Endocrine Abstracts

Introduction: The novel severe-acute-respiratory-syndrome-coronavirus-2 virus has led to the ongoing Coronavirus disease 2019 (COVID-19) disease pandemic. There are increasing reports of extra pulmonary clinical features of COVID-19, either as initial presentations or sequelae of disease ((gastrointestinal, hepatobiliary, pancreatic, cardiovascular, ocular, and neurologic) Autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome) can be seen as a post-vaccination phenomenon that occurs after exposure to adjuvants in vaccines We report cases of subacute thyroiditis following COVID infection or vaccine

Clinical cases: 1-A 47 years old female developed subclinical hypothyroidism 3 weeks after COVID 19 infection TSH was 10.1 IU/ml (0.4-4), FT4 was 0.94 ng/dl ((0.7-1.9), Ant microsomal abs: 945IU/ml (0-9), Ant thyroglobulin abs: 285IU/ml (n:<116) Thyroid sonar: diffuse heterogeneity & increased vascularity. 2-A 45 years old female developed subclinical hypothyroidism after exposure to COVID 19 infection by one month with TSH 7.74 IU/ml, FT4 1.2 ng/dl, Ant microsomal ab 959 IU/ml, Ant thyroglobulin ab 257 IU/ml Thyroid sonar: diffuse heterogeneity 3-A 35 years old female who had local pain in the neck 2 weeks after COVID infection. Investigations revealed non-uniform echo texture of the thyroid gland in the thyroid sonar TSH: 3.06 IU/ml, FT4 1.06 ng/dl, Ant microsomal ab 33 IU/ml, Ant thyroglobulin ab 955.7 IU/ml Post vaccine cases 1-A 59 years old female under treatment for thyrotoxicosis. She went into remission for 3 months with one tab neomercazole 5 mg 10 days of the first dose of vaccine for COVID 19, the patient developed exacerbation of her thyrotoxicosis with tachycardia, pulse 115, anxiety, insomnia and tremors. Her TSH became 0.009 IU/ml & increase of the dose of Inderal & neomercazole was done. Within 2 months the patient responded in a good way & entered into remission again 2-A 65 years old female who developed hypothyroidism after vaccine TSH: 10.21 IU/ml, FT4 0.82 ng/dl, Ant microsomal ab 600 IU/ml, Ant thyroglobulin ab 206 IU/ml 3-A 36 years old female who developed subclinical hyperthyroidism after vaccine Her thyroid sonar was normal sized sonar with heterogeneity TSH 0.03 IU/ml, FT4 0.93 ng/dl After 3 months her thyroid sonar is completely normal TSH 1.210 IU/ml, FT4 0.84 ng/dl, FT3 2.94 pg/ml (2.3-4.1)

Conclusion: Clinicians must be aware of the possibility of thyroid dysfunction and subacute thyroiditis after COVID-19 infection and after the inactive SARS-CoV-2 vaccine. Early recognition and timely anti-inflammatory therapy can help in successful management of the disease.