SARS-CoV-2 plays a pivotal role in inducing hyperthyroidism of Graves’ disease

Abstract

Coronavirus disease 2019 (COVID-19) advances to affect every part of the globe and remains a challenge to the human race. Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) was shown to affect many organs and organ systems including the thyroid gland as these parts highly express angiotensin-converting enzyme 2 (ACE2) protein, which functions as a receptor for initially entering the virus into the cells. Furthermore, some categories of the population including older people and persons with comorbidities are prone to be more vulnerable to COVID-19 and its complications. Recent reports showed that SARS-CoV-2 infection could cause Graves’ disease (autoimmune hyperthyroidism) in post-COVID-19 patients. Factors that may boost the mortality risk of COVID-19 patients are not completely known yet and a clear perception of the group of vulnerable people is also essential. This review briefly summarizes the features of Graves’ disease such as symptoms, risk factors, including environmental, genetic, immunological, and other factors, associated disorders, and therapeutic options. It comprehensively describes the recent advances in SARS-CoV-2-induced Graves’ disease and the pivotal role of autoimmune factors in inducing the disease. The review also discusses the possible risks of SARS-CoV-2 infection and associated COVID-19 in people with hyperthyroidism. Furthermore, it explains thyroid disease and its association with the severity of COVID-19.

Higher SARS-CoV-2 viral loads correlated with smaller thyroid volumes on ultrasound among male COVID-19 survivors

“…A recent case report described a 57-year-old woman with typical presentation of subacute thyroiditis, associated with positive anti-TPO and anti-Tg as well [ 24 ]. Moreover, a recent review discussed the potential of SARS-CoV-2 in inducing thyroid autoimmunity, hence, potentially Graves’ disease, which again predominantly affects women [ 29 ]. In contrast, our study focuses on SARS-CoV-2 associated thyroiditis, without the typical presentation of fever and neck pain.…”

SARS-CoV-2: Emerging Role in the Pathogenesis of Various Thyroid Diseases

“…121 Consistently, T-cell subsets, Th17 and Th22 were markedly implicated in the diverse clinical course of the autoimmune-thyroid diseases (AITDs) including, Hashimoto thyroiditis and Graves' disease suggest that rewiring the role of the Th1-Th2 on the AITD pathogenesis. 53,122 Furthermore, it is reasonable to suggest that hyperthyroid patients may have the paramount risk for SARS-CoV-2 infection and worst disease progression as these patients have hyperthyroidism-induced deregulated RAAS. This raises the possibility that susceptibility to the virus could be attributable to the cause of hyperthyroidism-induced overexpression of ACE2 or thyroid disease, particularly Graves' disease is the effect of viral pathogeneses.…”

“… 121 Consistently, T-cell subsets, Th17 and Th22 were markedly implicated in the diverse clinical course of the autoimmune-thyroid diseases (AITDs) including, Hashimoto thyroiditis and Graves’ disease suggest that rewiring the role of the Th1–Th2 on the AITD pathogenesis. 53 , 122 …”

Uncertainty around the Long-Term Implications of COVID-19

“…There has even been a suggestion acute COVID-19 disease should not be regarded as viral pneumonia, but instead considered an autoimmune disease [ 56 ]. SARS-CoV-2 has also been shown to play a pivotal role in inducing the autoimmune hyperthyroidism of Graves’ disease [ 57 ]. We echo the British Society for Immunology’s call for urgent research in this area [ 58 ].…”