CASE REPORT

Subacute Thyroiditis Secondary to SARS-COV-2 Infection; Case Studies From Turkey
SARS-COV-2 Enfeksiyonuna Sekonder Gelişen Subakut Tiroidit; Türkiye'den Vaka Serisi
Received Date : 14 Dec 2020
Accepted Date : 30 Mar 2021
Available Online : 13 Apr 2021
Doi: 10.25179/tjem.2020-80585 - Makale Dili: EN
Turk J Endocrinol Metab. 2021;25:232-237
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Coronavirus disease-2019 (COVID-19) has infected more than 100 million people globally, with the pandemic still showing a quick increase in number. We reported five new cases in Turkey, where subacute thyroiditis was developed after the COVID-19 infection. Our study included three females and two male patients aged between 27 and 51 with a mean age of 39. Out of the five, four patients had a mild COVID-19 infection, and one patient had mild COVID-19 pneumonia. After 18-25 days of the disappearance of COVID-19 symptoms, subacute thyroiditis was developed in patients. Laboratory tests such as thyroid hormones and, especially, free thyroxin showed high levels while the thyroid-stimulating hormone was found to be low. The thyroid-stimulating hormone receptor antibody, anti-thyroid peroxidase, and anti-thyroglobulin antibodies were negative in all patients while the inflammatory markers were high. Thyroid ultrasound showed diffuse hypoechoic areas and diffused enlargement. There was no iodine uptake observed in the thyroid scintigraphy. The patients were diagnosed with subacute thyroiditis and prescribed oral prednisolone therapy. After a few days of starting the treatment, symptoms disappeared in all patients, and after four weeks of the onset of subacute thyroiditis symptoms, inflammatory markers turned to normal range in all patients. Therefore, physicians should consider subacute thyroiditis in the differential diagnosis of thyroid dysfunction during and after COVID-19 infection.
ÖZET
Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] dünya çapında 100 milyondan fazla insanı enfekte etti ve bu pandemi süreci hâlâ hızla artıyor. COVID-19 enfeksiyonu sonrası gelişen 5 yeni subakut tiroidit olgusunu Türkiye’den sunuyoruz. Hastaların 3’ü kadın iken 2’si erkekti. Hastalar, 27-51 yaş aralığındaydı ve ortalama yaşı 39’du. Hastalardan 4’ünde hafif COVID-19 enfeksiyonu, 1’inde COVID-19 pnömonisi mevcuttu. COVID-19 hastalığının semptomlarının geçmesinden 18-25 gün sonra hastalarda subakut tiroidit semptomları başlamıştı. Laboratuvar testleri değerlendirildiğinde, tiroid hormonları, özellikle serbest tiroksin değeri yüksekti, tiroid stimülen hormon ise düşük bulundu. Tiroid stimülen hormon reseptör antikoru, antitiroid peroksidaz antikoru ve antitiroglobulin antikoru tüm hastalarda negatif saptandı. İnflamatuar belirteçler ise yüksek saptandı. Hastalara yapılan tiroid ultrasonunda yaygın hipoekoik alanlar ve diffüz büyüme saptandı. Tüm hastaların tiroid sintigrafisinde iyot tutulumu saptanmadı. Hastalara subakut tiroidit tanısı konuldu ve oral prednizolon tedavisi başlandı. Tedaviye başladıktan birkaç gün sonra tüm hastalarda semptomlar kayboldu. Subakut tiroidit semptomlarının başlamasından 4 hafta sonra, tüm hastalarda inflamatuar belirteçler normal aralığa döndü. Sonuç olarak, doktorlar COVID-19 enfeksiyonu sırasında ve sonrasında tiroid disfonksiyonunun ayırıcı tanısında subakut tiroiditi dikkate almalıdır.
