Endocrine Abstracts

A 43-year-old woman received the CoronaVac COVID-19 vaccine produced by Sinovac Biotech in September 2021. 1 month after the last dose of vaccine (10/2022), she developed pain in her right neck, palpitations, and fever. Laboratory studies revealed severe thyrotoxicosis (TSH - 0.1 mIU/ml, high FT4) and increased ESR - 59 mm/h; Ultrasound showed an asymmetric thyroid due to enlargement of the hypervascular right lobe. The left lobe was intact. She was diagnosed with subacute thyroiditis developed after CoronaVac vaccine and was treated with steroids for 3 months. She had an immediate improvement after the first dose of the methylprednisolone. After this episode, thyroid function tests were checked regularly and were normal. In January 2022 the patient tested positive for COVID-19. In April 2022, she developed pain in the left side of her neck, fever, and palpitations. The left lobe of the thyroid gland was painful on palpation, the right lobe was painless. Thyroid ultrasound revealed an increase in the left lobe compared to the previous report: 3.8→8.5 cm³, thyroid was heterogeneous, with inflammatory infiltration areas. TSH done 2 weeks ago showed the presence of subclinical hypothyroidism (TSH - 5.8 mIU/ml). CBC showed anemia, an increase in ESR of 62 mm/h and elevation of CRP. TFT were re-evaluated: TSH - 0.11 mIU/l, FT4 and FT3 were high normal. Thyroid scintigraphy showed absence of uptake in both lobes - 0%. Based on performed investigations, the patient was diagnosed with subacute thyroiditis, this time after a covid infection. She was given NSAIDs and propranolol, but the pain in her neck worsened, it was extremely difficult for her to swallow even liquids, and any touch on her neck was very painful. The fever was persistent despite the use of NSAIDs. Due to the deterioration of the clinical picture, despite taking ibuprofen 1200 mg per day, methylprednisolone 32 mg was prescribed with appropriate gastroprotection and potassium supplementation. Again, immediately after the first dose of the steroid, the patient felt a marked improvement, she was prescribed methylprednisolone at a dose of 32 mg for 1 month, and then down titrated according to laboratory data and clinical picture, and discontinued in July 2022. Since then, her thyroid function tests have been normal and she feels well. Besides the thyrotoxic phase of subacute thyroiditis, laboratory testing revealed vitamin D deficiency, vitamin B12 deficiency, and iron deficiency. The patient was prescribed the supplements for the aforementioned deficiencies.