Endocrine Abstracts

Introduction: The thyroid gland and COVID-19 infection with its associated inflammatory-immune responses are known to be engaged in complex interplay. Until now, the evidence on the outcome of COVID-19 in patients with a history of thyroid cancer remains scarce, and most of the recommendations given are based on common sense.

Case report: A 71-year-old man was admitted to Mikaelyan University hospital with general weakness shortness of breath, hiccup and tumor-like mass on the anterior part of neck. The patient had a history of tumor-like mass for 20 years. The patient presented with weakness and fatigue that became severe two days before hospitalization. Examination revealed Ps=77bpm, BP=125/70 mmHg, T=36.5⁰C, SpO₂ 84 % (O₂-), BMI=19.0kg/m². On the anterior surface of the neck, from the middle line to the left there was a tumor-like mass with mobile, smooth, elastic surface of about 7*8 cm. According to the results of the ultrasound scan, there were evidence of many metastases in the liver and the right kidney. Thyroid ultrasound showed significant diffuse changes and foci of cystic degeneration. There was a pronounced blood circulation in color Doppler mode. Parajugular lymph nodes up to 1.8 cm in size were visualized. The Chest X-ray revealed bilateral pneumonia and lung metastasis. Therefore, nasal swabs were collected for the COVID-19 PCR test, and the result was positive. Lab results: CRP-107.71 mg/l /N 0.0-5.0/, D-dimer-0.492ug FEU/ml /N0-0.5/, Ferritin-225.8ng/ml/N 13-350/, TSH-1.11uIU/ml /N 0.3-4.5/, FT4-12.5 pg/ml /N 8.9-17.2/. Diagnosis: COVIID-19, bilateral pneumonia, severe course, respiratory insufficiency stage. Multinodular goiter, euthyreosis. Lungs, liver and right kidney metastases. This patient underwent treatment for COVID-19, that included infusion therapy, dexamethasone 12 mg with dose decrease to 4 mg, ceftriaxone, heparin 10000U daily, aspirin, famotidine, oxygen. Finally, he was discharged in good general health condition after eight days. The patient was recommended to perform fine needle aspiration biopsies of thyroid nodules and total thyroidectomy afterwards.

Conclusion: As there are few cases of combination of thyroid tumor and COVID-19 reported worldwide, our clinical case can contribute the management of such patients. In our clinical case, a step-by-step management of the patient led the favorable outcome of COVID-19.