Cases Of Subacute Thyroiditis Research Articles

Subacute thyroiditis in the SARS-CoV-2 era: a multicentre prospective study.

Many cases of subacute thyroiditis (SAT) have been described related to SARS-CoV-2 infection, but no prospective data about follow-up are known. This prospective, longitudinal, 3-year, multicentre study aims to explore the clinical peculiarities and outcome of SAT in relation to SARS-CoV-2 infection, ascertained with antibody dosage. All patients receiving SAT diagnosis from November 2020 to May 2022 were enrolled. Data on anamnesis, physical examination, blood tests (TSH, freeT4, freeT3, thyroglobulin, anti-thyroid antibodies, C-reactive protein, erythrocyte sedimentation rate, complete blood count), and thyroid ultrasound were collected. At baseline, the presence of IgG against the SARS-CoV-2 spike protein or nucleocapsid was investigated. Patients were evaluated after 1, 3, 6, and 12 months. Sixty-six subjects were enrolled. At baseline, 54 presented with pain, 36 (67%) for at least 15 days. Serum SARS-CoV-2 IgG measurements documented that 7 out of 52 subjects (13.5%) had infection before SAT diagnosis (COVID+). No significant differences between the COVID+ and COVID- groups were found at baseline, except for respiratory symptoms and fever, which were more common in COVID+ (P = 0.039 and P = 0.021, respectively). Among the 41 subjects who completed follow-up, COVID+ and COVID- did not differ for therapeutic approach to SAT or outcome, all having an improvement in neck pain, inflammation parameters, and ultrasound features. This is the first prospective study investigating any difference both at diagnosis and at follow-up between SAT presentation in patients with previous SARS-CoV-2 infection and those without. Our data demonstrate that SARS-CoV-2 does not impact on SAT onset, evolution, and outcome.

THU656 Subacute Thyroiditis In Early Pregnancy: A Rare Case Report

Abstract Disclosure: F. El Sayed: None. D. Shelden: None. Background Subacute thyroiditis (SAT) is a self-limiting inflammatory disorder that can be caused by a viral infection and presents with neck pain, fever, and fatigue. To date, only 8 cases of SAT have been reported in pregnant women. Hyperthyroidism during pregnancy is associated with both maternal and neonatal complications. The early diagnosis and treatment of SAT during pregnancy may play a vital role in prevention of adverse fetal outcomes. Case Presentation A 37-year-old female in her 6th week was referred to the endocrinology clinic for neck pain that started two months ago following a viral sore throat. She also reported exhaustion, palpitations, and occasional dysphagia. This is her 10th pregnancy, and she reports a history of thyroid isthmic cysts with hemorrhagic degeneration drained in 2014.The patient is a former occasional smoker and denies alcohol or drug use. Family history is significant for autoimmune disease in her sibling, and type 2 diabetes mellitus in her father. On physical exam, her neck is soft, supple, with no lymphadenopathy. The thyroid gland is enlarged to approximately 40 grams and is mildly tender to palpation. Labs were significant for thyroid-stimulating hormone (TSH) of 0.01 uIU/ml (reference range 0.4-4.5 uIU/ml), serum-free triiodothyronine (FT3) of 4.7 pg/ml (reference rage 1.7-3.7 ng/dl), serum-free thyroxine (FT4) 1.6 pg/ml (reference range 0.7-1.5 pg/ml), ESR 67 mm/hr (reference range 0-18 mm/hr), CRP 52.6 mg/L(reference range <8 mg/L). Thyroid ultrasound revealed enlarged heterogeneous thyroid gland , with poorly defined hypoechoic areas. Based on patients’ symptoms, physical examination, and laboratory findings she was diagnosed with SAT. After review of prior literature and coordination with the patient’s obstetrician, she was started on prednisone 20 mg with a plan to taper by 5 mg weekly with close observation of thyroid function tests. Antibody assessment of thyroid was diffusely negative. Repeat assessment of the patient’s thyroid function tests showed improvement in tsh, FT3, and FT4 to 0.04, 2.4, and 0.9 respectively. The patient reported feeling significantly improved at the 2 week mark. Discussion and conclusion SAT during pregnancy is rare but requires careful management. To date, various treatment modalities are reported in case studies but there is a lack of consensus on medication dosing given the rarity of the presentation. The pathogenesis of SAT is still unknown but is thought to be secondary to destruction of thyroid follicular cells, resulting in the release of thyroid hormone and symptoms of thyrotoxicosis. SAT diagnosis is based on the patient's medical history, symptoms, physical and laboratory findings, and exclusion of other reasons for thyroid dysfunction. Pregnant women with hyperthyroidism need to be differentiated from Graves' disease, and monitoring of thyroid hormone levels is important for fetal outcomes. Presentation: Thursday, June 15, 2023

