Subacute Thyroiditis Patients Research Articles

The Effects of Corticosteroid and Nonsteroid Anti-Inflammatory Therapies on Permanent Hypothyroidism Occurring After the Subacute Thyroiditis

ABSTRACT Objective Subacute thyroiditis(SAT) is an acute inflammatory, self-limited, and destructive disease of the thyroid gland. Although it is a temporary disease, it has permanent consequences. We aim to investigate the influences of the treatment choice on permanent hypothyroidism occurring after SAT and whether there are predictive factors for the development of permanent hypothyroidism. Methods We retrospectively investigated 57 SAT patients admitted to our tertiary hospital between 2017 and 2019. After excluding 6 patients, demographic, clinical, laboratory, and imaging findings of 36 patients treated with NSAIDs and 15 patients treated with corticosteroids were compared. The median duration of follow-up was 4 (3.5-5.5) years. Results Permanent hypothyroidism occurred in 16 patients (31.4%) of 51 patients. It developed at a significantly higher rate in NSAID users (p=0.019). There was no significant difference in the occurrence of transient hypothyroidism and recurrence (p=0.472, p=0.082). The early maximum TSH values were strongly associated with permanent hypothyroidism. The Odds Ratio (OR) value was 2.59 (95% CI = 1.26 – 5.33, p=0.009), Nagelkerke R2 = 0.821. The early maximum TSH level had a predictive value, with an AUC of 0.966 for post-SAT permanent hypothyroidism (p<0.001). The cutoff values for the early maximum TSH were 9.07uIU/ml (81.3% sensitivity, 100% specificity), and 7.05 uIU/ml (87.5% sensitivity, 94.3% specificity). Conclusion Corticosteroid therapy is significantly effective in preventing permanent hypothyroidism from developing after SAT. The early maximum TSH values are an indicator for the prediction of the development of permanent hypothyroidism.

Determination of the Relationship Between the Development and Recurrence of Subacute Thyroiditis and Human Leukocyte Antigen Subtypes.

Background: There are several studies investigating the role of human leukocyte antigens (HLA) in the development and recurrence of subacute thyroiditis (SAT). The HLA subtypes associated with SAT were usually determined in a population-based manner and HLA-B*35, HLA-B*18:01, HLA-C*04:01, and HLA-DRB1*01 were detected to play a role in the disease susceptibility and prognosis. The aim of this study was to determine HLA alleles associated with the tendency of recurrence and prevention of SAT within the Turkish population. Methods: This prospective study was conducted with 51 SAT patients and 720 healthy bone marrow donor volunteers. HLA-A, -B, -C, -DRB1, and -DQB1 were genotyped using next-generation sequencing. Results: The frequency of HLA-A*02:09, HLA-B*35:01/35:02/35:03, HLA-C*04:01, HLA-DRB1*12:01, and DRB1*13:03 were associated with an increased risk of SAT development (Odds Ratio: 22.4, 9.5, 10.3, 4.2, and 3.5, respectively). While HLA-A*02:09, HLA-B*35:01, HLA-B*44:02 HLA-C*07:18, and HLA-C*16:04 were associated with nonrelapsing SAT, HLA-DR*12:01was associated with relapsing SAT. HLA-B*35:02, HLA-B*35:03, and HLA-C*04:01 were more frequent both in relapsing and nonrelapsing groups according to control group. The frequency of HLA-B*18:01, reported as a risk factor previously, was similar in the SAT and control groups (p = 0.959). HLA-DRB1*11:01 was associated with a lower risk of SAT development. Conclusions: Along with -B*358 and -C*04, HLA-A*02:09 was detected as an important risk factor for SAT development in our population. HLA-DRB1*11:01 appears to be the protective HLA subtype against SAT. HLA-A*02:09, HLA-B*35:01, HLA-B*44:02, HLA-C*07:18, HLA-C*16:04, HLA-DQ*06:03, and HLA-DR*12:01 subtypes can establish a tendency to relapsing or nonrelapsing SAT.

