Endocrine Abstracts

Introduction & Background

A COVID-19 pandemic smashed the world not only by it`s severity, but also by the tremendous amount of comorbidities, many of them having autoimmune basis. Thyrotoxicosis as one of the above - could result either from SARS-CoV-2 directly infecting the thyroid gland, as described in other viral infections, or can develop due to immune overactivation during the severe viral load. Subacute thyroiditis (SAT) is a self-limiting inflammatory disease of viral or post-viral origin, characterized by general symptoms, neck pain and thyroid dysfunction, lasting for a period of weeks or months— followed by hypothyroidism with subsequent restoration of euthyroidism. The pathogenesis of SAT started after SARS-Cov-2 infection is thought to be similar to the association with the other viral conditions.

Aim

In our study we aimed to analyze the variety of clinical, laboratory and ultrasonic data in the observed cases of subacute thyroiditis associated with SARS-Cov-2 infection.

Materials and methods

We have analyzed 8 cases of late-onset subacute thyroiditis in 6 Belarusian female and two male patients. All our patients have had a history of mild to severe SARS-Cov-2 infection, that required admission to the clinic. In a short period (from 2 to 7 weeks) after the discharge from the hospital they returned to an out-patient department with complaints for a tachycardia and a pain on the frontal area of the neck.

Discussion

The pathogenesis of subacute thyroiditis emerging in a short time after SARS-Cov-2 infection is thought to be similar to the association with the other viral-induced thyroid conditions. The viral etiology is supported by the onset of SAT after an upper respiratory infection and its occurrence during viral outbreaks. In our observed cases – only two of the females (2/6) had the diagnosis of autoimmune thyroiditis before the pandemic period, in other cases – ultrasound features of autoimmune thyroiditis and slightly decreased fT4 and fT3 levels were revealed during the exams.

Conclusion

An analysis of more cases is definitely needed to answer the question “Does antecedent autoimmune thyroiditis lead to a higher risk of SARS-Cov-2-associated subacute thyroiditis?” Current recommendation remains as a proposal of more thorough observation of thyroid out-patients with all forms of autoimmune disorders in case of reported SARS-Cov-2 reconvalescence.