Endocrine Abstracts

Background: COVID-19 is the pandemic of the new millennium. COVID-19 patients with comorbidities including hypothyroidism could develop a life-threatening situation. We would like to introduce the clinical manifestations of hypothyroidism that can aggravate COVID-19.

Case Presentation: A 78-yo woman was admitted to Heratsi University hospital with general weakness and shortness of breath. She had a history of Hypertension and Paroxysmal atrial tachycardia. Examination revealed BMI=31.2kg/m², Ps=54bpm, BP=190/110mmHg, T=36.60C, SpO2 60 % (O2-),90% (O2+). An ECG showed sinus bradycardia, complete RBBB. An Echocardiography showed severely concentric hypertrophy. EF40-45%. Pericardial effusion without tamponade. SARS COV-2PCR test positive. Chest CT showed bilateral pneumonia with a typical viral etiology, lesions up to 40%, right hydrothorax, expressed hydropericardium. Deviated lab results: Red blood cells (1012/l) -3.58 (N 4.20-6.20), Hemoglobin (g/l)-96 (N 120-170), Leucocytes (109/l)-3.67 (N 4.0-10.0), ESR (mm/hr)-51 (N 2-15), Total protein (g/l)-61.7 (N 65-85), T. Cholesterol (mmol/l)-6.02 (N<5.2), CRP (mg/dL)-3.795 (N<0.5), LDH ( mmol/l)-399.5 (N 120-240), Prothrombin time (s)-16.2 (N 12-16), Fibrinogen (g/l) -4.67 (N 2-4), TSH (mlU/ml)-73.19 (N 0.27-4.2), FT4 (pg/ml)-0.946 (N 10-24), Anti-TPO (mm/ml)-386.5 (N<35).

Diagnosis: Autoimmune thyroiditis. Hypothyroidism, manifestation. Sars-cov-2.

Treatment given: Levothyroxine 12.5 mkg (2days), 25 mkg (3days), 37.5 mkg (7days), then 50 mkg, Ramipril, Furosemide, Hydrochlorothiazide, Amlodipine, Spironolactone, Heparin, Famotidine, Remdesivir, Infusion therapy. The patient improved on treatment.

Conclusion: Serous effusions have been thought to be not very frequent complications of hypothyroidism. In our case, pleural and pericardial effusions because of undiagnosed and untreated hypothyroidism caused desaturation and aggravated COVID-19.