Comparison of the therapeutic effects of 15 mg and 30 mg initial daily prednisolone doses in patients with subacute thyroiditis: a multicenter, randomized, open-label, parallel-controlled trial

Introduction Current guidelines recommendations for the initial dose of prednisolone (PSL) in the treatment of subacute thyroiditis (SAT) are based on low-quality studies. We designed a randomized controlled trial (RCT) to compare the efficacy and safety of using a low initial dose of PSL with a standard initial dose of PSL in SAT patients. Patients and methods This open-label RCT was conducted at five hospitals in China from June 2019 to January 2022. SAT patients with moderate-to-severe pain or a poor response to non-steroidal anti-inflammatory drugs (NSAIDs) were randomly assigned in a 1:1 ratio to the experimental and control groups. The initial dose of PSL was 15 mg/d in the experimental group and 30 mg/d in the control group. The primary outcome was the total duration of PSL treatment, with non-inferiority prespecified with a margin of 7 days. Clinical trial registration number: ChiCTR1900023884. Results The full analysis set included 60 patients (30 in each group). The mean duration of PSL treatment in the experimental and control group was 34.62 ± 14.12 and 41.18 ± 16.89 days, respectively, meeting the non-inferiority criterion (pnon-inferiority = 0.0006). The total dose of PSL used in the experimental group was lower than in the control groups (330 vs 595 mg, p < 0.0001). There were no differences in the mean time to pain relief and complete resolution, the occurrence of recurrence, hypothyroidism, or adverse events between the groups. Conclusions The initial dose of 15 mg/d of PSL was not inferior to the dose of 30 mg/d in terms of efficacy and showed a similar safety profile. A low initial dose of PSL could be recommended for Chinese adult SAT patients who have a suboptimal response using NSAIDs or experience moderate-to-severe pain. KEY MESSAGES Low initial dose (15 mg/d) of prednisolone was non-inferior to the standard initial dose of prednisolone (30 mg/d) in treatment duration, time to pain relief, or the prevalence of hypothyroidism, recurrence, and adverse reactions in the treatment of subacute thyroiditis. Patients with subacute thyroiditis administered a low initial dose of prednisolone had a lower total dose of prednisolone compared to those receiving the standard dose of prednisolone.

Subakut Tiroiditte Prognoz Öngörülebilir mi?

Aim: Subacute thyroiditis (SAT) is a thyroid disease that seriously affects the quality of life for patients&#x0D; caused by acute inflammation of the thyroid gland. Apart from classical acute phase reactants, the values&#x0D; and rates obtained from peripheral blood count (mean platelet volume (MPV), neutrophil-to-lymphocyte&#x0D; ratio (NLR), and platelet-to-lymphocyte ratio (PLR)) values are also accepted as practical indicators&#x0D; of systemic inflammation. Our aim in this study is to compare the effects of systemic inflammation&#x0D; markers and the treatments given in the laboratory tests of our patients with a diagnosis of SAT, on the&#x0D; hypothyroid state one year later.&#x0D; Material and Methods: In this study, which was carried out with a retrospective method, 133 patients&#x0D; were included in the study. The medical data of these patients at the time of SAT diagnosis and one&#x0D; year later were analyzed. 37 patients were in the steroid group and 97 patients were in the nonsteroidal&#x0D; anti-inflammatory drug (NSAID) group.&#x0D; Results: The male/female ratio was similar in both groups. Female dominance was observed in both&#x0D; groups in patients diagnosed with SAT. The thyroid tests of the groups, which were hyperthyroid at the&#x0D; beginning and euthyroid one year later, were similar between the groups (p&gt;0.05). Both groups had&#x0D; an increase in acute phase reactants at baseline (erythrocyte sedimentation rate [ESR] and C-reactive&#x0D; protein (CRP) levels) and normalized after treatment. Neutrophil (p0.05) and&#x0D; platelet (p0.05).&#x0D; Conclusion: Inflammation markers and treatments applied in SAT patients did not have a significant&#x0D; effect on the prognosis

