Subacute thyroiditis linked to SARS-COV-2 infection

Purpose

Subacute thyroiditis (SAT) refers to post-viral inflammation of the thyroid. SAT is typically characterised by an episode of thyrotoxicosis, followed by a period of hypothyroidism and ultimately return to euthyroidism. There are emerging case reports describing SAT post-SARS-CoV-2 infection.^1,2,3,4  This is an evolving area of interest as the pandemic continues to unravel and an understanding of the sequelae of infection with SARS-CoV-2 comes to light.

Methods

Case presentation of a 34-year-old female who presented with grossly diffuse neck swelling and deranged thyroid function tests following confirmed infection with SARS-CoV-2. Coronavirus disease (COVID-19) symptoms included fever, cough, widespread myalgia, shortness of breath on exertion and heavy central chest pain with left sided pleuritic chest pain. Symptoms were conservatively managed with no specific treatment and her recovery is still ongoing 5 months post infection. She was not hospitalised.

Results

Thirty-two days following the onset of upper respiratory symptoms, the patient developed profound neck swelling and tenderness with symptoms of upper airway obstruction when lying supine. At this time, the patient was self-isolating in a remote location, and therefore no physical examination was performed.

The patient reported weight loss, fatigue and cervical tenderness with a diffuse and tender goitre. Biochemical evaluation a week following symptom onset showed suppressed TSH (0.44mIU/L, Ref 0.5-4.0).

Thyroid ultrasound performed 6 weeks after symptom onset revealed a multinodular goitre with right lobe measuring 13cc and the left lobe 7cc. Multiple spongiform nodules were present in the right lobe but were not reported as suspicious. No more formal investigations were performed, and symptoms were conservatively managed with ongoing monitoring. Around this time serological testing for SARS-CoV-2 confirmed recent infection with significant IgG antibodies present (80AU/ml). 8 weeks after the onset of symptoms, biochemical thyroid function had returned to baseline and thyroid antibodies were not significant. Although the cervical tenderness had subsided, her goitre remains. To date she is still experiencing symptoms of fatigue and breathlessness, most likely due to a post viral syndrome

Conclusion

Here we report a case of subacute thyroiditis post-infection with SARS-CoV-2. Clinicians should be aware of the thyroid manifestations potentially associated with COVID-19.

References

1. Brancatella, A., Ricci, D., Viola, N., Sgrò, D., Santini, F., Latrofa, F. (2020). Subacute thyroiditis after SARS-CoV-2infection. The Journal of Clinical Endocrinology &Metabolism, 105(7), dgaa276.
2. Mattar, S. A. M., Koh, S. J. Q., Chandran, S. R., & Cherng,B. P. Z. (2020). Subacute thyroiditis associated withCOVID-19. BMJ Case Reports CP, 13(8), e237336
3. Muller, I., Cannavaro, D., Dazzi, D., Covelli, D., Mantovani,G., Muscatello, A., & Cuzzocrea, M. (2020). SARS-CoV-2-related atypical thyroiditis. The Lancet Diabetes &Endocrinology, 8(9), 739-741
4. Ruggeri, R. M., Campennì, A., Siracusa, M., Frazzetto, G.,& Gullo, D. (2020). Subacute thyroiditis in a patient infectedwith SARS-COV-2: an endocrine complication linked to theCOVID-19 pandemic. Hormones, 1-3.