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Management of thyroiditis in the context of Covid-19: cause-effect and beyond
G S Gherlan1,2, M L Gheorghiu1,3, C Constantin1,3
1"Carol Davila" University of Medicine and Pharmacy.
Background:
The COVID-19 pandemic hit the world in late 2019, and by 2020, everyone was affected. Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) belongs to the beta-coronavirus genre and uses the angiotensin-converting enzyme 2 (ACE2) receptor to penetrate cells. Thyroid cells are rich in such receptors. Therefore, this gland is frequently involved alongside other organs in the COVID-19 disease.
Aim:
To describe COVID-19 inflammation and, eventually, dysregulations of normal thyroid function in a case series of patients diagnosed in a tertiary endocrinology care centre.
Patients And Methods:
We described subacute thyroiditis cases related to COVID-19 infection or vaccination against SARS-CoV2 infection (clinical manifestations and evolution). We also reviewed the literature data regarding COVID-19 infection or vaccination implications in thyroid pathology.
Results:
The literature describes two types of thyroid involvement in SARS-CoV2 infection or vaccination: subacute thyroiditis (SAT) and non-thyroidal illness syndrome (NTIS). In our case series, 5 patients (3 males), aged 41-54 years, developed the classical clinical manifestation of SAT related to COVID-19 infection (3 patients, concomitantly to upper respiratory infection or a few weeks apart) or anti-SARS-CoV2 ARNm vaccination (1-2 weeks after the vaccine administration). Clinical, laboratory and imaging findings and the evolution (steroid anti-inflammatory treatment used in 4/5 cases) were unremarkable compared to other SAT etiologies.
Conclusion:
We found no differences between the "typical" viral and post-COVID-19 SAT regarding clinical presentation, severity, response to treatment, and thyroid function alteration. The only remarkable difference is the association of SAT with anti-SARS-CoV2 ARNm vaccination.
Insights
COVID-19 infection and vaccination can cause subacute thyroiditis (SAT). This study found no significant differences in SAT presentation or treatment response between COVID-19 and typical viral causes, but noted a link to vaccination.
Area of Science:
- Endocrinology
- Infectious Diseases
- Virology
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) utilizes the ACE2 receptor for cell entry, and thyroid cells express this receptor, leading to potential thyroid involvement in COVID-19.
- Thyroid gland involvement is observed in COVID-19 patients, manifesting as inflammation and dysregulation of thyroid function.
Purpose of the Study:
- To describe COVID-19-related inflammation and thyroid function dysregulation in a case series.
- To analyze clinical manifestations and evolution of subacute thyroiditis (SAT) linked to COVID-19 infection or vaccination.
- To review existing literature on SARS-CoV-2 infection or vaccination's impact on thyroid pathology.
Main Methods:
- Described cases of subacute thyroiditis (SAT) associated with COVID-19 infection or anti-SARS-CoV-2 mRNA vaccination.
- Reviewed literature data concerning the implications of COVID-19 infection or vaccination on thyroid pathology.
- Analyzed clinical, laboratory, and imaging findings, along with treatment responses (steroid anti-inflammatory treatment).
Main Results:
- Two types of thyroid involvement are documented: subacute thyroiditis (SAT) and non-thyroidal illness syndrome (NTIS).
- Five patients (3 male, ages 41-54) presented with classical SAT symptoms following COVID-19 infection (3 cases) or mRNA vaccination (2 cases).
- Clinical presentation, severity, treatment response, and thyroid function alterations in post-COVID-19 SAT were comparable to other SAT etiologies, with vaccination noted as a distinguishing factor.
Conclusions:
- No significant differences were observed between typical viral and post-COVID-19 SAT regarding clinical presentation, severity, treatment response, or thyroid function.
- The association of SAT with anti-SARS-CoV-2 mRNA vaccination is a notable finding.
- COVID-19 and its vaccination represent potential triggers for subacute thyroiditis, similar to other viral infections.
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