The effects of circulating MIR22-3p and MIR16-1-3p levels in different stages of subacute thyroiditis

Subacute thyroiditis (SAT) is an inflammatory thyroid disease with a frequency is 5% among all thyroid diseases. miRNAs are endogenous, non-coding RNAs ranging in length from 19 to 25 nucleotides. They play an important role in the posttranscriptional regulation of gene expression. In this study, we aimed to investigate whether the expression levels of two circulating miRNAs, MIR22 and MIR16-1, can be used as a parameter in the diagnosis and follow-up of SAT disease. Fifty patients diagnosed with SAT and 41 healthy controls were included in this study. Expression levels of miRNAs were determined by real time-PCR method. Expression data of miRNAs were calculated by fold change (2-ΔΔCt) method. The statistical significance of miRNA expression was evaluated by t-test. The expression levels of MIR22-3p and MIR16-1-3p were not found to be statistically different between SAT patients and controls and also between the patients in different stages (hyperthyroid, euthyroid, and hypothyroid) of the disease. According to correlation analyses, we observed a positive strong correlation between erythrocyte sedimentation rate (ESR) and the expression levels of MIR22-3p and MIR16-1-3p (r = 0.960, p = 0.000 and r = 0.865, p = 0.006, respectively), and a positive strong correlation between fT4 and the expression levels of MIR22-3p in SAT patients in euthyroid stage (r = 0.712, p = 0.047). In this study, we showed that the expression levels of MIR22-3p and MIR16-1-3p have correlation with clinical characteristics of SAT disease. Our results suggest that MIR22 and MIR16-1 may be effective in the pathogenesis of SAT.

A Novel Finding of an HLA Allele's and a Haplotype's Relationship with SARS-CoV-2 Vaccine-Associated Subacute Thyroiditis.

Subacute thyroiditis (SAT) is a thyroid disease associated with viral infections. Its relationship with major histocompatibility complex (MHC) antigens was shown before. SAT cases triggered by different types of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have been reported. In this study, human leukocyte antigen (HLA) genotypes of 27 SAT patients (13 vaccine-associated (V-SAT) and 14 non-SARS-CoV-2-infection non-vaccine-associated (non-V-SAT)) were compared with those of 362 healthy donors. HLA analyses were performed with low-resolution DNA-based sequence-specific oligonucleotide or sequence-specific primer methods. Statistical analyses were performed using IBM SPSS Statistics 25 and Stata/MP 14.1 with the hapipf function. Allele and haplotype frequencies were estimated by PyPop and gene[RATE] tool programs. The allele frequencies of HLA-A*11, HLA-B*35, and HLA-C*04 were higher in the patient groups. Both the allele frequency of HLA-A*11 and the haplotype frequency of A*11-B*35-C*04 were higher in the V-SAT group. The A*11-B*35-C*04 haplotype, including all three loci of MHC class I genes, is shown to be associated with the disease for the first time, especially in the V-SAT group. This finding will contribute to a better understanding of the etiopathogenesis of vaccine-associated SAT and the role of HLA genotypes in the functioning mechanisms of the SARS-CoV-2 vaccines.