KAYNAKLAR
  1. Benbassat CA, Olchovsky D, Tsvetov G, Shimon I. Subacute thyroiditis: Clinical characteristics and treatment outcome in fifty-six consecutive patients diagnosed between 1999 and 2005. J Endocrinol Invest. 2007;30:631-635. [Crossref]  [PubMed] 
  2. Desailloud R, Hober D. Viruses and thyroiditis: an update. Virol J. 2009;6:5. [Crossref]  [PubMed]  [PMC] 
  3. Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F. Subacute Thyroiditis After Sars-COV-2 Infection. J Clin Endocrinol Metab. 2020;105:dgaa276. [Crossref]  [PubMed]  [PMC] 
  4. Ippolito S, Dentali F, Tanda ML. SARS-CoV-2: a potential trigger for subacute thyroiditis? Insights from a case report. J Endocrinol Invest. 2020;43:1171-1172. [Crossref]  [PubMed]  [PMC] 
  5. Asfuroglu Kalkan E, Ates I. A case of subacute thyroiditis associated with Covid-19 infection. J Endocrinol Invest. 2020;43:1173-1174. [Crossref]  [PubMed]  [PMC] 
  6. Ruggeri RM, Campennì A, Siracusa M, Frazzetto G, Gullo D. Subacute thyroiditis in a patient infected with SARS-COV-2: an endocrine complication linked to the COVID-19 pandemic. Hormones (Athens). 2021;20:219-221. [Crossref]  [PubMed]  [PMC] 
  7. Brancatella A, Ricci D, Cappellani D, Viola N, Sgrò D, Santini F, Latrofa F. Is Subacute Thyroiditis an Underestimated Manifestation of SARS-CoV-2 Infection? Insights From a Case Series. J Clin Endocrinol Metab. 2020;105:dgaa537. [Crossref]  [PubMed]  [PMC] 
  8. San Juan MDJ, Florencio MQ V, Joven MH. Subacute thyroiditis in a patient with coronavirus disease 2019. AACE Clin case reports 2020;6:e361-e364. San Juan MDJ, Florencio MQV, Joven MH. Subacute thyroiditis in a patient with coronavirus disease 2019. AACE Clin Case Rep. 2020;6:e361-e364. [Crossref]  [PubMed]  [PMC] 
  9. Campos-Barrera E, Alvarez-Cisneros T, Davalos-Fuentes M. Subacute Thyroiditis Associated with COVID-19. Case Rep Endocrinol. 2020;2020:8891539. [Crossref]  [PubMed]  [PMC] 
  10. Wei L, Sun S, Xu CH, Zhang J, Xu Y, Zhu H, Peh SC, Korteweg C, McNutt MA, Gu J. Pathology of the thyroid in severe acute respiratory syndrome. Hum Pathol. 2007;38:95-102. [Crossref]  [PubMed]  [PMC] 
  11. Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. J Adv Res. 2020;24:91-98. [Crossref]  [PubMed]  [PMC] 
  12. Ziegler CGK, Allon SJ, Nyquist SK, Mbano IM, Miao VN, Tzouanas CN, Cao Y, Yousif AS, Bals J, Hauser BM, Feldman J, Muus C, Wadsworth MH 2nd, Kazer SW, Hughes TK, Doran B, Gatter GJ, Vukovic M, Taliaferro F, Mead BE, Guo Z, Wang JP, Gras D, Plaisant M, Ansari M, Angelidis I, Adler H, Sucre JMS, Taylor CJ, Lin B, Waghray A, Mitsialis V, Dwyer DF, Buchheit KM, Boyce JA, Barrett NA, Laidlaw TM, Carroll SL, Colonna L, Tkachev V, Peterson CW, Yu A, Zheng HB, Gideon HP, Winchell CG, Lin PL, Bingle CD, Snapper SB, Kropski JA, Theis FJ, Schiller HB, Zaragosi LE, Barbry P, Leslie A, Kiem HP, Flynn JL, Fortune SM, Berger B, Finberg RW, Kean LS, Garber M, Schmidt AG, Lingwood D, Shalek AK, Ordovas-Montanes J; HCA Lung Biological Network. Electronic address: lung-network@humancellatlas.org; HCA Lung Biological Network. SARS-CoV-2 Receptor ACE2 Is an Interferon-Stimulated Gene in Human Airway Epithelial Cells and Is Detected in Specific Cell Subsets across Tissues. Cell. 2020;181:1016-1035.e19. [Crossref]  [PubMed]  [PMC] 
  13. Fatourechi V, Aniszewski JP, Fatourechi GZ, Atkinson EJ, Jacobsen SJ. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study. J Clin Endocrinol Metab. 2003;88:2100-2105. [Crossref]  [PubMed] 
  14. Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003;348:2646-55. Erratum in: N Engl J Med. 2003;349:620. [Crossref]  [PubMed]