Clinical, biochemical features and functional outcome of patients with SARS-CoV-2-related subacute thyroiditis: a review

Abstract

Introduction SARS CoV-2 infection involves many organs and systems, including the thyroid, in which it manifests itself as subacute thyroiditis (SAT). After our first description of SAT due to SARS-CoV2 infection, other reports have confirmed the correlation between SARS-CoV-2 and SAT. We review the cases of SAT associated with COVID-19 to highlight its peculiar clinical and biochemical features, including its outcome and what it has added to our understanding of SAT. Results We have reviewed 24 articles, for a total of 69 cases of SAT related to SARS-CoV2 infection. All had neck pain, whereas thyrotoxicosis was documented in 68/68 who had their thyroid function checked. Ultrasound, performed in 67 patients, was typical of SAT in 65 and low uptake at scintigraphy was demonstrated in all 12 evaluated patients. Patients had a prompt response to the anti-inflammatory and/or glucocorticoid therapy, as expected in SAT. The rate of hypothyroidism was higher (36.5%) in COVID-19-related SAT compared to that observed in the pre-COVID era (10%). Conclusions Clinical, biochemical, and instrumental features of SAT related to SARS-CoV2 are like those observed in SAT cases reported prior to COVID-19 pandemic, but it appears more severe.

Subacute thyroiditis following COVID-19: A systematic review

“…Consistent with early reviews (4,11,(64)(65)(66), we observed at least one of the ESR or CRP variables elevating in all patients. The ESR increased in the majority of the cases (99%), while the CRP increased in 85%.…”

“…The clinical SAT symptoms might not be typical; thus, thyroid ultrasonography may help to get to the correct diagnosis. In this regard and in agreement with almost all the previous cases ( 4 , 11 , 64 – 66 ), 92 patients in this review had the classic sonographic findings of SAT, which include bilateral or unilateral, localized or multifocal, and poorly defined hypoechoic regions ( 72 ). The previously conducted studies also found that in order to assess thyroid function, radionuclide scanning combined with ultrasound examination could significantly increase the diagnostic rate of SAT.…”

“…In the mentioned instances, radionuclide uptake in the thyroid gland ranges from very low or absent in the hyperthyroid phase to a normal appearance in the late recovery phase ( 73 , 74 ). Confirming the findings of the previous studies ( 4 , 64 , 65 ), there was a significant decrease in radionuclide uptake in all 34 cases undergoing thyroid scintigraphy. A previously firm thyroid nodule can rapidly grow in SAT setting, initially suggesting thyroid malignancy ( 70 ).…”

“…Although the relatively prolonged lag may question the correlation between these two entities, we included these two cases based on their positive serology (IgM, IgG) when SAT manifested ( 58 ). Similar to classic SAT and prior reviews ( 4 , 11 , 64 – 66 ), the most prevalent symptom was neck pain (69%) in the present study. Fever (54%) was the second most common symptom in the present study, congruent with merely two of the previously conducted studies ( 11 , 66 ).…”

“…Similar to classic SAT and prior reviews on COVID-19-associated SAT ( 12 ), the current systematic review study was performed on the patients aged 18 to 85 years, with a majority of women (68%). The age range in the present study was longer than that of several previously-published reviews ( 4 , 11 , 64 – 66 ). In line with the most prevalent COVID-19 symptoms ( 66 , 67 ), fever and cough were the two most frequent complaints of the patients during COVID-19 infection and before SAT manifestations.…”