Effect of Hematologic Values in Determining the Resolution of Subacute Thyroiditis and Long-Term Hypothyroidism Risk

Subacute thyroiditis (SAT), which can be considered a disease with infectious signs and parameters, can affect humans and lead to permanent hypothyroidism. Haematological parameters play an essential role in SAT; these parameters begin to normalise after the thyrotoxic phase; however, there is still a gap in knowledge about how these parameters play a role in SAT prognosis. Therefore, we wanted to investigate haematological parameters and their impact on treatment response and recovery phase in patients with SAT. 51 SAT patients and 44 healthy controls were included in the study. ESR, CRP, NLR and MPV were recorded at the diagnosis and after resolution. The changes in these parameters were compared to determine the resolution phase. The ratio of permanent hypothyroidism after one year was studied, and its relevance with these parameters at the time of diagnosis was explored. 36 of 51 SAT patients were female in the study (70.5%). The mean age was 45.53 ± 11.46 years. In the acute phase, WBC, Neutrophil, platelet, ESR, N/L, and P/L were significantly higher (p&lt;0.05). In the recovery phase, MPV and lymphocyte count were significantly higher (p: 0.002 and p=0.002). WBC, CRP, and ESR had the highest AUC values in ROC analysis (0.990, 0.959, 0.907, p&lt;0.05). P/L and N/L ratios also had higher ratios for the acute phase (0.807, 0.98, p&lt;0.05, respectively). Δ ESR, Δ CRP, Δ N/L, and Δ P/L had the highest AUC for the recovery phase (AUC= 0.990, 0.899, 0889,0.800, p&lt;0.5, respectively). Permanent hypothyroidism after one year was 9/42 (21.4%). In addition to ESR and CRP, NLR, PLR and MPV were also successfully used to estimate SAT activity and response to treatment. Moreover, a decrease in NLR and PLR and an increase in MPV were associated with the treatment response and resolution phase. However, these parameters did not determine the long-term risk of hypothyroidism.

Impact of the COVID-19 pandemic on the incidence, seasonal distribution, and characteristics of subacute thyroiditis.

PurposeAn increasing number of cases of subacute thyroiditis (SAT) related to the coronavirus disease 2019 (COVID-19) and its vaccines continue to be published. The aim of this study was to investigate any change in the incidence and characteristics of SAT by comparing the pre-pandemic and pandemic periods.MethodsThis retrospective, single-center study included 432 newly-diagnosed SAT patients between January 2018 and December 2021. The annual frequency of SAT was calculated as the number of newly-diagnosed SAT cases divided by the total number of outpatients that year.ResultsThe frequencies of newly-diagnosed SAT were 0.136% in 2018, 0.127% in 2019, 0.157% in 2020, and 0.114% in 2021 (p = 0.19). While SAT patients were clustered in the autumn (35.1%) in 2018 and 2019, it was found that this cluster shifted to the winter (33.0%) in 2020 and 2021, in parallel with COVID-19 case peaks (p = 0.017). The patients were separated into two groups as pre-COVID-19 pandemic SAT (n = 272) and COVID-19 pandemic SAT (n = 160). The mean ages of the groups were similar. There were more male patients in the COVID-19 pandemic SAT group than in the pre-pandemic group (30.6% vs. 18.7%, p = 0.005). Frequencies of overt hyperthyroidism and median free-thyroxine levels were significantly higher in the COVID-19 pandemic SAT group (p = 0.029, p = 0.001). Treatment modalities, recurrence rates, and permanent hypothyroidism were similar in both groups.ConclusionWith the COVID-19 pandemic, although there was a change in seasonal variation of SAT and an increase in the number of male patients, there was no change in the incidence and clinical course of SAT.

Early Thyroid Volume Reduction in Subacute Thyroiditis Can be a Potential Indicator for Hypothyroidism.

