Table 1.
Clinical characteristics of the patients with post–COVID-19 subacute thyroiditis
| Ref no. | Age/ sex | Date of COVID-19 symptom onset or swab positivity | COVID-19 symptoms | Duration of COVID-19 symptoms | Severity | Treatment of COVID-19 | Date of SAT onset after COVID-19 | Duration between onset of COVID-19 symptoms and onset of SAT symptoms | SAT symptoms | Elevated inflammatory markers at SAT onset | Treatment of SAT | Steroid tapering or reduction | Symptom relief from SAT onset |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 4 | 38/F | March 1, 2020 | Fever (37.5°C), rhinorrhea, anosmia, asthenia | 4 days | Mild | n/a | March 17, 2020 | 16 days | Neck pain, asthenia, fever (38.5°C), palpitation, anorexia | ESR, CRP | Prednisone 25 mg/day | “At last evaluation (on May 10), while taking prednisone 15 mg/day, the patient was asymptomatic” | “Symptoms disappeared within a few days” |
| 4 | 29/F | March 3, 2020 | Rhinorrhea | 3 days | Mild | n/a | April 2, 2020 | 30 days | Neck pain, asthenia, palpitation, sweating, fever (37.2°C) | ESR, CRP | Prednisone 25 mg/day Propranolol 40 mg/day | “At last evaluation (on May 18), while taking 15 mg/day of prednisone, the patient was asymptomatic” | “Neck pain and fever disappeared within 3 days and the other symptoms within 2 weeks” |
| 4 | 29/F | March 17, 2020 | Fever (38.0°C), cough, rhinorrhea, anosmia, diarrhea | 14 days | Mild | n/a | April 22, 2020 | 36 days | Neck pain, palpitation, tachycardia, sweating, | n/a | Ibuprofen 600 mg/day | n/a | “Symptoms disappeared within 2 weeks” |
| 4 | 46/F | April 3, 2020 | Fever (38.2°C), cough, rhinorrhea, anosmia, asthenia | 6 days | Mild | n/a | May 2, 2020 | 20 days | Neck pain, fever (37.2°c), palpitation, asthenia, insomnia, anxiety, weight loss | CRP | Prednisone 25 mg/day | “At the last evaluation (on June 15), while taking 20 mg/day of prednisone, the patient was asymptomatic” | “Neck pain and fever disappeared within a few days and other symptoms within 2 weeks” |
| 5 | 69/F | n/a | Mild fever, cough, dyspnea | n/a | Moderate | Hydroxychloroquine, lopinavir, ritonavir, low-flow oxygen therapy | n/a | 5 days after initiation of treatment of COVID-19 | Palpitation, insomnia, agitation | n/a | Methylprednisolone 40 mg/day | “then continuing with 25 mg oral prednisone, to be progressively tapered over 4 weeks or more, according to clinical response” | “Within a few days, symptoms markedly improved” |
| 10 | 18/F | February 28, 2020 | Fever (37.5°C), rhinorrhea, cough, fatigue | 4 days | Mild | No treatment | March 17, 2020 | 18 days | Fever (37.5°C), fatigue, neck pain, palpitation | ESR, CRP, WBC | Prednisone 25 mg/day | “Steroid was progressively tapered and at the last evaluation (April 27) while taking prednisone 16 mg/day, the patient was asymptomatic” | “Neck pain and fever disappeared within 2 days and the remaining symptoms within 1 week” |
| 11 | 37/F | April 10, 2020 | Odynophagia, anosmia | 1 day | Mild | Symptomatic treatment | n/a | “A month after her initial presentation” | Neck pain, fatigue | ESR, CRP | n/a | n/a | “During her follow-up visit one month after diagnosis, the patient has remained asymptomatic” |
