Endocrine Abstracts

Context

Thyroiditis is defined as an inflammation of the thyroid gland. There are several kinds of thyroiditis, and they can be associated with either increased, decreased, or normal thyroid function (triphasic-course). Subacute granulomatous thyroiditis, also known as subacute thyroiditis (SAT), giant-cell thyroiditis, or de Quervain thyroiditis, is a self-limited thyroiditis characterized by neck pain and thyroid dysfunction. Generally, it is preceded by an upper respiratory tract infection, which supports the viral or postviral origin (parotitis, Coxsackie, Influenza, adenovirus and echovirus). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that began in Wuhan, China, has spread rapidly worldwide and is triggering more cases of thyroid disease. Routine assessment of thyroid function during hospitalization for COVID-19 is not recommended by the clinical management guidelines. However, worsening of pre-existing thyroid dysfunction (i.e. differentiated thyroid cancer [DTC], Hashimoto thyroiditis [HT]) or de novo (SAT), possibly caused by infection itself, should not be missed, to avoid misleading work-up, unnecessary medicalization, and its potential negative prognostic impact.

Objectives

The aim of this case is to report a SAT related to the triggering factor for SARS-CoV-2 infection and associated with a cerebral venous thrombosis (CVT).

Methods

A 49-year-old woman who, in the context of a SARS-CoV-2 pandemic, was referred to the Emergency-Department for fever, neck pain radiated to the jaw, palpitations and sinus tachycardia (110 bpm) without structural heart disease, intense headache, predominantly occipital and right temporal, associated with nausea, vomiting and visual disturbances, occurring 7 days after a SARS-CoV-2-positive oropharyngeal swab.

Results

A CT-scan was performed, which revealed a hyperdense image of the superior longitudinal sinus which, after intravenous administration of contrast, presented a filling defect in its interior, suspecting CVT. MRI and MRA confirmed the absence of flow in the right transverse and longitudinal sinus. A congenital thrombophilia study was conducted. The G20210A mutation of the prothrombin gene was evidenced in heterozygosity (A/G). Thyroid-function-tests: TSH <0.005 µIU/dl, FT4 8.7 ng/dl, TPOAb 0.84 IU/ml and TSHrAb <1 IU/l. CRP 33 mg/l and ESR 52 mm. Hemogram: lymphocytic leukocytosis. Thyroid-ultrasound: hypertrophic, heterogeneous gland (multiple diffuse hypoechoic areas), without significant vascularization. The patient had no history of thyroid disease.

Conclusions

We reported a case with a clinical suspicion of SAT associated CVT potentially related to SARS-CoV-2 infection as a triggering factor (underlying hypercoagulability-state) in presence with other acquired or hereditary prothrombotic factors. Physicians should be aware of possible connections between SARS-CoV-2 with thyroid and neurologic disfunctions or additional clinical manifestations, which should be investigated by prospective studies.