BackgroundThyroid volume has been reported to decrease significantly after episodes of subacute thyroiditis (SAT); however, the relationship between thyroid volume and hypothyroidism remains unclear. This study assessed the association between thyroid volume changes and the hypothyroid phase in patients with SAT, a condition that can progress to persistent hypothyroidism.MethodsThis retrospective study evaluated 37 patients diagnosed with SAT at the Department of Endocrinology and Metabolism of Chonnam National University Hwasun Hospital (CNUHH) between 2016 and 2021. Since we could not determine the clinical characteristics of patients with SAT before their episodes, 120 healthy individuals who underwent thyroid ultrasonography during regular check-ups from 2019 to 2021 at CNUHH were selected for comparison. Subgroup analyses were performed on patients with SAT with and without the hypothyroid phase during their clinical course.ResultsThyroid volume was significantly greater in SAT patients at the first visit than in controls (p<0.05), and it decreased constantly throughout the follow-up period. Subgroup analysis showed that the initial thyroid volumes were similar in patients with SAT with and without the hypothyroid phase. However, SAT patients with the hypothyroid phase had significantly smaller thyroid volumes at the 1 month (p=0.025) and 3 month (p=0.006) follow-up visits. The reduction rate of the thyroid volume was significantly different within the first month (p=0.009).ConclusionA greater reduction in thyroid volume in SAT patients within 1 month of episode had a higher chance of developing a subsequent hypothyroid phase, which can lead to persistent hypothyroidism. Serial thyroid ultrasonography in patients with SAT, especially within the first month, may help in predicting the disease course of SAT.

THE ROLE OF NEUTROPHIL TO LYMPHOCYTE RATIO AND PLATELET TO LYMPHOCYTE RATION IN DIAGNOSIS OF SUBACUTE THYROIDITIS

Purpose: Patients with subacute thyroiditis (SAT) usually apply to clinics with thyrotoxicosis and neck pain. Hemogram is frequently applied tests in primary health care services, and it can warn physicians for SAT in a thyrotoxic patient. In our study, the role and usability of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in the diagnosis of SAT were evaluated. Material and Methods: Between January 2015 and January 2020, 192 SAT patients who applied to endocrinology clinics and 85 healthy control were included in the study. Neutrophil (Neu), lymphocyte (Lym), platelet (PLT) leves were recorded. Results: The median NLR and PLR values of SAT patients before treatment were 2.78 (0.91-11.33) and 168.3 (25.7-818.3), respectively, and were significantly higher than the control group (p&amp;lt;0.001). The optimum cut-off values for NLR and PLR for SAT were 1.84 (specificity 85.9% and sensitivity 90.1%; p&amp;lt;0.001; AUC=0.934; 95% CI: 0.905-0.964 ) and 140.2 (specificity 83.5% and sensitivity 77.1%, p&amp;lt;0.001, AUC=0.821 95% CI: 0.767-0.874), respectively. Pretreatment NLR, PLR, CRP, and ESR levels were significantly higher than the posttreatment levels (all p&amp;lt;0.001). Correlation analysis revealed positive linear relations between pretreatment PLR and CRP (p=0.002, r=0.220), pretreatment PLR and ESR (p=0.018, r=0.171), pretreatment NLR and CRP (p&amp;lt;0.001, r=0.330), and pretreatment NLR and ESR (p=0.001, r=0.242). Multiple linear regression analysis revealed a 0.008 unit of increment of NLR per 1 unit increase in CRP levels (B=0.008; p&amp;lt;0.001; %95 CI=0.004-0.012). Conclusion: High NLR and PLR values accompanying thyrotoxicosis are both warning and helpful parameters for the diagnosis of SAT.

COVID-19 and COVID-19 vaccines-related subacute thyroiditis: analysis of a case series

