The Association of Subacute Thyroiditis with COVID-19: a Systematic Review

Abstract

The multisystem effects of SARS-CoV-2 encompass the thyroid gland as well. Emerging evidence suggests that SARS-CoV-2 can act as a trigger for subacute thyroiditis (SAT). We conducted a systematic literature search using PubMed/Medline and Google Scholar to identify cases of subacute thyroiditis associated with COVID-19 and evaluated patient-level demographics, major clinical features, laboratory findings and outcomes. In the 21 cases that we reviewed, the mean age of patients was 40.0 ± 11.3 years with a greater female preponderance (71.4%). Mean number days between the start of COVID-19 illness and the appearance of SAT symptoms were 25.2 ± 10.1. Five patients were confirmed to have ongoing COVID-19, whereas the infection had resolved in 16 patients before onset of SAT symptoms. Fever and neck pain were the most common presenting complaints (81%). Ninety-four percent of patients reported some type of hyperthyroid symptoms, while the labs in all 21 patients (100%) confirmed this with low TSH and high T3 or T4. Inflammatory markers were elevated in all cases that reported ESR and CRP. All 21 cases (100%) had ultrasound findings suggestive of SAT. Steroids and anti-inflammatory drugs were the mainstay of treatment, and all patients reported resolution of symptoms; however, 5 patients (23.8%) were reported to have a hypothyroid illness on follow-up. Large-scale studies are needed for a better understanding of the underlying pathogenic mechanisms, but current evidence suggests that clinicians need to recognize the possibility of SAT both in ongoing and resolved COVID-19 infection to optimize patient care.

COVID-19-Associated Subacute Thyroiditis: Evidence-Based Data From a Systematic Review

“…The 17 case reports (16,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(36)(37)(38)(39)(40)(41) and the 2 case series (17,35) described carefully the history of patients and their SAT. In this context, it should be highlighted that two recent systematic reviews on a similar topic included 21 (48) and 17 (49) SAT cases, respectively. Our systematic review, conducted 3 months later and conceived with two specific aims, found 27 cases.…”

Vaccine-Induced Subacute Thyroiditis (De Quervain’s) after mRNA Vaccine against SARS-CoV-2: A Case Report and Systematic Review

“…Diagnosis is usually performed by clinical features, laboratory findings, and ultrasound, whereas fine needle aspiration is reserved for selected cases to differentiate it from a thyroid neoplasm [ 5 ]. SARS-CoV-2 infection can act as a trigger for subacute thyroiditis [ 24 ], and a few cases of subacute thyroiditis were also reported after the SARS-CoV-2 vaccine [ 16 , 17 , 18 , 19 , 20 , 21 , 22 ], also referred to as ASIA syndrome [ 16 ]. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is responsible for numerous autoimmune disorders such as systemic lupus erythematosus, rheumatoid arthritis, or autoimmune endocrinopathies such as Hashimoto and subacute thyroiditis.…”

Subacute Thyroiditis Exacerbated by the COVID-19 Pandemic

“…Similarly, the detection of widespread follicular damage and parenchymal destructions in the thyroid gland in the autopsy series after the SARS pandemic in 2002-2003 strengthens the relationship between SAT and SARS-CoV-2. 28,29 Moreover, many case reports and case series showing the relationship between SARS-CoV-2 and subacute thyroiditis have been published in the literature so far [10][11][12][13][14] . This relationship is so strong that there are cases that develop subacute thyroiditis even after vaccination.…”

“…This relationship is so strong that there are cases that develop subacute thyroiditis even after vaccination. 30 The most common symptoms in subacute thyroiditis cases developing after COVID-19 is fever and sore throat (81%) as in other agents 11 Therefore, it is difficult to diagnose SARS-CoV-…”

“…It is also possible for a condition of essentially autoimmune origin to arise, such as subacute thyroiditis. [10][11][12][13][14] In this study, we aimed to highlight that SARS-CoV -2 may play a role in the etiology of subacute thyroiditis, which usually manifests clinically within a few weeks to months following upper respiratory tract infection or other viral infections. We also wanted to emphasize that SAT should be kept in mind in the clinical differential diagnosis of COVID-19 during the pandemic period.…”