Remdesivir

Abstract

Subacute thyroiditis: case report A 33-year-old man developed subacute thyroiditis (SAT) during treatment with remdesivir for COVID-19. The man presented to the clinic on 25 September 2020 with lethargy, fever, sore throat and body aches for 2 days. Because of the clinical features and the COVID-19 pandaemic, a nasopharyngeal swab was used for sampling, and SARS-CoV-2 nucleic acid was detected by reverse transcription polymerase chain reaction (RT-PCR) test. He was considered to have COVID-19 and received offlabel treatment with paracetamol [acetaminophen], diphenhydramine and naproxen. On the sixth day, he presented to the Emergency Room with fever and chills, sore throat, dry cough and sweating. Besides the heart rate, all other vital signs were normal. Electrocardiogram showed sinus tachycardia. After admission, a lung CT scan revealed bilateral peripheral ground-glass opacification. Owing to clinical symptoms and ground-glass opacification, nasopharyngeal swabs were used for sampling, and RTPCR again detected SARS-CoV-2 nucleic acid. By controlling his fever with injected paracetamol, his heart rate reduced to 90 bpm. Interleukin-6 and D-dimer were 11 pg/mL and 156 μg/mL, respectively. He was initiated on remdesivir 200mg on the first day, followed by 100mg daily [route not stated] with enoxaparin for 4 days. On the eighth day, his general condition ameliorated, but he complained of a sore throat. On re-examination, a slight tenderness in the neck in the thyroid area was noticed. On thyroid ultrasound, a heterogeneous thyroid gland with bilateral ill-defined hypoechoic areas showed SAT. His laboratory tests showed elevated erythrocyte sedimentation rate and C-reactive protein, but normal leucocyte and platelet counts. His thyroid function tests were thyroid-stimulating hormone (TSH) < 0.001 mUI/L, total tri-iodothyronine 236 ng/dL and total thyroxine 23.1 μg/dL. In blood culture, following 48 hours of incubation, bacterial culture was found to be negative. Infectious thyroiditis, autoimmune thyroiditis and Graves’ disease were ruled out. Eventually, considering the recent COVID-19 infection, it was suspected that the SAT was caused by COVID-19. The occurrence of SAT because of the use of remdesivir seemed unlikely. The man was treated with dexamethasone for 5 days. He was discharged with prednisone taper. The symptoms of subacute thyroiditis slowly disappeared with a slow increase in TSH and the gradual elimination of thyrotoxicosis.