Keywords
COVID-19
Corticosteroids
Hypothyroidism
Viruses
Nonsteroidal anti-inflammatory drugs
How to Cite
Abstract
Introduction: Subacute thyroiditis (SAT) is the most common painful thyroid inflammatory disorder. It is preceded by predominantly viral respiratory infections.
Purpose: Review of the literature in the Pubmed database of SAT regarding the etiology, and its relationship with the SARS-COV-2 virus, the clinical presentation, and a comparison between the different treatment schemes with glucocorticoids.
Case presentation: 29-year-old female, presented mild respiratory infection by COVID-19. Thyroid function tests with suppressed TSH and increased free T4, previously normal. Absence of symptoms of SAT or other thyroid condition. Thyroid ultrasound with evidence of bilateral adenopathies. Scintigraphy with report of "almost absence of scintigraphic representation of the thyroid gland" with technetium trapping index: 1.4 (N: 2-5-4.5).
Discussion and conclusion: Compromise of the thyroid gland as a sequel to acute respiratory infection by COVID-19, manifests from Graves' disease, Hashimoto's thyroiditis, to subacute thyroiditis, this being the most commonly associated disorder. The clinical course of TSA in SARS-COV-2 is painless; latency period between infection and thyroiditis is shorter or even occurs simultaneously. SAT is an inflammatory thyroid disorder, with SARS-COV-2 being a new causal agent, with changes in clinical presentation. The greatest impact of corticosteroids in the management of subacute thyroiditis is in pain control; consider its use after the use of NSAIDs, and in case of possible recurrence of pain, it should be given for 4-6 weeks.
References
Bindra A, Braunstein GD. Thyroiditis. Am Fam Physician. 2006;73(10):1769-76.
Asociación Colombiana de Endocrinología, Colombiana de Salud S. A. Guía de atención y manejo de hipotiroidismo. Acta Med Colomb. 1999;24:159-74.
Desailloud R, Hober D. Viruses and thyroiditis: An update. Virol J. 2009;6. https://doi.org/10.1186/1743-422X-6-5
Brancatella A, Viola N, Rutigliano G, Sgrò D, Santini F, Latrofa F. Subacute Thyroiditis during the SARS-CoV-2 Pandemic. J Endocr Soc. 2021;5(10):1-8. https://doi.org/10.1210/jendso/bvab130
Sato D, Nishiguchi S, Tanaka E. Successful management of subacute thyroiditis following SARS-CoV-2 infection. Intern Med. 2021;60(22):3573-6. https://doi.org/10.2169/internalmedicine.7913-21
Stasiak M, Lewi?ski A. New aspects in the pathogenesis and management of subacute thyroiditis. Rev Endocr Metab Disord. 2021;22(4):1027-39. https://doi.org/10.1007/s11154-021-09648-y
Stasiak M, Michalak R, Stasiak B, Lewi?ski A. Clinical characteristics of subacute thyroiditis is different than it used to be - Current state based on 15 years own material. Neuroendocrinol Lett. 2018;39(7):489-95.
