Endocrine Abstracts

Introduction: The information on prognosis morbidity chronic autoimmune thyroiditis and relationship with coronavirus disease 2019 (COVID-19) is lacking but endocrine involvement has been increasingly reported. The symptoms of thyroid’s dysfunction can be due to relationship after SARS-CoV-2 infection. In addition, the patients with COVID-19 leading to an increased risk of post COVID-19 complications of chronic autoimmune thyroiditis. As such, post COVID-19 complications outcomes among people with autoimmune disorders remain poorly understood.

Case report: We present clinical case of patient with chronic autoimmune thyroiditis with severe hypothyroidism which developed few weeks after resolution of COVID-19 infection. We discuss clinical presentation, diagnostic evaluation and principle of treatment of post COVID-19 complication in patient with Hashimoto thyroiditis. A 58-year-old female with a past medical history of chronic autoimmune thyroiditis diagnosed two years ago after COVID-19 pneumonia who later manifested hypothyroidism. She was diagnosed with COVID-19 infection with nasopharyngeal reverse transcriptase polymerase reaction (RT-PCR) at an outpatient clinic 68 days ago. An IgG against SARS-CoV-2 was positive. After tree weeks for the treatment of COVID-19 pneumonia the patient complaining of worsening depression, dry skin, hair loss extreme and fatigue. Laboratory examinations showed significant increased for thyroid-stimulating hormone (TSH) 108 mIU/l (range 0,27–4,2), free thyroxine (T₄) level 0.01 ng/dL (range 0,93–1,7), anti-thyroid peroxidase antibody >800 IU/ml (normal less than 34) and anti-thyroglobulin antibodies >1000 IU/ml (normal less than 4,0). After additional examination the patient with Hashimoto thyroiditis was diagnosed severe hypothyroidism. The patient was prescribed treatment with levothyroxine a starting dose of 25 μg/day followed by titration at a daily dose of 175 μg. After 3 months, the therapy resulted in patient’s improvement of the general conditions and compensation of hypothyroidism (TSH- 4,1 mIU/l, free T₄ – 1,0 ng/dL).

Conclusions: Our clinical case suggests that the temporal relationship between post COVID-19 complications and the severe hypothyroidism manifestations in the patients with Hashimoto thyroiditis. Further studies are needed to clarify the link between combined effects of SARS-CoV-2 infection on the thyroid gland and the immune system.