ObjectiveRecent reports have suggested a link between COVID-19 infection and subacute thyroiditis (SAT). We aimed to describe variations in clinical and biochemical parameters in patients developing post-COVID SAT.DesignOurs was a combined retrospective-prospective study on patients presenting with SAT within 3 months of recovery from COVID-19 infection, who were subsequently followed up for a further 6 months since diagnosis of SAT.ResultsOut of 670 patients with COVID-19, 11 patients presented with post-COVID-19 SAT (6.8%). Those with painless SAT (PLSAT, n=5) presented earlier, had more severe thyrotoxic manifestations and exhibited higher C-reactive protein, interleukin 6 (IL-6), neutrophil-lymphocyte ratio and lower absolute lymphocyte count than those with painful SAT (PFSAT, n=6). There were significant correlations of total and free T4 and total and free T3 levels with serum IL-6 levels (pall <0.04). No differences were observed between patients with post-COVID SAT presenting during the first and second waves. Oral glucocorticoids were needed for symptomatic relief in 66.67% of patients with PFSAT. At 6 months of follow-up, majority (n=9, 82%) achieved euthyroidism, while subclinical and overt hypothyroidism were found in one patient each.ConclusionsOurs is the largest single-centre cohort of post-COVID-19 SAT reported until, demonstrating two distinct clinical presentations—without and with neck pain—depending on time elapsed since COVID-19 diagnosis. Persistent lymphopaenia during the immediate post-COVID recovery period could be a key driver of early,painless SAT. Close monitoring of thyroid functions for at least 6 months is warranted in all cases.

A 16.5-year-old Indian female presented with secondary amenorrhoea, cubitus valgus, scoliosis and multiple lentigines on the face. Karyotyping revealed mosaic Turner syndrome (TS) with 45, X/46, X iXq. She also had multiple café-au-lait macules and axillary freckles but no neurofibroma and did not fulfil the classic criteria for diagnosis of Neurofibromatosis-1 (NF1). Many of her macules were smaller than 15 mm in diameter, which might be due to her hypoestrogenic state. However, exome-sequencing found a pathologic variant consistent with NF1. She was started on daily oral estrogen, and oral progesterone for 10 days every month with close monitoring for neurofibroma and/or glioma expansion. Co-occurrence of NF1 and TS is extremely rare, TS and NF1 can both affect growth and puberty, cause different cutaneous and skeletal deformities, hypertension, vasculopathy and learning disabilities. Our case highlights the need for genetic testing in some cases with NF1 who do not strictly fulfil the NIH diagnostic criteria. We also emphasize the need for close monitoring during therapy with growth hormone, estrogen and progesterone due to the potential risk of tumour expansion in NF1.

BackgroundAdult women with Turner syndrome (TS) have high rates of miscarriage, presumably due to the abnormal size and shape of the uterus. There is a paucity of data regarding the determinants of uterine volume (UtVol) in young girls with TS before the initiation of oestrogen replacement therapy (ERT).MethodsWe performed a cross‐sectional study on premenarchal girls with TS, aged 5–15 years, pubertal stage B1–B3, not having received ERT (n = 73) and 50 age‐matched healthy controls. Anthropometric parameters and a history of growth hormone (GH) therapy (≥1 year) were noted. Uterine length (UtL), UtVol, and mean‐ovarian‐volume (MOV) standard‐deviation scores (SDS) were determined from transabdominal ultrasonography data.ResultsGirls with TS had lower median UtVol‐SDS (−1.07 vs. 0.86; p < .001), UtL‐SDS (−3.72 vs. −0.41; p < .001) and MOV‐SDS (−5.53 vs. 1.96; p < .001) compared to age‐matched controls. Among TS girls, recipients of GH (n = 38) had higher UtVol‐SDS (−0.63 vs. −1.39; p = .0001), UtL‐SDS (−1.73 vs. −6.49; p < .0001) but similar MOV‐SDS compared to nonrecipients (n = 35). Those with normal uterine volume for age (NUVA, n = 29) had earlier initiation (7.8 vs. 9.3 years; p = .03) and a longer duration of GH (3.71 vs. 2.14 years; p = .002) than those with low UtVol for age (n = 44). UtVol‐SDS correlated with duration of GH (ρ = 0.411, p = .01) and negatively with age at GH initiation (ρ = −0.479, p = .003). In a model adjusted for pubertal status, karyotype and height‐SDS, GH use could independently predict having NUVA (odds ratio: 5.09, confidence interval: 1.63–15.94, p = .005).ConclusionGH therapy has a stimulatory effect on uterine dimensions in pre‐and peripubertal girls with TS. Earlier initiation and longer duration of GH is important in TS girls before ERT.