Subacute thyroiditis presenting as simple acute headache was misdiagnosed as meningitis: case report and literature review

BackgroundThe relationship between headache and thyrotoxicosis has been occasionally mentioned in case reports, but there are few related reports. Thus, the relationship cannot be determined. Few cases of subacute thyroiditis (SAT) presenting as simple headache have been reported.Case presentationThis case report describes a middle-aged male patient who came to our hospital with acute headache for 10 days. He was initially misdiagnosed as meningitis due to headache, fever, and increased C-reactive protein. Routine antibacterial and antiviral therapy did not improve his symptoms. Blood test suggested thyrotoxicosis, and color ultrasound suggested SAT sonography. He was diagnosed with SAT. With the treatment of SAT, the headache was relieved after the thyrotoxicosis improved.ConclusionThis patient is the first detailed report of SAT presenting with simple headache, which is helpful for clinicians to differentiate and diagnose atypical SAT.

Subacute Thyroiditis and the SARS-Cov-2: What Relationship?

Background: De Quervain's thyroiditis is an inflammatory thyroid disorder. The new coronavirus is incriminated as the causative agent. Aims: We describe two cases of subacute thyroiditis, the first is linked to covid-19 infection, and the second is secondary to the SARS-CoV-2 vaccine. Methods: A 48-year-old female, presented with severe anterior neck pain, and thyroid dysfunction; the thyroid ultrasound showed an enlarged gland, with external hypoechoic areas. The RT-PCR was positive, the patient was treated according to the protocol of covid-19. A 49-year-old female, consulted for intense neck pain, one month after receiving the first dose of vaccination (Astrazeneca); the cervical ultrasound showed an external hypoechoic areas. Results: In first case, neck pain and other signs disappeared in one week. In second case, neck pain disappeared within two weeks. Conclusion: Clinicians should be aware of the possibility of thyroiditis in patients infected with Sars-COV-2.

COVID INDUCED THYROIDITIS: A CASE REPORT

INTRODUCTION: Thyroiditis is one of the manifestations of novel Covid-19 virus. Thyroid function test (TFTs) shows typical features of hyperthyroidism. Inflammatory markers [erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and serum ferritin] and thyroid scan give clue to the diagnosis. Up till now very few cases of subacute thyroiditis (SAT) due to Covid-19 have been reported CASE DESCRIPTION: We present a case of 39-year-old female with no personal or family history of thyroid disorder presented with features suggestive of thyrotoxicosis along with pain in the neck, odynophagia and intermittent fever after recovering from covid-19 recently i.e. 2 weeks before the onset of symptoms. TFTs revealed high triiodothyronine-T3 (1.8 ηg/ml) and thyroxine-T4 (2.66 ηg/dl) and low TSH (<0.04 uIU/ml). Thyroid scan revealed decrease uptake, ESR was 115 mm/hour, CRP was 48 mg/L and serum ferritin was 740ηg/ml. She was started on non-steroidal anti-inflammatory drugs, steroids and beta blocker. Four weeks later she reverted back with the resolution of symptoms and normal TFTs. CONCLUSION: Early recognition and timely management of SAT with anti-inflammatory therapy can help in successful management of the disease.