Aim: It has been indicated that COVID-19 is related to many endocrinological abnormalities. The aim of this study is to demonstrate whether there is an impact of COVID-19 and COVID-19 vaccines on development of subacute thyroiditis (SAT).&#x0D; Material and Method: This retrospective single-center study includes individuals with SAT who were diagnosed between March 2020 and August 2021. Patients were evaluated for a recent Covid-19 history and SARS-CoV-2 vaccination. SAT was diagnosed based on the clinical presentation and laboratory tests; including thyroid function tests, sedimentation rate, C-reactive protein, and thyroid ultrasound. SARS-CoV-2 PCR results of patients with past COVID-19 were obtained from the Ministry of Health electronic patient data system. Type, number, and dates of vaccine doses were recorded for each participant.&#x0D; Results: A total of 31 patients were included in the study. Six patients (19.4%) were diagnosed with SAT following a COVID-19 vaccination schedule. Four patients with SAT had received two inactive (CoronaVac) + one dose of mRNA vaccines (Pfizer-BioNTech). The other 2 patients had received either two doses of inactive vaccine or two doses of mRNA vaccine. Five patients were diagnosed with SAT after the second dose of the vaccine. The median interval between last vaccination dose and diagnosis of SAT was 25.8 days. In one patient, SAT developed 28 days after the mRNA vaccine. Seven patients (22.6%) were diagnosed with SAT after COVID-19 disease. The median interval from the diagnosis of COVID-19 disease to SAT was 27.3 days. All cases of post-COVID-19 and post-vaccination SAT patients exhibited similar clinical presentation and findings to idiopathic SAT.&#x0D; Conclusion: Covid-19 itself and Covid-19 vaccines might let a tendency to development of subacute thyroiditis. This study has to be supported by further studies.

Thyroid dysfunction following vaccination with COVID-19 vaccines: a basic review of the preliminary evidence.

PurposeThe safety and efficacy of the several types of COVID-19 vaccines, including mRNA-based, viral vector-based, and inactivated vaccines, have been approved by WHO. The vaccines can confer protection against severe SARS-CoV-2 infection through induction of the anti-spike protein neutralizing antibodies. However, SARS-CoV-2 vaccines have been associated with very rare complications, such as thyroid disorders. This review was conducted to highlight main features of thyroid abnormalities following COVID-19 vaccination.MethodsA comprehensive search within electronic databases was performed to collect reports of thyroid disorders after vaccination with COVID-19 vaccines.ResultsAmong 83 reported cases including in this review, the most cases of thyroid abnormalities were observed after vaccination with mRNA-based vaccines (68.7%), followed by viral vector vaccines (15.7%) and 14.5% cases following inactivated vaccines. Subacute thyroiditis (SAT) was the most common COVID-19 vaccination-related thyroid disease, accounting for 60.2% of all cases, followed by Graves' disease (GD) with 25.3%. Moreover, some cases with focal painful thyroiditis (3.6%), silent thyroiditis (3.6%), concurrent GD and SAT (2.4%), thyroid eye disease (1.2%), overt hypothyroidism (1.2%), atypical subacute thyroiditis (1.2%), and painless thyroiditis with TPP (1.2%) were also reported. Overall, in 58.0% of SAT cases and in 61.9% of GD cases, the onset of the symptoms occurred following the first vaccine dose with a median of 10.0 days (ranged: 3–21 days) and 10.0 days (ranged: 1–60 days) after vaccination, respectively. Moreover, 40.0% of SAT patients and 38.1% of GD patients developed the symptoms after the second dose with a median of 10.5 days (ranged: 0.5–37 days) and 14.0 days (ranged: 2–35 days) after vaccination, respectively.Conclusion Fortunately, almost all cases with COVID-19 vaccination-associated thyroid dysfunctions had a favorable outcome following therapy. The benefits of COVID-19 vaccinations in terms of terminating the pandemic and/or reducing mortality rates can exceed any risk of infrequent complications such as a transient thyroid malfunction.

FT3 index/TSH index ratio and free thyroid hormone index in the differential diagnosis of thyrotoxicosis

