ECE2024 Poster Presentations Thyroid (58 abstracts)
Subacute thyroiditis in the SARS-Cov-2 era: a multicenter prospective study
Roberta Sueri 1 , Sara De Vincentis 2 , Simona Loiacono 3 , Eleonora Zanni 3 , Maria Laura Monzani 2 , Daniele Santi 2 , Ilaria Muller 4 , Francesco Di Marco 5 , Erica Crivicich 5 , Uberto Pagotto 6 , Carolina Cecchetti 6 , Lorenzo Tucci 6 , Manuela Simoni 2 & Giulia Brigante 2
1Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 2Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy; 3Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 4Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Endocrinology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 5School of Specialisation in Endocrinology, University of Milan, Milan, Italy; 6Alma Mater Studiorum - Bologna University, Medical and Surgical Sciences Department, Bologna, Italy; IRCCS Sant’Orsola-Malpighi Polyclinic, Endocrinology and Diabetes Care and Prevention Unit, Bologna, Italy
Introduction: Several cases of subacute thyroiditis (SAT) have been described in patients with SARS-CoV-2. However, no prospective data about follow-up in SARS-CoV-2-related SAT are known.
Aim: The characterization of clinical peculiarities and response to medical treatment of SAT cases, correlating to virus exposure, ascertained with antibody (Ab) dosage.
Methods: A prospective, 3-years, multicentre study was conducted, enrolling patients with SAT diagnosis based on anamnesis, physical examination, blood tests (TSH, freeT4, freeT3, thyroglobulin (Tg), TgAb, Ab to thyroperoxidase (TPOAb), TSH receptor-Ab, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), complete blood count and thyroid ultrasound (US). At baseline, a serum sample was taken to assess the presence of IgG against the SARS-CoV-2 spike protein or nucleocapside, distinguishing natural infection and vaccination. Patients were evaluated after 1, 3, 6, 12 months with anamnesis, physical examination, blood tests and US. The study was supported by the ‘ESE COVID-19 Research Grant’, from the European Society of Endocrinology.
Results: A total of 66 subjects were enrolled. Eight were excluded because of symptoms onset earlier than 60 days before diagnosis. At baseline, 54 subjects presented with pain, 36 (67%) for at least 15 days. Only 4 did not report previous/concomitant neck pain but they all presented with non-homogeneous thyroid echostructure, TgAb and TPOAb negativity, thyrotoxicosis, elevated ESR and/or CRP. In 52 subjects, serum SARS-COV-2 IgG measurement was performed, documenting that the 13.5% had infection before SAT diagnosis (Covid+). At baseline, 17 patients were taking nonsteroidal anti-inflammatory drugs (NSAIDs), 7 β-blockers, 14 steroids, 2 levothyroxine, and 3 methimazole. However, this bias equally affected the Covid+ and Covid- groups. Between them, at diagnosis, there were no statistically significant differences except for respiratory symptoms and fever, more represented in Covid+ (P=0.039 and 0.021), despite significantly lower ESR values (P=0.021). 41 subjects completed follow-up. Covid+ and Covid- did not differ for therapeutic approach to SAT (NSAIDs, β-blockers, steroid), all having an improvement in pain, inflammation parameters, US features. The 30% of subjects experienced transient hypothyroidism without difference in the percentage that restored thyroid function (100% in Covid+ and 81% in Covid-) or developed permanent hypothyroidism (0% in Covid+ and 8.3% in Covid-) at 12 months.
Conclusions: This is the first prospective study investigating any difference at diagnosis and at follow-up between classical and SARS-CoV-2–related SAT. Our data confirm that the diagnosis of SAT is often delayed and demonstrate that SARS-CoV-2 infection does not modify SAT onset, progression and outcome.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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