Recurrent Graves’ disease post SARS-CoV-2 infection
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SARS-CoV-2, the causative agent for COVID-19, has been reported to be a trigger for new or recurrent autoimmune thyroid disease. The acute inflammatory response to SARS-CoV-2 is believed to trigger an immunological response causing reactivation of Graves’ disease. A handful of similar cases have been reported and our index case sheds more light on this possible complication post infection with SARS-CoV-2.

A 22-year-old woman was diagnosed with thyrotoxicosis 8 weeks after the diagnosis of a mild COVID-19 infection. She had reported significant unexplained weight loss after testing positive for COVID-19, but failed to seek medical attention. She recovered well from COVID-19, but presented to the emergency department with worsening symptoms of thyrotoxicosis after 2 months.

In view of her known history of previously treated Graves’ disease, a recurrence of Graves’ thyrotoxicosis was suspected. A positive thyroid stimulating hormone receptor antibody confirmed the diagnosis. She was started on carbimazole and propranolol treatment with significant improvement of her symptoms.

Learning points:
- New or recurrent Graves’ disease may present during or a few weeks after mild or severe COVID-19 infection.

- A low threshold for the diagnosis of Graves’ disease should be kept in mind in patients who present with symptoms of thyrotoxicosis post COVID-19.

- These patients respond well to antithyroid medication.