Endocrine Abstracts

A 65 year old female presented to ER with progressive massive lower limb oedema and dyspnea on mild exertion of insidious onset. The patient started to complain of progressive lower limb oedema shortly after her discharge from Hospital ICU in June 2020 where she was being treated for severe COVID-19. She presented then with acute kidney injury, generalized oedema and was diagnosed with COVID-19 based on clinical, laboratory criteria, PCR, and CT findings. She is a known patient with type 2 diabetes and hypertension since 20 years on premixed insulin, she was diagnosed with heart failure since 3 years for which she was receiving diuretics and she had a past history of recurrent cellulitis since 10 years. Family history was negative for thyroid illness. Following her post Covid-19 discharge she started to suffer of progressive lower limb oedema that was assumed to be exacerbation of her cardiac condition and consequently the diuretics therapy was titrated up to 500 mg Lasix daily, followed by metozolone 10 mg and spironolactone 100 mg twice with no response. Lower limb oedema extended to thighs, incapacitating the patient ability to move, skin started to be dry, scaly with oozing blisters. On examination she was obese BMI = 35 kg /m², orthopneic, her neck showed congested pulsating neck veins and no goiter, her Left UL and both lower limbs exhibited lymphoedema, her chest revealed moderate pleural effusion. Her laboratory profile showed renal impairment creatinine= 1.8 mg/dl on admission, normocytic normochromic anemia Hb=9 gm/dl, hypoalbuminemia = 3 gm/dl and hyperuricemia = 15 mg /dl.She underwent pleural tap that revealed exudative pleural effusion. Screening for thyroid functions showed a TSH of 33.5 mIU/l. Patient was instituted on escalating dose of levothyroxine starting with 25 mgm/dl followed by 50 mgm/dl and by the end of 10 days marked decrease of pleural effusion was noted and improvement of kidney functions creatinine = 1.3 mg/dl. To our knowledge this is the second case reporting myxedema complicating COVD-19 that hypothesized invasion of thyroid tissue via surface expressed ACE2 receptors.¹

Conclusion

COVID-19 had a short and long term extrapulmonary effects. Thyroid state should not be overlooked in the assessment of post and long COVID states.

Reference

1. Neal M Dixit et al Sudden Cardiac Arrest in a Patient With Myxedema Coma and COVID-19, Journal of the Endocrine Society, Volume 4, Issue 10, October 2020, bvaa130, https://doi.org/10.1210/jendso/bvaa130