due to duplication, and 7 articles on COVID-19 were excluded because they did not address subacute thyroiditis and 1 was excluded because it scored low on Critical Appraisal. Finally, 13 articles-11 case reports and 2 case series [5][6][7][8][9][10][11][12][13][14][15][16][17]-were included in the final analysis. Since 10 patients were described in the two case series, individual data from 21 total patients is described here, in the form of 2 tables each for case reports (Tables 1 and 3) and case series (Tables 2 and 4).…”

“…The interplay between thyroid hormones and immune system along with the direct cytotoxic effect of the virus is proposed to play a role in these abnormalities, including subacute thyroiditis [4]. The increasing evidence of SAT during or after the COVID-19 infection has been reported in various published cases [5][6][7][8][9][10][11][12][13][14][15][16][17], which highlights the concern that physicians ought to consider COVID-19 (ongoing or previous) as an etiological factor/trigger in patients presenting with subacute thyroiditis. This is especially important amidst the ongoing pandemic or even in the future as physicians encounter SARS-CoV-2.…”

Thyroiditis and SARS-CoV-2 pandemic: a review

“…Subacute or de Quervain's thyroiditis is a granulomatous thyroiditis, usually during or after a viral episode in genetically predisposed patients (HLA-Bw35, HLA-B67, HLA-Drw8) [14]. Since the initial observation of subacute thyroiditis in a Covid-19 patient [15], at the present time 22 patients have been reported in the literature either as a clinical case report [15][16][17][18][19][20][21][22][23][24][25][26] or in small series of patients [27,28] (Table 1).…”

Post-Coronavirus Disease 2019 De Quervain’s Thyroiditis – A Case Report and Literature Review

“…Hereby, we report a case of subacute (de Quervain's) thyroiditis triggered by recent SARS-CoV-2 infection. To the best of our knowledge, eight cases of subacute thyroiditis (SAT) following COVID-19 infection have been reported so far in world literature [1][2][3][4][5], none of them is from the Indian population. The purpose of presenting this case is to alert clinician about this new complication following COVID-19 as well as identify the thyrotoxic symptoms which may be missed during the current devastating pandemic.…”