Endocrine Abstracts

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that caused a global pandemic in 2020. The virus has infected more than 100 million people worldwide and the pandemic is still spreading. It can affect practically all organs. Data on the impact of SARSCoV-2 on the thyroid gland are very scarce. Two patients with Graves’ disease (GD) and COVID-19 have been recently published(1). We present a case GD occurring after SARS-CoV-2 infection.

Methods

We describe the clinical findings, thyroid function tests, and neck ultrasound of a patient presenting with thyrotoxicosis signs.

Results

A 38-year-old, Tunisian female, having a medical history of autoimmune diseases, had been hospitalized on september, 2020, at COVID-19 department (a naso-pharyngeal swab test for SARS-CoV-2 was positive, and chest high resolution computed tomography without iodinated contrast agents) showed bilateral ground glass areas typical of SARS-CoV-2-related interstitial pneumonia. Due to persisting asthenia and onset of tremor and palpitations, thyroid function was assessed on November, 2020, showing suppressed serum TSH (<0.01 mU/ml) with increased serum-free thyroxine (FT4 31.6 pmol/l). Physical examination revealed a non-tender goiter. TSH receptor antibodies were positive (14.1 IU/l). Therapy with corticosteroid and propranolol was started with improvement of symptoms and thyroid function. Anti-thyroid drugs were not started because the patient has leukopenia contraindicating this treatment. Clinical presentation and positive TSH receptor antibodies are compatible with a diagnosis of GD (autoimmune hyperthyroidism). Our cases of hyperthyroidism were diagnosed 2 months after the clinical onset of COVID-19.

Conclusion

In conclusion, we report a case of Graves’ disease after COVID-19, with no previous known thyroid disease. Of course, with Graves’ disease being the most frequent cause of hyperthyroidism, especially in middle-aged women, the association might be casual. However, the increasing number of publications on autoimmune diseases related to COVID-19 suggests that SARS-CoV-2 could act as a trigger of latent or new-onset autoimmunity. Physicians working in COVID-19 departments should be aware of possible connections between SARSCoV-2 and thyroid dysfunction, both subacute thyroiditis and Graves’ disease, which should be investigated by future prospective studies.

1. Mateu-Salat M, Urgell E, Chico A. SARS-COV-2 as a trigger for autoimmune disease: report of two cases of Graves’ disease after COVID-19. J Endocrinol Invest [Internet]. oct 2020 [cité 30 janv 2021];43(10):1527‑8. Disponible sur: http://link.springer.com/10.1007/s40618-020-01366-7