Subacute Thyroiditis Associated with COVID-19: A Case Report
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Subacute thyroiditis is a self-limiting inflammatory disorder, characterized by neck pain or discomfort, a tender diffuse goiter, and sometimes a transient episode of hyperthyroidism followed by euthyroidism and sometimes hypothyroidism. There is usually a normalization of thyroid function within a few weeks. Subacute thyroiditis has a higher incidence in summer and has been linked to a viral or bacterial upper respiratory postinfection inflammatory response.

A previously healthy 37-year-old female experienced odynophagia and anosmia with no other respiratory symptoms. Her laboratory exams confirmed COVID-19 (RT-PCR for SARS-Cov-2) and was prescribed symptomatic treatment for her mild disease improving completely in the following days.

A month after her initial presentation, she presented to the ENT doctor with severe neck pain (8/10) irradiating to the right jaw and ear as well as fatigue. She did not mention any clinical signs of hyperthyroidism (tremor, anxiety, or diaphoresis) but was referred to the endocrinologist with the suspicion of SAT. At this time, her physical exam was significant only for a moderately enlarged tender thyroid gland and neck adenopathies. Her lab test results showed elevated ESR and CRP, anemia, and normal platelet and leukocyte counts. Her thyroid tests were positive for hyperthyroidism with an undetectable TSH, T4 total 13.5?mcg/dL, T4 free 1.6?ng/dL, and T3 total 211?ng/dL. Anti-Tg and anti-TPO were negative. Thyroid iodine scan showed no radioactive iodine uptake. The diagnosis of subacute thyroiditis (SAT) was confirmed.

During her follow-up visit one month after the diagnosis, the patient has remained asymptomatic, but her lab tests are still relevant for anemia, thrombocytopenia, high ESR, and low TSH.

As most patients with SARS-Cov-2 are asymptomatic, researchers suggest to rule out SARS-Cov-2 infection in patients presenting with symptoms suggesting SAT.