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

Kaynakça

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