Thyrotoxicosis occurrence in SARS-CoV-2 infection: A case report

Anwar, Sumadi Lukman; Wahyono, Artanto; Dwianingsih, Ery Kus; Avanti, Widya Surya

doi:10.1016/j.amsu.2022.103700

Cited by 3 publications

(4 citation statements)

References 27 publications

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“…Recent studies have answered this question in two ways. First, angiotensin-converting enzyme 2 receptor and transmembrane protease serine 2, which are known to play important roles in SARS-CoV-2 invasion of the human host cells, are more highly expressed in thyroid cells than in the lungs, oral cavity, pharynx, and larynx, which may cause a TS[ 10 - 12 ]. Second, Lania et al [ 8 ] suggested that SARS-CoV-2 could affect the thyroid cells indirectly through a cytokine storm.…”

Section: Discussionmentioning

confidence: 99%

“…SARS-CoV-2 can also cause a wide variety of extrapulmonary symptoms owing to its inflammatory effects. For example, cardiac (myocarditis, pericardial effusion, shock), renal (glomerulonephritis), hematological (thrombocytopenic purpura, anemia), neurological (Guillain–Barré syndrome, meningoencephalitis, optic neuritis), and musculoskeletal (myositis, arthritis) complications have been reported[ 10 , 27 - 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Thyroid storm in a pregnant woman with COVID-19 infection: A case report and review of literatures

Kim¹,

Yang²,

Park³

et al. 2023

World J Clin Cases

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BACKGROUND The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019 (COVID-19). SARS-CoV-2 infections not only result in significant respiratory symptoms but also cause several extrapulmonary manifestations, such as thrombotic complications, myocardial dysfunction and arrhythmia, thyroid dysfunction, acute kidney injury, gastrointestinal symptoms, neurological symptoms, ocular symptoms, and dermatological complications. We present the first documented case of thyroid storm in a pregnant woman precipitated by SARS-CoV-2. CASE SUMMARY A 42-year-old multiparous woman at 35 + 2 wk of gestation visited the emergency room (ER) with altered mentation, seizures, tachycardia, and high fever. The patient showed no remarkable events in the prenatal examination, and the nasopharyngeal COVID-19 polymerase chain reaction (PCR) test was positive two days before the ER visit. The results of laboratory tests, such as liver function test, serum electrolytes, blood glucose, blood urea nitrogen, and creatinine, were all within the normal ranges. However, the thyroid function test showed hyperthyroidism, and the nasopharyngeal COVID-19 PCR test was positive, as expected. No specific findings were observed on the brain computed tomography, and there were no signs of lateralization on neurological examination. Fetal heartbeat and movement were good, and there were no significant uterine contractions. The initial impression was atypical eclampsia. However, the patient's condition worsened, and a cesarean section was performed under general anesthesia; a healthy boy was delivered, and 12 h after delivery, the patient's seizures disappeared and consciousness was restored. The patient was referred to an endocrinologist for hyperthyroidism, and a thyroid storm with Graves' disease was diagnosed. Here, SARS-CoV-2 was believed to be the trigger for the thyroid storm, considering that the patient tested positive for COVID-19 two days before the seizures. CONCLUSION In pregnant women presenting with seizures or changes in consciousness, the possibility of a thyroid storm should be considered. There are various causes for a thyroid storm, but given the recent pandemic, it is necessary to bear in mind that the thyroid storm may be precipitated by COVID-19.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thyroid storm in a pregnant woman with COVID-19 infection: A case report and review of literatures

Kim¹,

Yang²,

Park³

et al. 2023

World J Clin Cases

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“…The overaction of the T helper cell response and elevation in interleukin-6 due to COVID-19 infection resulted in a change in thyroid gland functionality [32]. Prasankati et al [105] described TS and COVID-19 in a patient without a history of heart or thyroid disease who presented with SVT.…”

Section: Discussionmentioning

confidence: 99%

Data Analysis and Systematic Scoping Review on the Pathogenesis and Modalities of Treatment of Thyroid Storm Complicated with Myocardial Involvement and Shock

