Endocrine Abstracts

Introduction

Recently, there has been an increasing number of reports about subacute thyroiditis (SAT) developing after COVID-19. SAT and transient gestational thyrotoxicosis constitute the majority of emerging thyrotoxicosis during pregnancy.

Case report

A 27-year-old, 34-week pregnant women complained of pain in a very small area on the anterior side of her neck and fatigue. Thyroid function tests performed four months ago were found to be in the normal range. A nasopharyngeal swab test for SARS-CoV-2 was negative but both IgM and IgG against SARS-CoV-2 were positive. On physical examination of the patient, there was no symptoms other than pain in the neck, and bilateral thyroid gland was large with tenderness. Thyroid function was assessed, showing suppressed TSH (0.1 mIU/ml, normal range 0.27–4.2), normal free thyroxine (fT4 – 1.6 ng/dl, normal range 0.93–1.7), and elevated free triiodothyronine (fT3 – 4.96 pg/ml, normal range 2.0–4.4), anti-thyroid peroxidase (anti-TPO) were negative (12.24 IU/ml, normal range <34.0), thyroid receptor antibody (TRAb) and thyroglobulin antibodies (anti-TG) were also positive (TRAb -5.78 IU/ml, normal range <1.75, anti-TG – 200 IU/ml, normal range < 138). C-reactive protein (CRP) were increased (10.49 mg/l, normal range <10.0), and D-dimer were normal (310 ngFEO/ml, normal range < 800.0). In the blood sample were increased white blood cells (WBC) – 9.8 *10⁹ (normal range 4.0–9.0), red blood cells (RBC)- 4.95 *10¹² (normal range 3.7–4.7), erythrocyte sedimentation rate (ESR)- 46 mm/h (normal range <20.0). In the thyroid gland ultrasound both lobes were large and parenchymal blood flow was not increased. There was a distinct view of SAT. Paracetamol (daily dose – 1500 mg) was started because of the thyroid’s pain. The subject’s pain was significantly decreased 5 days later. Clinical and laboratory findings in pregnant woman was compatible with SAT. During 2 weeks pain and tenderness in the thyroid lodge was completely relieved. After repeated laboratory tests were normal levels and patient didn’t experience any problem during pregnancy and when she was 38 weeks pregnant delivered a healthy girl who weighs 3560 g.

Conclusion

This case report demonstrates a new trigger of subacute thyroiditis in pregnant women due to COVID-19. When determining the differential diagnosis of gestational thyrotoxicosis, subacute thyroiditis should also be considered and detailed history and physical examination of the thyroid gland should not be neglected during pregnancy.