Endocrine Abstracts

Introduction: COVID-19 has been established as a multisystemic disease with the potential of affecting all the organs of the human organism including the thyroid gland which features ACE2 receptors for the cellular entry of SARS-CoV-2. Graves’ disease comprises the most common cause of thyrotoxicosis, manifests in genetically predisposed individuals with an autoimmune background and may be triggered by a variety of environmental factors, including viral infections. A few cases of new-onset or relapsed Graves’ disease related to SARS-CoV-2 infection have been reported globally. Herein, we present the case of an otherwise healthy patient who developed hyperthyroidism due to Graves’ disease reactivation after 3 decades of remission following exposure to SARS-CoV-2.

Case report: A 65-year old female patient with a history of active Graves’ disease over a period of 2 years and remission over the past 30 years presented for endocrinological evaluation due to newly detected hyperthyroidism. The patient had been tested positive for COVID-19 10 days ago with persistent fever over a period of 2 days and concomitant heart palpitations. The neck ultrasound revealed a pattern typical of autoimmune thyroiditis with diffuse heteroechogenicity and inhomogeneity accompanied by elevated blood flow bilaterally. The adjunctive laboratory evaluation showed a hyperthyroid state with elevated TRAb-titers and negative anti-Tg and anti-TPO autoantibodies. The patient was started on thyrostatic medication with methimazole 15 mg daily combined with propranolol 10 mg thrice daily. Biochemical and clinical euthyroidism was rapidly restored in 6 weeks and the methimazole dosis was progressively reduced till complete cessation 8 months after diagnosis. Neck ultrasound at that point showed a remission of the autoimmune process with normalization of the blood flow, whereas the laboratory assessment showed negative TRAb. The patient remained euthyroid without related medication since.

Conclusion: The above case presentation comprises the first official report of Graves’ disease relapse following COVID-19 in northern Greece, as well as the case of autoimmune hyperthyroidism with the second longest remission duration before relapse due to SARS-CoV-2 infection in the literature. Clinicians should be aware of thyroid-related complications due to SARS-Cov-2, especially in individuals with a known history of autoimmune thyroid diseases and conduct the appropriate diagnostic and therapeutic procedures in cases of suspected infection-triggered thyroid dysregulation.