COVID-induced thyroid autoimmunity

Brancatella, Alessandro; Viola, Nicola; Satini, Ferruccio; Latrofa, Francesco

doi:10.1016/j.beem.2023.101742

Cited by 18 publications

(9 citation statements)

References 56 publications

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“…During the SARS-CoV-2 (COVID-19) pandemic, cases of Graves disease and subacute thyroiditis related to COVID-19 infection or vaccination were reported, presumably due to the immunogenic nature of COVID-19. [18][19][20] A retrospective study reported a 2-fold increase in the incidence of Graves disease in a Spanish hospital in 2020-2021 compared with the pre-COVID-19 years (2017-2019). 21…”

Section: Covid-19 and Hyperthyroidismmentioning

confidence: 99%

Hyperthyroidism

Lee,

Pearce

2023

JAMA

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ImportanceOvert hyperthyroidism, defined as suppressed thyrotropin (previously thyroid-stimulating hormone) and high concentration of triiodothyronine (T3) and/or free thyroxine (FT4), affects approximately 0.2% to 1.4% of people worldwide. Subclinical hyperthyroidism, defined as low concentrations of thyrotropin and normal concentrations of T3 and FT4, affects approximately 0.7% to 1.4% of people worldwide. Untreated hyperthyroidism can cause cardiac arrhythmias, heart failure, osteoporosis, and adverse pregnancy outcomes. It may lead to unintentional weight loss and is associated with increased mortality.ObservationsThe most common cause of hyperthyroidism is Graves disease, with a global prevalence of 2% in women and 0.5% in men. Other causes of hyperthyroidism and thyrotoxicosis include toxic nodules and the thyrotoxic phase of thyroiditis. Common symptoms of thyrotoxicosis include anxiety, insomnia, palpitations, unintentional weight loss, diarrhea, and heat intolerance. Patients with Graves disease may have a diffusely enlarged thyroid gland, stare, or exophthalmos on examination. Patients with toxic nodules (ie, in which thyroid nodules develop autonomous function) may have symptoms from local compression of structures in the neck by the thyroid gland, such as dysphagia, orthopnea, or voice changes. Etiology can typically be established based on clinical presentation, thyroid function tests, and thyrotropin-receptor antibody status. Thyroid scintigraphy is recommended if thyroid nodules are present or the etiology is unclear. Thyrotoxicosis from thyroiditis may be observed if symptomatic or treated with supportive care. Treatment options for overt hyperthyroidism from autonomous thyroid nodules or Graves disease include antithyroid drugs, radioactive iodine ablation, and surgery. Treatment for subclinical hyperthyroidism is recommended for patients at highest risk of osteoporosis and cardiovascular disease, such as those older than 65 years or with persistent serum thyrotropin level less than 0.1 mIU/L.Conclusions and RelevanceHyperthyroidism affects 2.5% of adults worldwide and is associated with osteoporosis, heart disease, and increased mortality. First-line treatments are antithyroid drugs, thyroid surgery, and radioactive iodine treatment. Treatment choices should be individualized and patient centered.

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Section: Covid-19 and Hyperthyroidismmentioning

confidence: 99%

Hyperthyroidism

Lee,

Pearce

2023

JAMA

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“…Euthyroid sick syndrome is less likely to be a problem for patients with long COVID since it resolves after COVID-19 recovery 10 . There have been reports of new cases of GD after COVID-19 and an increase in the incidence of GD during the COVID-19 pandemic 23 , 24 . Possible mechanisms include aberrant T-cell subtype responses, presence of autoantibodies, regulatory cell dysfunction, and excessive inflammation and immunity due to cytokine overproduction 25 .…”

Section: Discussionmentioning

confidence: 99%

Occult endocrine disorders newly diagnosed in patients with post-COVID-19 symptoms