Pearce EN, Farwell A, Braverman L. Thyroiditis. N Engl J Med. 2003;(3):2646-55. https://doi.org/10.1056/NEJMra021194
Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016;26(10):1343-421. https://doi.org/10.1089/thy.2016.0229
Zhang J, Ding G, Li J, Li X, Ding L, Li X, et al. Risk Factors for Subacute Thyroiditis Recurrence: A Systematic Review and Meta-Analysis of Cohort Studies. Front Endocrinol (Lausanne). 2021;12:1-11. https://doi.org/10.3389/fendo.2021.783439
Lui DT, Lee CH, Chow WS, Lee AC, Tam AR, Fong CH, et al. Thyroid dysfunction in relation to immune profile, disease status, and outcome in 191 patients with COVID-19. J Clin Endocrinol Metab. 2021;106(2):E926-35. https://doi.org/10.1210/clinem/dgaa813
Murugan AK, Alzahrani AS. SARS-CoV-2: Emerging role in the pathogenesis of various thyroid diseases. J Inflamm Res. 2021;14:6191-221. https://doi.org/10.2147/JIR.S332705
Lania A, Sandri MT, Cellini M, Mirani M, Lavezzi E, Mazziotti G. Thyrotoxicosis in patients with COVID-19: The THYRCOV study. Eur J Endocrinol. 2020;183(4):381-7. https://doi.org/10.1530/EJE-20-0335
Christensen J, O’Callaghan K, Sinclair H, Hawke K, Love A, Hajkowicz K, et al. Risk factors, treatment and outcomes of subacute thyroiditis secondary to COVID?19: A Systematic Review. Intern Med J. 2021. https://doi.org/10.1111/imj.15432
Stasiak M, Zawadzka-Starczewska K, Lewi?ski A. Clinical manifestation of subacute thyroiditis triggered by SARS-CoV-2 infection can be HLA-dependent. Viruses. 2021;13(12):1-9. https://doi.org/10.3390/v13122447
Ur-Rehman MA, Farooq H, Mohsin M, Ebaad-Ur M, Anwar-Dar Q, Hussain A. The Association of Subacute Thyroiditis with COVID-19: a Systematic Review. SN Compr Clin Med. 2021;3(7):1515-27. https://doi.org/10.1007/s42399-021-00912-5
Pirola I, Gandossi E, Rotondi M, Marini F, Cristiano A, Chiovato L, et al. Incidence of De Quervain’s thyroiditis during the COVID-19 pandemic in an area heavily affected by Sars-CoV-2 infection. Endocrine. 2021;74(2):215-8. http://dx.doi.org/10.1007/s12020-021-02841-8
Hanife S, Nahit S, Gönül B, Gürlek A, Erbas T, Ünlütürk U. SARS-CoV-2 Vaccine-induced Thyroiditis: Safety of Revaccinations and Clinical Follow-up. J Clin Endocrinol Metab. 2022;107(5):e1823-34. https://doi.org/10.1210/clinem/dgac049
Duan L, Feng X, Zhang R, Tan X, Xiang X, Shen R, et al. Short-term versus 6-week prednisone in the treatment of subacute thyroiditis: a randomized controlled trial. Endocr Pract. 2020;26(8):900-8. https://doi.org/10.4158/EP-2020-0096
Sencar ME, Calapkulu M, Sakiz D, Hepsen S, Kus A, Akhanli P, et al. An Evaluation of the Results of the Steroid and Non-steroidal Anti-inflammatory Drug Treatments in Subacute Thyroiditis in relation to Persistent Hypothyroidism and Recurrence. Sci Rep. 2019;9(1):1-8. https://doi.org/10.1038/s41598-019-53475-w
Kubota S, Nishihara E, Kudo T, Ito M, Amino N, Miyauchi A. Initial treatment with 15 mg of prednisolone daily is sufficient for most patients with subacute thyroiditis in Japan. Thyroid. 2013;23(3):269-72. https://doi.org/10.1089/thy.2012.0459
Arao T, Okada Y, Torimoto K, Kurozumi A, Narisawa M, Yamamoto S, et al. Prednisolone dosing regimen for treatment of subacute thyroiditis. J UOEH. 2015;37(2):103-10. https://doi.org/10.7888/juoeh.37.103
Koirala KP, Sharma V. Treatment of acute painful thyroiditis with low dose prednisolone: A study on patients from Western Nepal. J Clin Diagnostic Res. 2015;9(9):2-4. https://doi.org/10.7860/JCDR/2015/14893.6427
Hepsen S, Akhanli P, Sencar ME, Duger H, Sakiz D, Kizilgul M, et al. The evaluation of low- and high-dose steroid treatments in subacute thyroiditis: a retrospective observational study. Endocr Pract. 2021;27(6):594-600. https://doi.org/10.1016/j.eprac.2020.11.009
Görges J, Ulrich J, Keck C, Müller-Wieland D, Diederich S, Janssen O. Long-term Outcome of Subacute Thyroiditis. Exp Clin Endocrinol Diabetes. 2020;128(11):703-8. https://doi.org/10.1055/a-0998-8035
Gozariu L, Stroe M, Vladutiu T, Yepez-Escobar NG, Simionescu L, Szantay I, et al. Late Hypothyroidism Following Subacute Thyroiditis. Exp Clin Endocrinol Diabetes. 1986;87(1):48-52. https://doi.org/10.1055/s-0029-1210522
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