Thyroiditis following vaccination against COVID-19: Report of two cases and review of the literature

IntroductionImmune response following viral infections has been suggested as a probable mechanism leading to subacute thyroiditis (SAT). A few cases of SAT following SARS-CoV-2 infection have been described since the outbreak of the pandemic in 2019. Cases of SAT after vaccination against influenza have also been reported. We describe two female patients with thyroiditis after vaccination against SARS-CoV-2. Presentation of casesThe first patient presented with fever and pain in the thyroid area typical of SAT two weeks after vaccination with the BNT162B2 mRNA (Pfizer-BioNTech) COVID-19 vaccine. The second patient presented with biochemical and imaging features consistent with silent thyroiditis three weeks after vaccination with the ChAdOx1-S (AstraZeneca) vaccine. Both patients were asymptomatic prior to vaccination and PCR of nasopharyngeal swab for SARS-CoV-2 and other respiratory viruses associated with SAT was negative. Serology testing for measles, mumps, rubella, CMV and EBV viruses was suggestive of immunity. Antibody titre against spike S protein of SARS-CoV-2 was measured for both patients and was indicative of adequate post vaccination antibody response. Two months after initial assessment, both patients were euthyroid and asymptomatic. ConclusionsSubacute as well as silent thyroiditis may rarely occur after vaccination against COVID-19. Further research is needed to investigate the prevalence and pathogenesis of thyroid dysfunction following vaccination against COVID-19.

Evaluation of Thyroid Status in Hospitalized Patients with COVID-19.

Abstract Background: Preliminary data suggest that thyroid dysfunction may commonly occur in association with coronavirus disease-2019 (COVID-19). Objective: To clarify the significance of abnormal thyroid tests in patients with COVID-19 admitted to the hospital. Methods: PUBMED search of English literature until September 22, 2020. Since there is lack of randomized trials, case reports, retrospective studies, and National guidelines are reviewed. Results: Retrospective studies suggest that 7%-60% of patients with COVID-19 admitted to the hospital display thyroid hormone alterations typical of non-thyroidal illness (NTI). The extent of thyroid hormone changes correlates with severity of COVID-19. In NTI, thyroid hormones normalize with recovery of COVID-19 without specific treatment. Measurement of thyroid hormones in admitted COVID-19 patients without symptoms or signs suggestive of abnormal thyroid function may lead to unnecessary further investigations and increase cost. In addition, routine measurement of thyroid hormones can create confusion in interpretation of results. Other new onset thyroid diseases are rarely reported in admitted COVID-19 patients. Only 4 well-documented cases of subacute thyroiditis were reported in association with infection with COVID-19. Conclusions: Alterations of thyroid hormones due to NTI are common in hospitalized patients with COVID-19 and return to normal spontaneously with recovery without thyroid-directed therapy. Routine measurement of thyroid hormones is not indicated in patients who do not have pertinent thyroid symptoms or signs.

Is Dipeptidyl Peptidase-4 Inhibitor a Risk Factor to Develop Permanent Hypothyroidism in Subacute Thyroiditis in Patients with Type 2 Diabetes Mellitus?

