Subacute Thyroiditis Exacerbated by the COVID-19 Pandemic

Abstract

Objective: It was aimed to evaluate the etiological relationship between the SARS-CoV-2 virus and subacute thyroiditis (SAT). We also wanted to point out the fact that these two entities may have similar clinical features.

Materials and Methods: During the 4th month of the Coronavirus disease-19 (COVID-19) pandemic in our country; five patients were referred to our clinic for neck ultrasonography (USG) with a suspected diagnosis of SAT based on clinical and laboratory features. Past medical history, contact history, and COVID-19 Polyerase Chain Reaction (PCR) test results of these cases were evaluated.

Results: Subfebrile fever, sore throat, burning sensation in the throat, difficulty in swallowing were the presenting symptoms of the patients. All cases had abnormal thyroid hormone values and elevated erythrocyte sedimentation rate/C-Reactive Protein (CRP) values. USG showed increased thyroid gland volume in four patients. Hypovascularized heterogeneous hypoechoic patchy areas in thyroid parenchyma were observed in all patients without discrete nodules. Ultrasound elastography revealed parenchymal heterogeneity and stiffness. Low-dose non-contrast chest computerized tomography (CT) findings was normal with negative Polymerase chain reaction (PCR) test results in patients.

Conclusion: Subacute thyroiditis, which is often accused by viral agents in etiology, may also be associated with SARS-CoV-2. The similarity of clinical and laboratory findings between subacute thyroiditis and COVID-19 infection may pose diagnostic challenges.

Keywords

• Subacute thyroiditis
• De Quervain's thyroiditis
• COVID-19
• SARS-CoV-2
• elastography

COVID-19 Pandemisiyle Artış Gösteren Subakut Tiroidit

Öz

Amaç: Bu çalışmada SARS-CoV-2 virüsü ile subakut tiroidit (SAT) arasındaki etiyolojik ilişkiyi değerlendirmek ve bu iki antitenin benzer klinik özelliklere sahip olabileceğine dikkat çekmek amaçlandı.

Materyal ve Metot: Ülkemizde Coronavirus disease-19 (COVID-19) salgınının 4. ayında; klinik ve laboratuvar özelliklerine göre SAT şüphesi olan 5 hasta boyun ultrasonografi (USG) için kliniğimize sevk edildi. Bu olguların geçmiş tıbbi öyküsü, temas öyküsü ve COVID-19 Polimeraz Zincir Reaksiyonu (PCR) test sonuçları değerlendirildi.

Bulgular: Subfebril ateş, boğaz ağrısı, boğazda yanma hissi, yutma güçlüğü hastaların başvuru semptomlarıydı. Tüm olgularda anormal tiroid hormon değerleri ve yüksek eritrosit sedimantasyon hızı/C-reaktif proteini (CRP) değerleri vardı. USG'de dört hastada tiroid bezi hacmi artmıştı. Belirgin demarkasyon nodülü saptanmayan tüm hastalarda tiroid parankiminde hipovaskülarize heterojen hipoekoik düzensiz alanlar gözlendi. Ultrason elastografisinde parankimal heterojenite ve sertlik saptandı. PCR testi negatif olan olguların düşük doz kontrastsız toraks bilgisayarlı tomografi bulguları (BT) normaldi.

Sonuç: Etiyolojisinde viral ajanlar sıklıkla suçlanan subakut tiroidit SARS-CoV-2 ile de ilişkili olabilir. Subakut tiroidit ve COVID-19 enfeksiyonu arasındaki klinik ve laboratuvar bulgularının benzerliği tanısal zorluklar yaratabilir.

Anahtar Kelimeler

• Subakut tiroidit
• De Quervain tiroiditi
• COVID-19
• SARS-CoV-2
• elastografi

References

1. Yasuji I. Subacute thyroiditis in a patient with juvenile idiopathic arthritis undergoing etanercept treatment: a case report and review of the literature. Mod Rheumatol. 2013;23(2):397-400. doi:10.1007/s10165-012-0670-5
2. Fatourechi V, Aniszewski JP, Fatourechi GZ, Atkinson EJ, Jacobsen SJ. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study. J Clin Endocrinol Metab. 2003;88(5):2100-2105. doi:10.1210/jc.2002-021799
3. Martino E, Buratti L, Bartalena L, et al. High prevalence of subacute thyroiditis during summer season in Italy. J Endocrinol Invest. 1987;10:321-323. doi:10.1007/BF03348138
4. Xie P, Xiao Y, Liu F. Real-time ultrasound elastography in the diagnosis and differential diagnosis of subacute thyroiditis. J Clin Ultrasound. 2011;39(8):435-440. doi:10.1002/jcu.20850
5. Langer JE, Khan A, Nisenbaum HL, et al. Sonographic appearance of focal thyroiditis. AJR Am J Roentgenol. 2001;176(3):751-754. doi:10.2214/ajr.176.3.1760751
6. Bennedbaek FN, Hegedüs L. The value of ultrasonography in the diagnosis and follow-up of subacute thyroiditis. Thyroid. 1997;7(1):45-50. doi:10.1089/thy.1997.7.45
7. Cappelli C, Pirola I, Gandossi E, Formenti AM, Agosti B, Castellano M. Ultrasound findings of subacute thyroiditis: A single institution retrospective review. Acta Radiol. 2014;55(4):429-433. doi:10.1177/0284185113498721
8. Liu J, Zhang Y, Ji Y, Wan Q, Dun G. The value of shear wave elastography in diffuse thyroid disease. Clin Imaging. 2018;49:187-192. doi:10.1016/j.clinimag.2018.03.019