| 12 | 49/M | n/a | Sore throat, fever, cough, shortness of breath | n/a | Moderate | Hydroxychloroquine 200 mg twice daily, enoxaparin 0.4 mL once daily | n/a | 10 days post-discharge from infection control facility for COVID-19 | Sore throat, swallowing difficulty, fever (38.3°c), “tonsils were hyperemic” | ESR, CRP, WBC | Methylprednisolone 32 mg/day | “steroid dose was gradually decreased and was planned to be completed in 4 weeks and called for control 1 month after.” | “At 1-week post-treatment, the patient was asymptomatic” |
| 13 | 41/F | n/a | Fever (38.5°C), neck pain | n/a | Mild | Hydroxychloroquine tablet 200 mg twice daily for 5 days | n/a | n/a | Fever (38.5°C), neck pain | ESR, CRP, WBC | Prednisolone 16 mg/day | “She was discharged on prednisolone tapering dose for 4 weeks” | “Prednisolone 16 mg daily was given and she showed significant improvement of clinical condition” |
| 14 | 41/F | n/a | Fever, cough, coryza | n/a | Mild | Oral azithromycin, supportive therapy | n/a | 4 weeks | Neck pain, fever (39.5°c), odynophagia, chills, diaphoresis, weight loss (6 kg), fatigue, alopecia, heat intolerance, irritability, headaches, bilateral hand tremors, palpitation | ESR, CRP | Ibuprofen 600 mg (every 6 h), prednisone 40 mg/day | “She completed a 4-week corticosteroid taper” | “complete symptom resolution at her last outpatient follow-up visit 45 days from hospital discharge (2 days of hospitalization)” |
| 15 | 34/M | n/a | Fever, dry cough, headache, anosmia, sore throat | n/a | Mild | Paracetamol, dequalinium lozenges | n/a | 9 days | Neck pain, tachycardia | CRP, WBC | Prednisolone 20 mg/day, atenolol 25 mg/day | “A steroid-tapering regimen was planned for him to decrease the dosage of prednisone to the minimum required for symptomatic relief with periodic monitoring of thyroid function.” | “He was reviewed after 10 weeks in the outpatient clinic. He had completed his tapering course of steroids and was clinically well with no symptoms.” |
| 16 | 28/F | April 15, 2020 | Diarrhea, abdominal pain | n/a | Mild | n/a | May 14, 2020 | 29 days | Fever (38.5°C), neck pain, sore throat, palpitation, asthenia | ESR, CRP, WBC | Aspirin 500 mg (every 6 h), propranolol 40 mg (every 6 h) | n/a | “Symptoms improved in 24 h, with a total relief in 2 weeks” |
| 17 | 43/F | Beginning of March 2020” | Fever, rhinorrhea, painful swallowing, cough, hoarseness, conjunctivitis | n/a | Mild | No specific treatment | Mid-April 2020 | 6 weeks | Fever (37.5°C), pain and tenderness in the anterior cervical region, fatigue, tremors, palpitation | n/a | Prednisone 25 mg/day | “25 mg/day as the starting dose, gradually tapered” | “4 weeks after starting steroid therapy, all thyroid functional tests normalized, as well as inflammatory indexes” |
| 18 | 47/F | n/a | “She did not have fever or respiratory symptoms but had right lower lobe pneumonia on chest radiograph” | n/a | Mild | Oral hydroxychloroquine, intravenous ceftriaxone | n/a | n/a | Anterior neck pain | CRP | Mefenamic acid, celecoxib | n/a | “The patient reported full resolution of symptoms a month later.” |
| 19 | 26/F | n/a | Dry cough | 1 week | Mild | n/a | n/a | n/a | Fever, fatigue, palpitation, anterior neck pain | CRP, ESR, WBC | n/a | n/a | n/a |