Abstract Introduction: Permanent hypothyroidism rationale is presented in 5 - 26% of the subacute thyroiditis patients. In the last decade, three cases of Subacute Thyroiditis (SAT) were treated with Dipeptidyl Peptidase-4 Inhibitor (DPP-4i) in patients with Type 2 Diabetes Mellitus (T2DM). Case Presentation: Case 1:52-year-old woman presented with T2DM on tolbutamide and sitagliptin. She was diagnosed with SAT and managed with loxoprofen sodium hydrate while maintaining her antidiabetic agents. Three months later, the thyroid function returned to euthyroid condition. Case 2: 74-year-old man T2DM patient on metformin, glimepiride, and sitagliptin. He was diagnosed with SAT and managed with loxoprofen sodium hydrate while maintaining ongoing antidiabetic management. One month later, his thyroid function deteriorated to hypothyroidism and further nine months later, the thyroid returned to euthyroid function. Case 3: 69-year-old-man T2DM patient on vildagliptin. He was diagnosed with SAT and managed with prednisolone (10mg/ day) with cessation of vildagliptin and introduction of insulin therapy. One month later, the thyroid function returned to euthyroid function. Conclusions: We experienced SAT during the administration of DPP-4i in three T2DM patients. Although one of them experienced transient hypothyroidism, none developed permanent hypothyroidism. DPP-4i may not be a risk factor of permanent hypothyroidism in SAT patients with T2DM. Keywords DPP4 inhibitors; Subacute thyroiditis; Type 2 diabetes mellitus Abbreviations DPP-4i: Dipeptidyl Peptidase-4 Inhibitor; TSH: Thyroid Stimulating Hormone; FT3: Free Triiodothyronine; FT4: Free Thyroxine; Tg: Thyroglobulin; CRP: C-Reactive Protein; Trab: TSH Receptor Antibody; Anti-Tg-Ab: Anti-Thyroglobulin Antibody

Management of Subacute Thyroiditis with Conventional High-Dose Prednisolone; Shooting a Tree Sparrow with a Cannonball

Background: A well-established medical entity, and typically self-limited disorder, the subacute thyroiditis (SAT), has been conventionally treated with a large dose (40-80 mg) of prednisolone per day for decades: a nonevidence- based and utterly large dose of corticosteroid for a disease with clearly predictable self-limiting course. The current study was designed to evaluate the efficacy of prednisolone 15 mg/day instead of routinely prescribed large dose of 40-80 mg, and to investigate the rate of early relapse with low-dose protocol. Subjects and methods: In a prospective study, forty-five cases of SAT were consecutively included. The diagnosis of SAT was made based on defined criteria of persistent sore throat, rapidly developed painful goiter, suppressed TSH, high ESR, and low RAIU. They were treated with 15 mg of prednisolone per day during the first month, 10 mg per day for the second month, and finally 5 mg daily over the third month. All cases were carefully followed for a minimum of one year to track the clinical and biochemical response to therapy and to find out any evidence of early relapse after discontinuation of medication. Results: Of forty-five patients who completed the oneyear- course of follow-up, 38 were female and 7 were male (male/female ratio 5.4). Mean age of affected subjects was 39 ± 10 years, and mean ESR was 70 ± 23 mm/hr (median 75 mm/hr, range 30-117 mm/hr). Among all subjects with full-blown SAT, only one case (2.2%) remained noticeably symptomatic on 15 mg prednisolone daily after two weeks, requiring 30 mg of medicine per day for symptomatic relief and normalization of ESR. After corticosteroid withdrawal, significant relapse occurred in only two patients (4.4%). Conclusion: Our results, not only endorse the efficacy of low-dose prednisolone in management of subacute thyroiditis, but also demonstrate the remarkably less relapse with low dose corticosteroid.

Erythrovirus B19 and autoimmune thyroid diseases. Review of the literature and pathophysiological hypotheses.

Erythrovirus B19 (EVB19) has been incriminated, over recent years, in the onset and/or pathogenesis of many diseases, especially autoimmune thyroid diseases. This review of the literature (published over the last 40 years using Pubmed and Science Direct search engines) was designed to define the role of EVB19, particularly in autoimmune thyroid diseases.Two cases of subacute thyroiditis, one case of Graves' disease (associated with type 1 diabetes and rheumatoid arthritis), and one case of Hashimoto's thyroiditis following acute EVB19 infection were reported. A retrospective case-control study in a pediatric population demonstrated the role of EVB19 in Hashimoto's thyroiditis. Four retrospective studies of pathology slides (including PCR, immunohistochemistry or in situ hybridization) and a prospective case-control study on pathology slides demonstrated the presence of EVB19 in thyroid tissue of patients with benign multinodular goiter, Graves' disease, autoimmune thyroiditis (including Hashimoto's thyroiditis), and thyroid cancer. EVB19 can be demonstrated in the thyroid gland in a wide range of diseases. Although acute EVB19 infection could theoretically trigger autoimmune thyroid disease, there is currently no evidence that EVB19 plays a specific role in the pathophysiology of autoimmune thyroid diseases.

