Subacute Thyroiditis After Sars-COV-2 Infection

J Clin Endocrinol Metab. 2020 Jul 1;105(7):dgaa276. doi: 10.1210/clinem/dgaa276.

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: COVID-19; SARS-CoV-2; coronavirus; subacute thyroiditis; thyroid; virus.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Betacoronavirus / isolation & purification*
  • Betacoronavirus / pathogenicity
  • Clinical Laboratory Techniques / methods
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / virology
  • Female
  • Humans
  • Italy
  • Leukocyte Count
  • Oropharynx / virology
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / virology
  • Prednisone / therapeutic use*
  • Thyroid Gland / diagnostic imaging
  • Thyroiditis, Subacute / blood
  • Thyroiditis, Subacute / diagnosis*
  • Thyroiditis, Subacute / drug therapy
  • Thyroiditis, Subacute / virology
  • Thyroxine / blood
  • Treatment Outcome
  • Triiodothyronine / blood
  • Ultrasonography

Substances

  • Triiodothyronine
  • Thyroxine
  • Prednisone

Supplementary concepts

  • COVID-19
  • COVID-19 diagnostic testing
  • severe acute respiratory syndrome coronavirus 2