| 19 | 37/F | n/a | Myalgia | Few days | Mild | n/a | n/a | n/a | Fever, fatigue, palpitation, anterior neck pain | CRP, ESR, WBC | n/a | n/a | n/a |
| 19 | 35/M | n/a | No symptoms | n/a | Mild | n/a | n/a | n/a | Fever, fatigue, palpitation, anterior neck pain | CRP, ESR, WBC | n/a | n/a | n/a |
| 19 | 41/F | n/a | Low-grade fever, mild myalgia | Few days | Mild | n/a | n/a | n/a | Fever, fatigue, palpitation, anterior neck pain | CRP, ESR, WBC | n/a | n/a | n/a |
| 19 | 52/M | n/a | Low-grade fever, dry cough, mild myalgia | Few days | Mild | n/a | n/a | n/a | Fever, fatigue, palpitation, anterior neck pain | CRP, ESR, WBC | n/a | n/a | n/a |
| 19 | 34/F | n/a | No symptoms | n/a | Mild | n/a | n/a | n/a | Fever, fatigue, palpitation, anterior neck pain | CRP, ESR, WBC | n/a | n/a | n/a |
| 20 | 64/M | n/a | Oppressive chest pain, fever, productive cough, headache, fatigue | 14 days | Moderate | Steroids, azithromycin, Acetaminophen | n/a | “Three weeks after the first positive PCR test for COVID-19” | Distal tremor, diaphoresis | Ferritin | Atenolol 50 mg twice daily, prednisone 50 mg | “gradual dosage tapering over the course of 2 weeks” | “Three days after admission, the patient was discharged with full clinical relief. On his last outpatient visit to the endocrine clinic, he had discontinued steroids. His thyroid tests revealed a slight primary hypothyroidism, which was treated with 100 μg of levothyroxine.” |
| 21 | 58/M | June 6, 2020 | Fever, myalgia, fatigue | n/a | Moderate | Azithromycin, paracetamol | June 12, 2020 | 6 days | Fever, fatigue, delirium, staring gaze, weakness, weight loss, tender thyroid, odynophagia, tachycardia | ESR, CRP, WBC, ferritin | Dexamethasone (4 mg), naproxen oral prednisolone (15 mg) | “Stepwise tapering off” | 8 days |
| 22 | 37/M | n/a | Cough, chills, fever, dyspnea | 7 days | Mild | Supportive care | n/a | 1 month | Anterior neck pain, fatigue, chills, postural tremor, palmar erythema, tachycardia | ESR, CRP | Aspirin, propranolol | n/a | 1 week hypothyroidism |
| 23 | 58/M | n/a | n/a | n/a | Mild | Analgesics, favipiravir, azithromycin, zinc tablets, vitamin c capsules | n/a | n/a | Fever, tachycardia, neck pain, increased stool frequency | ESR, CRP | Prednisolone 30 mg/day, propranolol 40 mg/day | “gradually tapered over next 1 month and then stopped” | Hypothyroidism |
| 24 | 44/M | n/a | Shortness of breath, loose stools, fatigue, hypoxia, fever, dyspnea | 5 months | Severe | 15 L of oxygen, intravenous antibiotics and fluids | n/a | n/a | Malaise, odynophagia, neck pain | ESR, CRP, WBC | Propranolol 40 mg, paracetamol, ibuprofen | n/a | 6 weeks |
| 25 | 45/F | n/a | Nasal congestion, cough, weakness, muscle pain, headache | 7 days | Moderate | “Symptomatic and antibacterial therapy” | n/a | 30 days | Neck pain, fever, myalgia, palpitation, sweating, tachycardia | ESR, WBC | Prednisone 30 mg/day | “Reduction in the dosage by 5 mg weekly” | Within a week |
| 25 | 40/F | n/a | n/a | n/a | Moderate | n/a | n/a | 30 days | Neck pain, fever, palpitation, tachycardia | CRP, ESR, WBC | Prednisone 30 mg/day | “Reduction in the dosage by 5 mg weekly” | Within a week |