Subacute thyroiditis: clinical presentation and long term outcome.

Few studies have been reported from the Kingdom of Saudi Arabia (SA) to describe the clinical presentation and long term outcomes of subacute thyroiditis (SAT). Our aim was to review the demographic, anthropometric, clinical presentation, laboratory results, treatment, and disease outcome in Riyadh region and to compare those with results from different regions of the Kingdom and different parts of the world. We reviewed the medical files of patients who underwent thyroid uptake scan during an 8-year period in King Khalid University Hospital. Only 25 patients had confirmed diagnosis of thyroiditis. Age and gender distribution were similar to other studies. Most patients presented with palpitation, goiter, and weight change. Elevated thyroid hormones, suppressed thyroid-stimulating hormone, and elevated ESR were reported. Among those, 7 cases of SAT were recorded. β-Blockers were prescribed to 57% and nonsteroidal anti-inflammatory drugs to 29% of SAT. Long follow-up demonstrated that 85.7% of SAT cases recovered, while 14.3% developed permanent hypothyroidism. In conclusion, SAT is uncommon in the central region of SA. Compared to the western region, corticosteroid is not commonly prescribed, and permanent hypothyroidism is not uncommon. A nation-wide epidemiological study to explain these interprovincial differences is warranted.

Subacute thyroiditis (de Quervain’s) due to influenza A: Presenting as fever of unknown origin (FUO)

Subacute (de Quervain’s) thyroiditis is a rare but important cause of fever of unknown origin. Most cases of subacute thyroiditis are caused by a variety of viruses, for example, Coxsackie, cytomegalovirus, Epstein–Barr virus, and adenovirus. Influenza immunization or infection may cause subacute thyroiditis. We present the first reported case of a fever of unknown origin due to seasonal influenza A in a 67-year-old woman.

Diagnostic value of qualitative and quantitative variables in thyroid lesions.

Two hundred and thirty-three thyroid lesions were studied by fine needle aspiration (FNA) cytology using standard cytologic criteria available in the literature. These included 114 cases of nodular colloid goitre (NCG), 47 cases of Hashimoto's thyroiditis (HT), 12 follicular adenomas (FAd), five cases of subacute thyroiditis and three cases of thyrotoxicosis among the benign lesions. The malignant lesions seen were 30 cases of papillary carcinoma (PCa), 16 follicular carcinomas (FCa), three cases with double lesions, e.g. papillary carcinoma with coexisting NCG, and three of papillary carcinoma with HT. Emphasis was given to eight qualitative and quantitative (morphometric) variables in these various thyroid lesions. Cell measurements were done using a Visopan Lux projection microscope. The three qualitative variables included type of nuclear membrane (regular/irregular), type of nuclear chromatin and the presence or absence of conspicuous nucleoli. The quantitative variables studied were nuclear diameter, nuclear area, cytoplasmic diameter, cytoplasmic area & N/C ratio. Statistical analysis was performed in order to know whether the standard cytologic criteria used at FNA cytology in the literature (increased cellularity, microfollicles, increased N/C ratio, absence of significant haemosiderin-laden macrophages and scanty colloid) could differentiate a follicular adenoma from a follicular carcinoma. A statistical analysis was also performed to establish the utility of the qualitative and quantitative variables. The results showed that none of the standard cytologic criteria applied could differentiate follicular adenoma from a follicular carcinoma. With regard to qualitative variables, irregularity of nuclear membrane and presence of conspicuous nucleoli were most significant in papillary carcinoma, followed by follicular carcinoma, then by follicular adenoma; these features being hardly evident in nodular colloid goitre and Hashimoto's thyroiditis. A coarse nuclear chromatin was most significant in follicular carcinomas followed by follicular adenomas. It was less obvious in the benign conditions, but more prominent in Hashimoto's thyroiditis compared with a goitre. It was also not obvious in a papillary carcinoma. Of the quantitative variables, all measurements were greatest in PCa > FCa > FAd > NCG = HT. When differentiating follicular adenoma from follicular carcinoma the qualitative variables of significance were the presence or absence of nucleoli, the chromatin pattern and regularity/irregularity of nuclear membrane; the nuclear area was the most important feature among quantitative variables.

