Subacute Thyroiditis After Sars-COV-2 Infection

Alessandro Brancatella

Debora Ricci

Nicola Viola

Daniele Sgrò

Ferruccio Santini

Francesco Latrofa

Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy

Correspondence and Reprint Requests: Francesco Latrofa, MD, Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56127, Italy. E-mail: ti.ipinu@afortal.ocsecnarf.

Received 2020 Apr 15; Accepted 2020 May 13.

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Abstract

Context

Subacute thyroiditis (SAT) is a thyroid disease of viral or postviral origin. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that began in Wuhan, China, has spread rapidly worldwide and Italy has been severely affected by this outbreak.

Objectives

The objective of this work is to report the first case of SAT related to SARS-CoV-2 infection.

Methods

We describe the clinical, laboratory, and imaging features of an 18-year-old woman who came to our attention for fever, neck pain radiated to the jaw, and palpitations occurring 15 days after a SARS-CoV-2–positive oropharyngeal swab. Coronavirus disease 2019 (COVID-19) had been mild and the patient had completely recovered in a few days.

Results

At physical examination the patient presented with a slightly increased heart rate and a painful and enlarged thyroid on palpation. At laboratory exams free thyroxine and free triiodothyronine were high, thyrotropin undetectable, and inflammatory markers and white blood cell count elevated. Bilateral and diffuse hypoechoic areas were detected at neck ultrasound. One month earlier, thyroid function and imaging both were normal. We diagnosed SAT and the patient started prednisone. Neck pain and fever recovered within 2 days and the remaining symptoms within 1 week. Thyroid function and inflammatory markers normalized in 40 days.

Conclusions

We report the first case of SAT after a SARS-CoV-2 infection. We alert clinicians to additional and unreported clinical manifestations associated with COVID-19.

Keywords: subacute thyroiditis, coronavirus, COVID-19, SARS-CoV-2, thyroid, virus

Subacute thyroiditis (SAT) is a self-limited inflammatory thyroid disease characterized by neck pain, general symptoms, and thyroid dysfunction (1, 2). SAT is usually preceded by an upper respiratory tract infection. Direct and indirect evidence support a viral or postviral origin of this disease, and many viruses have been reported as potentially causative agents (3).

Since January 2020, coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in an emerging respiratory infection with a pandemical diffusion (4). Here, we report the first case of SAT in a patient affected by SARS-CoV-2.

Glossary

Abbreviations

COVID-19	coronavirus disease 2019
CRP	C-reactive protein
ESR	erythrocyte sedimentation rate
FT3	free triiodothyronine
FT4	free thyroxine
HLA	human leukocyte antigen
SARS-CoV-2	severe acute respiratory syndrome coronavirus 2
SAT	subacute thyroiditis
Tg	thyroglobulin
TgAb	thyroglobulin antibodies
TPOAb	thyroperoxidase antibodies
TSH	thyrotropin

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