Thyrotoxic Crisis and COVID-19 Infection: An Extraordinary Case and Literature Review

Abstract

The novel coronavirus SARS-CoV-2, which causes the disease commonly known as COVID-19, has spread around the world, associated mostly with respiratory tract symptoms. We report the first case of a thyrotoxic crisis precipitated by COVID-19 and describe its identification, diagnosis, and management in the emergency unit. We also conduct a systematic review of thyrotoxic crisis literature and COVID-19 infection. This case highlights the importance of considering the SARS-CoV2 virus as a potential trigger of a thyroid storm. It also shows the need to maintain extreme contact precautions even after one month of COVID-19 symptom onset.

SARS-COV-2-related immune-inflammatory thyroid disorders: facts and perspectives

“… No data on long-term follow-up. [ 92 ] COVID-19 = coronavirus disease 2019; FT4 = free thyroxine; FT3 = free triiodothyronine; GD = Graves’ disease; GO = Graves’ ophthalmopathy; PPT = post-partum thyroiditis; TgAb = thyroglobulin antibodies; TH = Hashimoto’s thyroiditis; TPOAb = thyroperoxidase antibodies; TRAb = TSH receptor antibodies; TS = Thyroid scintigraphy; TSH = Thyroid-stimulating hormone; US = ultrasonography; …”

“…Finally, a thyroid storm probably precipitated by COVID-19 infection has been recently reported in a 45-year-old Caucasian woman, with a previous history of Graves’ disease in stable remission for more than four years. The patient reported the onset of respiratory symptoms more than one month before, and her nasopharyngeal swab was still positive when the thyrotoxic crisis occurred ( Table 3 ) [ 92 ]. In all patients, the temporal sequence suggests that GD could have been triggered by SARS-CoV-2 infection.…”

Coronavirus Disease 2019 and the Thyroid - Progress and Perspectives

“…Management would be more difficult if drug-induced agranulocytosis were to take place (but fortunately not so far reported), or thyroid storm ( 84 ), or myxedema coma were to occur ( 85 ). As shown here, our understanding of the thyroidal manifestation of COVID-19 is far from complete as is the etiologic view of COVID-19 and thyroid insults.…”

COVID-19 Associated Thyroid Storm: A Case Report

“…4,5 There appears to be only a single case in the literature of overt thyroid storm triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. 6 We present a case of a critically ill patient with thyroid storm associated with COVID-19 infection.…”