Risk factors, treatment and outcomes of subacute thyroiditis secondary to COVID‐19: a systematic review

Abstract

Background COVID‐19 is known to cause an acute respiratory illness, although clinical manifestations outside of the respiratory tract may occur. Early reports have identified SARS‐CoV‐2 as a cause of subacute thyroiditis (SAT). Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. MEDLINE, Web of Science and PubMed databases were queried in February 2021 for studies from December 2019 to February 2021. MeSH search terms ‘COVID‐19’, ‘SARS‐CoV‐2’ and ‘coronavirus’ along with search terms ‘thyroiditis’, ‘thyrotoxicosis’ and ‘thyroid’ were used. Descriptive statistics for continuous variables and proportions for categorical variables were calculated. Results Fifteen publications reporting on 17 individual cases of COVID‐19‐induced SAT were identified. Age ranged from 18 to 69 years. The majority (14 of 17; 82%) of cases were female. The delay between onset of respiratory symptoms and diagnosis of SAT ranged from 5 to 49 days (mean, 26.5). Systemic inflammatory response syndrome related to viral infection was uncommonly reported at the time of SAT diagnosis. Thyroid ultrasonography frequently reported an enlarged hypoechoic thyroid with decreased vascularity and heterogenous echotexture. Elevated C‐reactive protein (CRP) was common at the time of SAT diagnosis, with results ranging from 4.5 to 176 mg/L (mean, 41 mg/L). Antithyroid antibodies were frequently negative. SAT‐specific treatment included corticosteroids for 12 of 17 (70.5%) patients. Most returned to normal thyroid status. Conclusion COVID‐19‐associated SAT may be difficult to identify in a timely manner due to potential absence of classic symptoms, as well as cross‐over of common clinical features between COVID‐19 and thyrotoxicosis.

Evaluation of the diagnostic features and clinical course of COVID-19 vaccine–associated subacute thyroiditis

“…SAT developed in 10 patients after inactivated COVID-19 vaccine (CoronaVac®, Sinovac Life Sciences, Beijing, China) and in six patients after the COVID-19 messenger RNA (mRNA) (Pfizer-BioNTech®) vaccination. The median duration of symptom onset after vaccination was 6.5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) days. Baseline characteristics of the study population are depicted in Table 1.…”

Tiroiditis por infección por COVID-19: reporte de caso

“…En el caso presentado, se encuentra el diagnóstico de la infección a los siete días de inicio de los síntomas, 19 días después se documenta la fibrilación auricular. En la literatura se reporta un rango entre 5 a 49 días entre aparición de síntomas y aparición de sintomatología de tiroiditis (7), lo cual se ajustaría a lo presentado en este caso clínico.…”

“…En el caso en mención el paciente no tiene antecedentes de enfermedad tiroidea, acorde con los hallazgos de tiroiditis atípica observada en los reportes de caso encontrados en el metaanálisis de Christensen (4,7). El paciente del caso por la intubación y, posteriormente, la traqueostomía, junto con el soporte analgésico, no se pudo definir si presentó dolor como síntoma más frecuentemente asociado en las revisiones previas.…”

Thyroid Dysfunction and COVID-19: The Emerging Role of Selenium in This Intermingled Relationship

“…Multiple mechanisms have been proposed as contributors to pathogenic pathways resulting in thyroid follicular cell destruction [ 85 ]. Thyroid damage could result from a direct effect of SARS-CoV-2 [ 23 ].…”