Endocrine Abstracts

Subacute thyroiditis (SAT) is a relatively uncommon and self-limited cause of thyrotoxicosis of viral or post-viral origin. During the COVID-19 pandemic a thyroid impact was also considered due to the potential of SARS-CoV-2 virus to cause multiorgan effects. Several SAT cases associated with SARS-CoV-2 infection or vaccination were recently reported in the literature. We present the case of a 52-year-old female who presented with neck pain, fever, asthenia, and malaise for approx. 2 weeks. On examination she had a moderately asymmetrically enlarged and tender thyroid gland, and was tachycardic, with no respiratory symptoms. From her medical history we retain no SARS-COV2 vaccine or any form of upper respiratory airways infection recently. A prior endocrinology evaluation in 2020 revealed thyroid cysts of max 12mm and a normal thyroid function. Currently she had mildly high serum free T4 and suppressed serum TSH, high ESR of 111 mm/h, mild leukocytosis with neutrophilia. Liver function tests were also abnormal-elevated ALT (138 IU/l), mildly elevated GGT and alkaline phosphatase. The patient did not have any history of liver disease or alcoholic intake. On ultrasonography, the thyroid appeared enlarged with bilateral hypoechogenic areas that had reduced vascularization on Color Doppler. The liver appeared normal on ultrasound. Thoracic X-Ray was also normal. One week prior to presentation the patient had two nasopharyngeal swabs SARS-CoV-2 RT-PCR tests, both negative. However, at SAT diagnosis SARS-CoV-2 IgG antibodies were positive. Other viral serologies that can affect hepatic function were negative, including: anti CMV, anti-Epstein-Barr antibodies, IgM anti-HAV, HBsAg, Anti-HCV antibodies. A diagnosis of SAT post asymptomatic SARS-CoV-2 infection was made and the patient was started on corticosteroids with improvement of both clinical and biological parameters. A benign, short-lived and subclinical hepatic involvement is also common in subacute thyroiditis. The association of SAT with SARS-CoV-2 virus is reported in the literature, mostly following symptomatic SARS-COV 2 infection or vaccine, although the size of the problem is still unclear. In our case, SAT in asymptomatic COVID-19 patient remains a challenge in establishing the certain trigger of thyroiditis, although in a review of 27 patients with COVID-19 related SAT, 4 cases were described after asymptomatic SARS-COV 2 infections. (1) 1. Trimboli P, Cappelli C, Croce L, Scappaticcio L, Chiovato L, Rotondi M. COVID-19 Associated Subacute Thyroiditis: Evidence-Based Data From a Systematic Review. Front Endocrinol (Lausanne). 2021;12:707726. Published 2021 Sep 29.