COVID-19-related thyroiditis: A novel disease entity?

The literature on COVID-19-related thyroid complications has accumulated over the past year or so as the pandemic has accelerated throughout the world. In particular, several recent case reports have been published describing a possible correlation between COVID-19 disease and subacute thyroiditis (SAT). In this review, we briefly present one of our own patients and review the current published literature in this area up to January 2021, including analyses of major series of thyroid function tests in patients with significant COVID-19 infection. We conclude that while the great majority of patients with severe COVID-19 infection may show manifestations of the sick euthyroid syndrome, clinicians should be aware of the possibility of SAT, especially in the early weeks and months following even mild COVID-19 infection.

Subacute thyroiditis as a presenting manifestation of COVID-19: a report of an exceedingly rare clinical entity.

The SARS-CoV-2 has wreaked havoc globally and has claimed innumerable lives all over the world. The symptoms of this disease may range from mild influenza-like symptoms to severe acute respiratory distress syndrome with high morbidity and mortality. With improved diagnostic techniques and better disease understanding, an increased number of cases are being reported with extrapulmonary manifestations of this disease ranging from renal and gastrointestinal to cardiac, hepatic, neurological and haematological dysfunction. Subacute thyroiditis is a self-limiting and painful thyroid gland inflammation most often secondary to viral infections. We report a case of subacute thyroiditis in a 58-year-old gentleman presenting with a painful swelling in the neck who was subsequently detected to be positive for SARS-CoV-2. We seek to highlight the broad clinical spectrum of the COVID-19 by reporting probably the first case of subacute thyroiditis possibly induced by SARS-CoV-2 infection from India.

Subacute thyroiditis associated with COVID-19.

We report a case of a hospitalised patient with COVID-19 who developed subacute thyroiditis in association with SARS-COV-2 infection. The patient presented with tachycardia, anterior neck pain and thyroid function tests revealing hyperthyroidism together with consistent ultrasonographic evidence suggesting subacute thyroiditis. Treatment with corticosteroids resulted in rapid clinical resolution. This case illustrates that subacute thyroiditis associated with viruses such as SARS-CoV-2 should be recognised as a complication of COVID-19 and considered as a differential diagnosis when infected patients present with tachycardia without evidence of progression of COVID-19 illness.

Subacute Thyroiditis After Sars-COV-2 Infection.

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.

Dengue Fever Presenting Atypically with Viral Conjunctivitis and Subacute Thyroiditis.

The majority of dengue viral infections are asymptomatic, though symptoms may range from self-limiting febrile illness to life threatening hemorrhagic manifestations. As the burden of disease is dramatically rising in recent years, more patients with atypical presentations and rare complications are increasingly reported. Dengue virus may rarely involve different organ systems including CNS, liver, and heart. However, involvement of eye and thyroid is extremely rare. We present a case of 32-year old patient who presented with conjunctivitis and subacute thyroiditis and was found to have dengue viral infection as the cause of these conditions.

Subacute thyroiditis (de Quervain's) due to influenza A: presenting as fever of unknown origin (FUO).

Subacute (de Quervain's) thyroiditis is a rare but important cause of fever of unknown origin. Most cases of subacute thyroiditis are caused by a variety of viruses, for example, Coxsackie, cytomegalovirus, Epstein-Barr virus, and adenovirus. Influenza immunization or infection may cause subacute thyroiditis. We present the first reported case of a fever of unknown origin due to seasonal influenza A in a 67-year-old woman.

de Quervain thyroiditis in a young boy following hand-foot-mouth disease.

de Quervain thyroiditis, also known as subacute thyroiditis, is a self-limited inflammatory disease of the thyroid gland. It is extremely rare in children. The hallmarks for diagnosis are painful thyroid enlargement, elevated inflammatory markers, and decreased uptake of the thyroid gland on thyroid scintigraphy. Viral infection has been proposed to be associated with de Quervain thyroiditis. Coxsackie virus has been reported to be one of the viruses associated with the disease. To our knowledge, childhood de Quervain thyroiditis associated with hand-foot-mouth disease caused by coxsackie infection has never been reported. We report a 2.7-year-old boy who presented with typical features of de Quervain thyroiditis following hand-foot-mouth disease caused by coxsackie B4 infection. He had a brief thyrotoxic phase initially, followed by transient hypothyroid phase and euthyroidism thereafter. His thyroid scintigraphy showed a typical faint uptake at the diagnosis, and an improvement of the thyroid scan and uptake was shown 8 weeks later. He was treated with prednisolone and nearly complete resolution was documented within 2 months. Careful evaluation of the patient led to the correct diagnosis and appropriate management.

