Abstract #1004269: Subacute Thyroiditis in Patients Infected with SARS-COV-2

Abstract

1004269 Subacute Thyroiditis in Patients Infected with SARS-COV-2 Author Block: Zelija Velija Asimi Outpatient Clinic with Daily hospital; Almira Hadzovic Dzuvo, professor co-author, Outpatient Clinic dr Al-Tawil Introduction: Subacute thyroiditis (SAT) is an inflammatory disorder of the thyroid gland that causes destructive thyrotoxicosis and is attributed to a viral or post-viral response. The Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus enters human cells through the angiotensin-converting enzyme 2 (ACE2) receptor. Thyroid follicular cells express the ACE2 receptor, thus making thyroid tissue a possible target of direct infection by the SARS-CoV-2 virus. The aim was to describe cases of SAT associated with SARS-CoV-2 infection to alert physicians that SAT may be a manifestation of SARS-CoV-2 infection. Case Description: We describe clinical, biochemical, and imaging features of 11 patients with SAT related to SARS-CoV-2 infection. Discussion: All patients were female (age, 30-45 years). Neck pain radiated to the jaw, fatigue, tremors, and palpitations were the main presenting symptoms and were associated with fever and asthenia. Physical examination revealed mild tremors of the extremities, a diffuse and painful goitre, and enlarged and tender cervical and submandibular lymph nodes. At biochemical evaluation, inflammatory markers were high. Thyroid function tests were suggestive of destructive thyroiditis. TSH was suppressed, free thyroxine (FT4) and free triiodothyronine (FT3) levels were elevated, and serum thyroglobulinwasmarkedly increased (175 ng/ ml; referral range 2.68-33.2). Anti-thyroid peroxidase, anti-thyroglobulin, and thyroid-stimulating hormone receptor antibodies were negative. At neck ultrasound the thyroid was enlarged, with diffuse and bilateral hypoechoic areas and absent vascularization at colour Doppler. Thyroid scintigraphy showed markedly reduced 99mTc-perthecnetate uptake in the gland. Reverse transcriptionpolymerase chain reaction for SARS-CoV-2 using nasopharyngeal and oropharyngeal swabs were positive. Chest X-rays and computed tomography scanning of the chest were normal. Symptoms were alleviated a few days after commencement of treatment (aspirin in 3 patients, prednisone in 2 patients, paracetamol in 3 and ibuprofen in 3) together with propranolol for tachycardia and tremors. Ten weeks after the onset of SAT, all patients were asymptomatic and inflammatory markers had returned to normal range. Eight patients were euthyroid, whereas 3 were with subclinical hypothyroidism. Conclusion: Clinicians should be aware of thyroid manifestations potentially associated with COVID-19. https://doi.org/10.1016/j.eprac.2021.04.845