Endocrine Abstracts

Objective

Subacute thyroiditis (SAT) was first described by Fritz De Quervain in 1904 and is generally a self-limiting disease causing pain, fever and temporary hyperthyroidism. It generally develops as a result of postviral inflammatory response following viral upper respiratory tract infections, and it has increased since the covid-19 pandemic in March 2020. We aim to present 2 SAT cases associated with COVID-19.

Case Summary

We present 2 SAT patients associated with COVID-19 who are health workers.

Case-1

A 54-years old female patient was admitted to hospital with sore throat and fever in July 2020. Laboratory values were TSH:0.08 uIU/ml (low), freeT4:1.21 ng/dl (in normal range), freeT3:3.4 pg/ml (in normal range) and erythrocyte sedimentation rate (ESR):41 mm/h, c-reactive protein (CRP):5.76 mg/l.

Case-2

A 52-years old female patient was admitted to hospital with sore throat, fever and fatigue in August 2020. She was euthyroid but ESR:85 mm/h and CRP:74.81 mg/l. For both cases, there is no history of trauma, contrast agent exposure and infection in another part of the body. They did not have any comorbidities. Thyroid autoantibody levels were negative and ESR and CRP levels were very high. Ultrasonographic evaluation revealed decreased echogenicity and focal thyroiditis, no nodule was detected. Both of the patients stated that they had a mild upper respiratory tract infection a few months ago but didn’t have a PCR test because they didn’t have severe symptoms but laboratory values measured for COVID-19 antibodies were very high. Both of them didn’t benefit from the nonsteroid antiinflammatory drugs, but improved with methylprednisolon. After 8 weeks, patients recovered without any symptom.

Conclusions

The COVID-19 pandemic was declared by the WHO in March 2020, thus healthcare professionals focused on COVID-19 patients who presents with respiratory symptoms, but over time, the multisystem effects began to be noticed. As clinicians, it was noticed that the number of patients with SAT increased during the pandemic period. Just few studies and case reports are known. In some patients genetic disposition such as HLA-B35 is recorded. Severe SAT can be observed even after asymptomatic COVID-19 disease as in our cases. Although these sypmtoms can be confused with COVID-19, it should be kept in mind that they may be associated with postcovid SAT.

Key Words

Subacute thyroiditis, COVID-19, Viral infection