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Coronavirus as a Trigger Of Graves' Disease
A M Urbanovych1, F Laniush1, M Borovets1
1"Danylo Halytsky" Lviv National Medical University - Dept. of Endocrinology, Lviv, Ukraine.
Context:
SARS-CoV-2 infection was declared a pandemic in 2020 and affected millions of people worldwide. Angiotensin-converting enzyme-2 receptors, through which coronavirus enters the cells of different organs, have been detected in the thyroid gland. The most common cause of thyrotoxicosis is Graves' disease in which thyroid-receptors antibodies (TRAb) stimulate the TSH receptor, increasing thyroid hormone production and release.
Case Presentation:
A 22-year-old woman had symptoms of palpitation, tremor, muscle weakness, anxiety and sleep disturbance. 3 weeks before the onset of these symptoms, the patient suffered from COVID-19, which lasted 14 days and was characterized by a course of moderate severity with fever up to 38°C, general weakness without shortness of breath. The patient had no pre-existing thyroid problems. Her TSH was <0.01 mU/L, FT4, FT3 and TRAb were increased. Antithyroid drugs, glucocorticosteroids and β-blockers were prescribed. During 3 months of treatment doses of methimazole, methylprednisolone and bisoprolol were gradually reduced due to the improvement of the patient's condition and thyroid tests normalization.
Conclusions:
COVID-19 infection can cause Graves' disease and thyrotoxicosis. The onset of this disease after SARS-CoV-2 does not depend on the presence of pre-existing thyroid pathology and requires the appointment of glucocortisteroids.
Insights
COVID-19 can trigger Graves' disease, a thyroid condition causing thyrotoxicosis. This can occur even without prior thyroid issues and requires treatment with corticosteroids.
Area of Science:
- Endocrinology
- Infectious Diseases
- Immunology
Background:
- Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infects cells via Angiotensin-converting enzyme-2 (ACE2) receptors, found in various organs, including the thyroid.
- Graves' disease, the leading cause of thyrotoxicosis, involves thyroid-receptors antibodies (TRAb) stimulating the TSH receptor, elevating thyroid hormone levels.
Purpose of the Study:
- To investigate the potential link between COVID-19 infection and the development of Graves' disease.
- To report a case of new-onset Graves' disease following SARS-CoV-2 infection.
Main Methods:
- A case study of a 22-year-old woman presenting with thyrotoxicosis symptoms three weeks after a moderate COVID-19 infection.
- Clinical examination, thyroid function tests (TSH, FT4, FT3), and TRAb levels were assessed.
- Treatment involved antithyroid drugs, glucocorticosteroids, and beta-blockers, with gradual dose reduction over three months.
Main Results:
- The patient, with no prior thyroid history, exhibited suppressed TSH (<0.01 mU/L) and elevated FT4, FT3, and TRAb levels.
- Treatment led to clinical improvement and normalization of thyroid function tests within three months.
- SARS-CoV-2 infection was identified as a potential trigger for Graves' disease.
Conclusions:
- COVID-19 infection can precipitate the onset of Graves' disease and thyrotoxicosis.
- The development of post-SARS-CoV-2 Graves' disease is independent of pre-existing thyroid conditions.
- Glucocorticosteroid therapy is indicated for managing this condition.
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