Thyroid disease and covid‐19 infection: Case series

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel RNA coronavirus responsible for the coronavirus disease-19 (COVID-19) pandemic. The clinical manifestations of COVID-19 are variable, ranging from asymptomatic cases to severe respiratory affection, and were found to cause thyroid dysfunction in some cases. Our case series aim to shed the light on the effect of SARS-COV-2 infection on thyroid function, thyroid gland size, and treatment of thyroid dysfunction. We demonstrated three cases indicating that COVID-19 infection can accentuate thyrotoxic state and Graves' ophthalmopathy, aggravate hypothyroidism, increase thyroid gland volume, and in euthyroid individuals can induce some sort of thyroiditis, characterized by hyperthyroidism followed by hypothyroidism which is eventually followed by euthyroidism. Furthermore, treatment of thyroid disease was found to be affected by COVID-19 infection.The novel coronavirus (SARS-COV-2) was first discovered at the end of the year 2019 in Wuhan, China. After which, it rapidly spread, causing an epidemic throughout China, which then spread across the entire world, resulting in coronavirus pandemic. In February 2020, the World Health Organization (WHO) designated the disease COVID-19, which stands for coronavirus disease 2019. 1 SARS-CoV-2-specific antibodies and cell-mediated responses are induced following infection. Preliminary evidence suggests that some of these responses are protective, but this remains to be definitively verified. Moreover, it is unknown whether all infected patients develop a protective immune response and how long a protective effect might last. 2 Data about the effect of SARS-COV-2 on the thyroid function are scarce; however, one study addressed this effect and demonstrated that, out of 287 patients with confirmed SARS-COV-2, 58 patients had hyperthyroidism and 15 patients had hypothyroidism. 3 Our case series aim to shed the light on the effect of SARS-COV-2 infection on thyroid function, which will ultimately influence thyroid disease sequelae and management in patients with COVID-19.

SARS-CoV-2: Emerging Role in the Pathogenesis of Various Thyroid Diseases

“…Subsequently, many cases of Hashimoto’s thyroiditis associated with SARS-CoV-2 infection were reported. 110 , 117 , 125 , 126 Besides, the duration taken from the initial respiratory-illness to Hashimoto’s thyroiditis outset was shown to be very similar in other cases of autoimmune complications which were shown to be consistent with the span of “cytokine storm”. 127–131 Thus, the hyperinflammatory condition is often sparked by the COVID-19 disease that possibly predisposes these infected cases to get autoimmune-related issues ( Figure 3 ).…”

“… Not done During COVID-19 Prednisolone 20 mg and tapered. Carbimazole six tablet/day Allam et al 2021 117 8 13 M Dizziness Fatigue Difficulty sleeping Presyncopal episode No <0.01 uIU/mL N.A. N.A.…”

“…HT, 10 years ago 1.27 mIU/L 1.32 ng/dL 3.921 pg/mL <60 IU/mL N.A. <35 IU/mL 21 days Levothyroxine 25 mcg once/day June, 2021 Allam et al 117 4. 33 F Fatigue Hair loss N.A.…”

“…These cases were shown to be recovered after the conventional ATDs treatment. 112,[114][115][116][117][118][119] Environmental risk factors including viruses and stress are often implicated in autoimmune thyroid diseases. 120 As depicted in Figure 3, SARS-CoV-2 infection-mediated hyperactivation of the pro-inflammatory conditions might reactivate Graves' disease via triggering an immunological cascade.…”

Hypothyroidism does not lead to worse prognosis in COVID-19: findings from the Brazilian COVID-19 registry

“…However, this analysis was limited by the sample size of patients who were hospitalized, limited number of events, and fixed selection of three controls per case, which forces selection of controls (van Gerwen M, 2020). The other previous cohort studies and case series were also limited by small sample sizes and lack of controls (Zhang Y, 2021;Bakshi SS, 2021;van Gerwen M, 2020;Daraei M, 2020;Tsivgoulis G, 2021;Lui DTW, 2021b;Allam MM, 2021). In the present study, a caliper width of 0.17 was used for the matched analysis.…”