Thyroiditis : Thyroid function and cytologic correlation - A study of 66 cases

During a study period from 1992 to 1994, 66 cases which were diagnosed as thyroiditis by Fine Needle Cytology were evaluated for functional status by assay of thyroid hormone levels. None of these patients had received treatment for their condition. Six of the 66 patients were diagnosed as sub-acute thyroiditis and the rest as lymphocytic thyroiditis without further qualification. Smears of lymphocytic thyroiditis were grouped into four morphological groups namely oxyphilic (21), mixed (16), focal (9), and hyperplastic (14 cases). The degree of lymphocytic infiltration as well as severity of follicle destruction was also graded. An attempt was made to correlate cytological findings with functional status of the thyroid gland. Eighty six percent of cases with severe follicle destruction and 90% of cases in the oxyphil subgroup were hypothyroid. Predictability was further bettered when both these findings were considered together. All 14 cases in the oxyphilic sub-group with significant destructive changes were hypothyroid. All six cases of subacute thyroiditis had elevated levels of thyroid hormones.

TWO CASES OF SUBACUTE THYROIDITIS DIFFICULT TO DISTINGUISH FROM THYROID CANCER

The diagnosis of subacute thyroiditis is not so difficult when it has typical symptoms. But in the case which has no tenderness of thyroid and no acute inflammatory symptoms, it is difficult to distinguish from another thyroid diseases. Recently we have encountered two cases of subacute thyroiditis. At first they were diagnosed as thyroid cancer because of lacking in typical symptoms. Both cases have a tumor in the thyroid, and we could not distinguish them from thyroid cancers by palpation and ultrasonographic findings. It was valuable to establish the diagnosis of subacute thyroiditis be following the changes in palpation and ultrasonographic findings of the tumors.

Increased Localization of 201 TI-Chloride in Subacute Thyroiditis

We present two cases of subacute thyroiditis in which increased radionuclide activity in the affected areas was observed on 201 Tl thyroid scintigrams. These were taken to evaluate cold areas on the 99m Tc-pertechnetate thyroid scintigrams. This finding suggests that 201 Tl may be a potentially useful radionuclide in visualizing inflammatory lesions.

Serum thyrotropin and thyroid hormones in the course of subacute thyroiditis.

ABSTRACT Three cases of subacute thyroiditis were observed throughout the course of the illness, in which serial measurements of protein-bound iodine (PBI), thyroxine (T4), triiodothyronine (T3), thyrotropin (TSH) and 24-hr thyroidal 131I uptake (131I uptake) were done. Suppressed TSH and 131I uptake were observed coincident with the elevation of PBI (or T4) and T3 during the acute phase. 131I uptake was hypernormal during the recovery phase, which was proceeded by the augmented secretion of TSH. In one subject, thyrotropin-releasing hormone (TRH) failed to produce TSH and T3 responses during acute phase. The elevations of TSH and T3 were observed with TRH during the recovery phase.

Subacute thyroiditis: Report of two cases

Two cases of subacute thyroiditis are reported. Cortisone produced dramatic suppression of all signs and symptoms in one case. In the second case cortisone, carried to the point of development of undesirable side-effects, produced no change in either the symptoms or the clinical appearance of the patient. This latter patient seemed to respond rapidly to x-ray therapy.