Nakano,

Sunada,

Tokumasu

et al. 2024

Sci Rep

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Determination of long COVID requires ruling out alternative diagnoses, but there has been no report on the features of alternative diagnoses. This study was a single-center retrospective study of outpatients who visited our clinic between February 2021 and June 2023 that was carried out to determine the characteristics of alternative diagnoses in patients with post-COVID-19 symptoms. In a total of 731 patients, 50 patients (6.8%) were newly diagnosed with 52 diseases requiring medical intervention, and 16 (32%) of those 50 patients (2.2% of the total) were considered to have priority for treatment of the newly diagnosed disorders over long COVID treatment. The proportion of patients with a new diagnosis increased with advance of age, with 15.7% of the patients aged 60 years or older having a new diagnosis. Endocrine and metabolic diseases and hematological and respiratory diseases were the most common, being detected in eight patients (16%) each. Although 35 of the 52 diseases (67%) were related to their symptoms, endocrine and metabolic diseases were the least associated with specific symptoms. Other disorders that require attention were found especially in elderly patients with symptomatic long COVID. Thus, appropriate assessment and differentiation from alternative diagnoses are necessary for managing long COVID.

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“…Although our patient had a history of GD before the infection, her symptoms were controlled even with her having slight intolerance to anti-thyroid medications. The exacerbation of GD following COVID-19 disease is rare, as the most common thyroid-related complication in such an illness is subacute thyroiditis [ 9 ]. When comparing our patient with other cases previously published, she had a similar presentation, with tachycardia, headache, and bilateral eye pressure; however, it is interesting to note that she had impending but not actual thyroid storm at presentation [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with a history of thyroid disease or a genetic disposition can experience a more severe infection [ 7 ]. New onset or exacerbation of GD is a rare complication that can occur from SARS-CoV-2 infection [ 8 , 9 ]. We report a case of a 42-year-old woman with a history of GD, with an impending thyroid storm, following a diagnosis of COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Graves\' Disease Exacerbation with Impending Thyroid Storm After SARS-CoV-2 Infection: A Case Report

Sebastian,

Parisa,

Pandya

et al. 2023

Am J Case Rep

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Patient: Female, 42-year-old Final Diagnosis: Graves disease Symptoms: Bilateral eye pressure • fatigue • muscle weakness • palpitations • goiter Clinical Procedure: — Specialty: Endocrinology and Metabolic • General and Internal Medicine Objective: Rare coexistence of disease or pathology Background: Since the COVID-19 pandemic, several cases of COVID-19 have been linked to the development of autoimmune disorders, including of the thyroid. Graves’ disease (GD) is a rare complication that can occur following SARS-CoV-2 infection. Reports have linked COVID-19 to new onset and exacerbation of GD. We present a case of a 42-year-old woman with a history of GD presenting with impending thyroid storm 3 weeks following a diagnosis of COVID-19. Case Report: A 42-year-old woman with a history of GD presented to the Emergency Department (ED) for an acute exacerbation of hyperthyroidism 3 weeks after SARS-CoV-2 infection was diagnosed on a home test. Symptoms included daily headaches, increased bilateral eye pressure, fatigue, muscle weakness, episodes of confusion and agitation, persistent heart palpitations, and goiter. Elevated free T4 of 5.57, free T3 of 15.68, total T3 of 4.43, and near-absent thyroid stimulating hormone were noted. The Burch-Wartofsky scale was 40, which was concerning for an impending thyroid storm; however, at the time of admission, she was not in a thyroid storm. Treatment included propylthiouracil, potassium iodide oral solution, and propranolol, with symptom improvement. Due to prior history of intolerance to antithyroid medications and recent exacerbation, a thyroidectomy was performed once she was in a euthyroid state. Conclusions: Our case demonstrates the importance of recognizing COVID-19 as an etiology or a trigger for new onset or exacerbation of GD. Our case highlights that being vigilant to recognize the association between COVID-19 and thyroid abnormalities for early diagnosis and treatment is imperative.

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COVID-induced thyroid autoimmunity

Cited by 18 publications

References 56 publications

Hyperthyroidism

Hyperthyroidism

Occult endocrine disorders newly diagnosed in patients with post-COVID-19 symptoms

Graves\' Disease Exacerbation with Impending Thyroid Storm After SARS-CoV-2 Infection: A Case Report

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