| 26 | 29/F | n/a | n/a | n/a | n/a | Azithromycin, hydroxychloroquine | n/a | 7 weeks | Fever, odynophagia, tachycardia, shortness of breath, weight loss, anterior neck tenderness, hand tremor | ESR, CRP | Prednisone 20 mg/day, atenolol 25 mg/day; “her prednisone was increased to 40 mg and atenolol to 50 mg daily” | “The prednisone was gradually tapered off over six weeks” | “The patient remained asymptomatic at ten weeks follow up” |
| 27 | 39/M | n/a | Sore throat, fatigue, fever | 7 days | Mild | Favipiravir | December 28, 2020 | n/a | Neck pain, fatigue, muscle pain, palpitation, tremors, sinus tachycardia | ESR, CRP, WBC | Prednisolone 16 mg/day, ibuprofen 1200 mg/day, propranolol 20 mg tid | “reduced consecutively” | 1 week |
| 28 | 31/F | n/a | Fever, painful sore throat | n/a | Mild | “No specific treatment” | n/a | 2 weeks | Anterior neck pain, fever, malaise | CRP, ESR, WBC | NSAIDs, prednisolone 15 mg/day | 7 weeks | 1 day |
| 29 | 41/F | September 15, 2020 | Headache, fatigue, loss of appetite, fever | n/a | Mild | “Symptomatic treatment” | n/a | 6 weeks | Palpitation, insomnia | n/a | n/a | n/a | “Three weeks later, she developed hypothyroidism” |
| 30 | 67/M | n/a | Shortness of breath, diarrhea | n/a | Severe | Ceftriaxone, azithromycin | n/a | n/a | Arrhythmia, weight loss, fatigue, diarrhea | ESR, CRP | Prednisone 20 mg/day | 9 months | n/a |
| 31 | 33/M | September 23, 2020 | Fever (39°C), sore throat, body aches, lethargy, chills, sweating, dry cough, tachycardia | n/a | Moderate | Acetaminophen, naproxen, diphenhydramine, remdesivir, enoxaparin | October 2, 2020 | 9 days | Sore throat, neck tenderness | ESR, CRP, IL-6 | Dexamethasone 4 mg every 8 hours for 5 days, prednisone 25 mg/day | “He was discharged with oral prednisone 25 mg daily with taper prescribed” | 7 weeks |
| 32 | 50/M | October 6, 2020 | Neck pain, fever (39°C), headaches, cough, malaise, loss of smell, retrosternal discomfort | n/a | n/a | Azithromycin Amoxicillin Dexamethasone | 6 October 2020 | Simultaneously | Fever, cough, headache, insomnia, neck pain, hard neck tumor | CRP, ESR | Prednisone | Gradual dose reduction | “No symptom recurrence was observed for 10 months of follow-up” |
| 32 | 39/F | December 2020 | Cough, headache, fever, malaise | n/a | n/a | n/a | n/a | 4 weeks | Neck pain, tachycardia, insomnia, tremor, fever | CRP, ESR | Prednisone 60 mg/day | 4 months | “No recurrence was observed for the 8 months of follow-up” |
| 32 | 55/F | n/a | “typical clinical symptoms” | n/a | n/a | n/a | n/a | 5 weeks | Neck pain, fever | CRP, ESR | Prednisone | n/a | n/a |
| 32 | 57/F | October 2020 | “The disease course was mild with common symptoms” | n/a | n/a | n/a | n/a | 4 months | Neck pain, fever, tachycardia, mood change | CRP, ESR | Prednisone 40 mg/day | “Gradual dose reduction” | n/a |
| 33 | 46/F | n/a | Asymptomatic | n/a | Mild | Untreated | n/a | n/a | Neck pain, earache, fever, malaise, insomnia | ESR | NSAIDs, prednisone 40 mg/day | Six weeks | Two weeks |
CRP = C-reactive protein; ESR = erythrocyte sedimentation rate; F = female; IL-6, interleukin-6; M = male; n/a = not available; NSAID = nonsteroidal antiinflammtory drug; PCR = polymerase chain reaction; Ref = reference; SAT = subacute thyroiditis; WBC = white blood cell count.