9. Nishihara E, Ohye H, Amino N, et al. Clinical characteristics of 852 patients with subacute thyroiditis before treatment. Intern Med. 2008;47(8):725-729. doi:10.2169/internalmedicine.47.0740
10. Khatri A, Charlap E, Kim A. Subacute Thyroiditis from COVID-19 Infection: A Case Report and Review of Literature. Eur Thyroid J. 2021;9(6):324-328. doi:10.1159/000511872
11. Aemaz Ur Rehman M, Farooq H, Ali MM, Ebaad Ur Rehman M, Dar QA, Hussain A. The Association of Subacute Thyroiditis with COVID-19: a Systematic Review. SN Compr Clin Med. 2021. doi:10.1007/s42399-021-00912-5
12. Trimboli P, Camponovo C, Franscella S, Bernasconi E, Buetti N. Subacute Thyroiditis during the COVID-19 Pandemic: Searching for a Clinical Association with SARS-CoV-2. Int J Endocrinol. 2021. doi:10.1155/2021/5588592
13. Ruggeri RM, Campennì A, Siracusa M, Frazzetto G, Gullo D. Subacute thyroiditis in a patient infected with SARS-COV-2: an endocrine complication linked to the COVID-19 pandemic. Hormones (Athens). 2021;20(1):219-221. doi:10.1007/s42000-020-00230-w
14. Kartal Baykan E, Çarlıoğlu A. Subacute Thyroiditis Secondary to SARS-COV-2 Infection; Case Studies From Turkey. Turk J Endocrinol Metab. 2021;25:232-237. doi:10.25179/tjem.2020-80585
15. Şeker S, Taş İ. Determination of thyroid volume and its relation with isthmus thickness. Eur J Gen Med. 2010;7(2):125-129 doi:10.29333/ejgm/82838
16. Jin YH, Cai L, Cheng ZS, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res. 2020;7(4):1-23. doi:10.1186/s40779-020-0233-6
17. Li LQ, Huang T, Wang YQ, et al. COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020;92(6):577-583. doi:10.1002/jmv.25757
18. Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the clinical characteristics of Coronavirus Disease 2019 (COVID-19). J Gen Intern Med. 2020;35:1545-1549. doi:10.1007/s11606-020-05762-w
19. Alfadda AA, Sallam RM, Elawad GE, Aldhukair H, Alyahya MM. Subacute thyroiditis: Clinical presentation and long term outcome. Int J Endocrinol. 2014;2014:1-7. doi:10.1155/2014/794943
20. Ippolito S, Dentali F, Tanda ML. SARS-CoV-2: A potential trigger for subacute thyroiditis? Insights from a case report. J Endocrinol Invest. 2020;43:1171-1172. doi:10.1007/s40618-020-01312-7
21. Brancatella A, Ricci D, Viola N, et al. Subacute thyroiditis after Sars-COV-2 Infection. J Clin Endocrinol Metab. 2020;105(7):1-4. doi:10.1210/clinem/dgaa276
22. Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing in Coronavirus Disease 2019 (COVID-19) in China: A report of 1014 Cases. Radiology. 2020;296:E32-E40. doi:10.1148/radiol.2020200642
23. Fang Y, Zhang H, Xie J, et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology. 2020;296:E115-E117. doi:10.1148/radiol.2020200432
24. Xu X, Yu C, Qu J, et al. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2. Eur J Nucl Med Mol Imaging. 2020;47:1275-1280. doi:10.1007/s00259-020-04735-9
25. Liu J, Yu H, Zhang S. The indispensable role of chest CT in the detection of coronavirus disease 2019 (COVID-19). Eur J Nucl Med Mol Imaging. 2020;47:1638-169. doi:10.1007/s00259-020-04795-x
26. Bai Y, Yao L, Wei T, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020;323(14):1406-1407. doi:10.1001/jama.2020.2565
27. Siordia JA Jr. Epidemiology and clinical features of COVID-19: A review of current literature. J Clin Virol. 2020;127:104357. doi:10.1016/j.jcv.2020.104357
28. Desailloud R, Hober D. Viruses and thyroiditis: an update. Virol J. 2009;6(5):1-14. doi:10.1186/1743-422X-6-5
29. Wei L, Sun S, Xu CH, et al. Pathology of the thyroid in severe acute respiratory syndrome. Hum Pathol. 2007;38(1):95-102. doi:10.1016/j.humpath.2006.06.011
30. Franquemont S, Galvez J. Subacute Thyroiditis After mRNA Vaccine for Covid-19, J Endocr Soc. 2021;5:A956–A957. doi:10.1210/jendso/bvab048.1954