Elmenyar,

Aoun,

Al Saadi

et al. 2023

Diagnostics

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Thyroid storm (TS) is a rare and fatal endocrine emergency that occurs due to undiagnosed and inadequately treated hyperthyroidism after stressful conditions in patients with thyroid disorders. The objective of this systematic scoping review was to better understand the pathophysiology of TS and its complications, in terms of myocardial affection, tachyarrhythmia, and cardiogenic shock. In addition, we explored the pharmacological, mechanical, and surgical treatments for TS. We also evaluated the outcomes of TS according to sex and cardiac involvement. Additionally, analytical analysis was performed on the selected data. A literature review of peer-reviewed journals was carried out thoroughly using medical terms, MeSH on PubMed, Google Scholar, and combinations such as thyrotoxicosis-induced cardiomyopathy, thyroid storm, cardiogenic shock, myocardial infarction, endocrine emergency, Burch–Wartofsky score, extracorporeal circulatory support, and thyroidectomy. A total of 231 papers were eligible (2 retrospective studies, 5 case series, and 224 case reports) with a total of 256 TS patients with cardiac involvement between April 2003 and August 2023. All age groups, sexes, patients with TS-induced cardiomyopathy, non-atherosclerotic myocardial infarction, tachyarrhythmia, heart failure, shock, and different forms of treatment were discussed. Non-English language articles, cases without cardiac involvement, and cases in which treatment modalities were not specified were excluded. Female sex was predominant, with 154 female and 102 male patients. Approximately 82% of patients received beta-blockers (BBs), 16.3% were placed on extracorporeal membrane oxygenation (ECMO) support, 16.3% received therapeutic plasma exchange (TPE), and 13.8% underwent continuous renal replacement therapy (CRRT), continuous venovenous hemofiltration (CVVHD), or dialysis. Overall, 18 females and 16 males died. BB-induced circulatory collapse, acute renal failure, CRRT, and ventricular fibrillation were significantly associated with mortality. Awareness of TS and not only thyrotoxicosis is vital for timely and appropriate treatment. The early diagnosis and management of TS in cardiac settings, including pharmacological, mechanical, and surgical modalities, can save high-risk patients. Sex matters in the presentation, treatment, and mortality of this population. However, further large-scale, and well-designed studies are required.

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“…In this case report, the patient was diagnosed with thyroid storm consistent with the BWPS for thyrotoxicosis and the 2016 JTA and Japanese Endocrine Society criteria for thyroid storm. 4 Thyroid crisis is a life-threatening condition often triggered by acute conditions or mental stress, developing into thyrotoxicosis and manifesting as multi-organ failure (MOF), 8 , 9 with a reported 10.7% mortality rate in Japan. 9 The thyroid crisis was triggered in this patient by SARS-CoV-2 infection in July 2021, at the peak of the second wave of COVID-19 infections in Indonesia.…”

Section: Discussionmentioning

confidence: 99%

Fatal Case of Possible Thyroid Crisis Induced by SARS-CoV-2 Infection: A Case Report

Hamzah

Aman

Iskandar

2022

JAFES

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Thyroid crisis is an emergency due to impaired thyroid function caused by various conditions, particularly infections such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that result in the dysfunction of various vital organs. We report a case of a 31-year-old Indonesian female with a 2-year history of hyperthyroidism with elevated thyroid-stimulating hormone (TSH) receptor antibodies. (TRAb) who developed thyroid crisis possibly in association with SARS-CoV-2 pneumonia, sepsis, and disseminated intravascular coagulation (DIC). Prior to admission, she was treated for her hyperthyroidism with propylthiouracil and had been in stable remission for a year. She was admitted to the Emergency Room with complaints of watery stools, icteric sclerae, jaundice, coughing, and shortness of breath. The physical examination showed a World Health Organization (WHO) performance score of 4, delirium, blood pressure within normal limits, tachycardia, tachypnea, axillary temperature of 36.7°C, icteric sclerae, jaundice, and exophthalmos. There was a 3 cm palpable nodule on the right side of the neck. Auscultation of the lungs revealed bilateral pulmonary rales. Abdominal examination noted a palpable liver and enlarged spleen. Laboratory tests showed thrombocytopenia, electrolyte imbalance, hypoalbuminemia and elevated transaminases. The thyroid function tests showed a suppressed TSH level with an elevated free thyroxine (FT4) level. The SARS-CoV-2 polymerase chain reaction (PCR) swab test was positive. Initial patient management was with supportive therapy that included favipiravir and anti-hyperthyroidism medication; however, despite these interventions, her condition continued to deteriorate and she died after a few hours. This case demonstrates no difference in therapy between patients with thyroid crises and COVID-19 or other infections. Proper and timely treatment is important for reducing mortality rates.

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Thyrotoxicosis occurrence in SARS-CoV-2 infection: A case report

Cited by 3 publications

References 27 publications

Thyroid storm in a pregnant woman with COVID-19 infection: A case report and review of literatures

Thyroid storm in a pregnant woman with COVID-19 infection: A case report and review of literatures

Data Analysis and Systematic Scoping Review on the Pathogenesis and Modalities of Treatment of Thyroid Storm Complicated with Myocardial Involvement and Shock

Fatal Case of Possible Thyroid Crisis Induced by SARS-CoV-2 Infection: A Case Report

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