Is subacute thyroiditis an underestimated manifestation of SARS-CoV-2 infection? Insights from a case series

Abstract

Context

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 18 million people worldwide and the pandemic is still spreading. After the first case we reported, we observed 4 additional cases of SAT related to SARS-CoV-2 infection.

Objectives

To describe additional cases of SAT associated with SARS-CoV-2 infection in order to alert physicians that SAT may be a manifestation of SARS-CoV-2 infection.

Methods

We describe clinical, biochemical and imaging features of the 4 patients with SAT related to SARS-CoV-2 infection.

Results

All patients were female (age 29-46 years). SAT developed 16 to 36 days after the resolution of coronavirus disease 2019 (COVID-19). Neck pain radiated to the jaw and palpitations were the main presenting symptoms and were associated with fever and asthenia. One patient was hospitalized because of atrial fibrillation. Thyroid function tests (available in three subjects) were suggestive of destructive thyroiditis and inflammatory markers were high. At neck ultrasound the thyroid was enlarged, with diffuse and bilateral hypoechoic areas and (in three patients) absent vascularization at color doppler. Symptoms disappeared a few days after commencement of treatment (prednisone in three patients and ibuprofen in one). Six weeks after the onset of SAT all patients were asymptomatic and inflammatory markers had turned back to the normal range. Two patients were euthyroid while two were diagnosed with subclinical hypothyroidism.

Conclusions

SAT may be an underestimated manifestation of COVID-19. Clinicians should keep in mind the possible occurrence of SAT during and after SARS-CoV-2 infection.