Subacute thyroiditis in the course of novel H1N1 influenza infection.

To describe the first documented case of subacute (De Quervain) thyroiditis in the course of novel H1N1 influenza infection. This is a case report of a patient diagnosed at the General Hospital "G. Hatzikosta" of Ioannina, Greece. A 55-year-old previously healthy male developed an influenza-like syndrome that was accompanied by severe neck pain, palpitations, weight loss, and disproportionately increased erythrocyte sedimentation rate. Polymerase chain reaction assay of pharyngeal swabs confirmed the diagnosis of novel H1N1 influenza infection. Serum thyroid-stimulating hormone was suppressed to zero and levels of free thyroxine and particularly triiodothyronine were increased. Technetium-99m-pertechnetate scintigraphy showed diffuse and inhomogeneous very low technetium trapping. The patient was treated with non-steroidal anti-inflammatory drugs and thyroid function gradually normalized without evolving to a hypothyroid phase. This is the first case of subacute thyroiditis associated with novel H1N1 influenza infection. Furthermore, this is the first case to definitely demonstrate active influenza infection of any type concurrent with thyroiditis, and one of the very rare similar cases for any active viral disease etiologically implicated in the pathogenesis of subacute thyroiditis.

Surgery versus pharmacotherapy of benign thyroid diseases.

Surgical management of benign thyroid diseases (BTDs) has been a topic of interest and confusion for many years. Almost 80% of thyroidectomies at an average endocrine surgical unit are carried out for BTDs. Resistance to surgical intervention in BTDs has been based on the belief that increased complication rate is inherent in its use, this is despite the potential advantages in terms of confirming the benign nature of the lesion, controlling the disease, and relieving local symptoms of large neck mass. Benign thyroid diseases are more likely to occur in middle-aged women living in iodine deficient areas, or have a family history of goiter, or in patients taking iodine-containing drugs, like amoidarone, or in patients with previous history of x-ray exposure. However, the physician must be careful in making the diagnosis of BTDs in patients at the extremes of age or in the presence of positive history of radiation, or in patients with family history of thyroid or colon cancer. In this article we will review the etiology, epidemiology, diagnostic methodologies and the recent trends in the surgical and medical management of BTDs.

Familial occurrence of subacute thyroiditis.

Although subacute thyroiditis (de Quervain's thyroiditis) is presumed to be caused by a viral infection, only 2 familial occurrences of subacute thyroiditis have been reported in the literature. Typical and severe subacute thyroiditis was diagnosed in an older sister who was hospitalized for 8 days. During this period her younger sister nursed her. Three weeks after, the same clinical picture occurred in the younger sister. We postulate that subacute thyroiditis might occur by transmission of possible viral infection in genetically predisposed individuals.

Atypical subacute thyroiditis: preliminary observations.

Nine patients with painless or minimally painful subacute thyroiditis were seen between late June and October 2000. Six had a history of antecedant viral symptoms. Thyroid peroxidase antibodies were negative in eight patients tested; none had a family history of autoimmune thyroid disease. It is possible that these patients represent examples of postviral painless subacute thyroiditis (atypical subacute thyroiditis). In order to establish the nature of the syndrome, cytological examination, HLA typing, and long-term follow-up are necessary.

Historical perspective of foamy virus epidemiology and infection.

Foamy viruses (FV) are complex retroviruses which are widespread in many species. Despite being discovered over 40 years ago, FV are among the least well characterized retroviruses. The replication of these viruses is different in many interesting respects from that of all other retroviruses. Infection of natural hosts by FV leads to a lifelong persistent infection, without any evidence of pathology. A large number of studies have looked at the prevalence of primate foamy viruses in the human population. Many of these studies have suggested that FV infections are prevalent in some human populations and are associated with specific diseases. More recent data, using more rigorous criteria for the presence of viruses, have not confirmed these studies. Thus, while FV are ubiquitous in all nonhuman primates, they are only acquired as rare zoonotic infections in humans. In this communication, we briefly discuss the current status of FV research and review the history of FV epidemiology, as well as the lack of pathogenicity in natural, experimental, and zoonotic infections.