Aim: Common causes of thyrotoxicosis are hyperthyroidism and destructive thyroiditis. Hyperthyroidism is a condition characterized by high serum thyroid hormone levels as a result of over-synthesis of thyroid hormones, the most common causes of which are Graves' disease (GD) and toxic nodular goiter (TNG). Subacute thyroiditis (SAT) causes thyrotoxicosis due to the circulating thyroid hormones of destructive thyroiditis. Differential diagnosis is important because GD, TNG and SAT treatment approaches are different. The aim of this study was to analyze whether it is possible to make a differential diagnosis for these conditions by examining free thyroid hormones, fT3/fT4 ratio, fT3 index/TSH index (fT3I/TSHI) ratio and Free Thyroid Hormone Index (FTHI).&#x0D; Material and Method: This retrospective study included 150 patients who were diagnosed with GD, TNG and SAT. The fT3 index (fT3I) was calculated as the ratio between the fT3 value and the fT3 upper limit of normal value (fT3I=fT3/4 pg/ml). The fT4 index (fT4I) was calculated as the ratio between the fT4 value and the fT4 upper limit of normal value (fT4I=fT4/1.23 mg/dl). The TSH index (TSHI) was calculated as the ratio between TSH value and the TSH lower limit of normal limit (TSHI=TSH/0.38 mIU/L). The FTHI index was calculated using the formula of (fT3 level/fT3 upper limit of normal) / (fT4 level/fT4 upper limit of normal).&#x0D; Results: The fT3, fT3/fT4 ratio and FTHI were found to be higher in hyperthyroid patients compared to subacute thyroiditis patients. fT4 and fT3I/TSHI levels were similar in hyperthyroid patients and SAT patients (p=0.49, p=0.11, respectively ). The cut-off level of FTHI for hyperthyroidism was determined as 0.97 with sensitivity of 75% and specificity of 76.3% (AUC=0.833, p&lt; 0.001). When hyperthyroidic patients were divided into two groups as GD and TNG, no significant difference was found in fT3/fT4 ratio (p:0.99). The fT3 (p

The diagnostic value of blood cell-derived indexes in subacute thyroiditis patients with thyrotoxicosis: a retrospective study.

BackgroundBoth subacute thyroiditis (SAT) and Graves’ disease (GD) can lead to thyrotoxicosis, but the methods to distinguish these two diseases are relatively complex. Therefore, it is necessary to find biomarkers which can quickly and efficiently identify the two kinds of thyrotoxicosis. Blood cell-derived indexes are widely used to evaluate systemic inflammation. We aimed to evaluate the diagnostic value of blood cell-derived indexes in SAT patients with thyrotoxicosis.MethodsTotally 139 SAT patients with thyrotoxicosis, 146 GD patients, and 100 euthyroid individuals were enrolled in the study. Complete blood cell (CBC) count, thyroid function, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), systemic immune-inflammatory index (SII), systemic inflammation response index (SIRI), aggregate inflammation systemic index (AISI), and mean platelet volume to platelet ratio (MPR) were evaluated in all subjects. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the capacity of blood cell-derived indexes in differentiating SAT patients with thyrotoxicosis from GD patients. We also evaluated the association between blood cell-derived indexes and other laboratory indicators and clinical outcomes in SAT patients.ResultsNLR, PLR, MLR, SII, SIRI, and AISI were significantly higher in the SAT group. MPR was significantly lower in the SAT group. A formula including NLR, PLR, MLR, SII, SIRI, AISI and MPR was developed. The combination formula with an optimal cutoff of 0.426 showed the better diagnostic value [area under the curve (AUC) =0.921; 95% confidence interval (CI): 0.891–0.950; P<0.001; sensitivity, 87.1%; specificity, 83.6%]. However, thyroid function, erythrocyte sedimentation rate (ESR), thyroid peroxidase antibodies (TPOAb), and blood cell-derived indexes, were not found to be significantly associated with hypothyroidism and recurrence.ConclusionsWe developed a formula combining 7 blood cell-derived indexes. The combination formula could be a novel biomarker to distinguish SAT patients with thyrotoxicosis from GD patients. However, we did not find significant association between the blood cell-derived indexes and clinical outcomes in SAT patients.

SARS-CoV-2 Vaccine-induced Thyroiditis: Safety of Revaccinations and Clinical Follow-up.

ContextThe number of reported cases with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine–induced subacute thyroiditis (SAT) and Graves’ disease (GD) is growing. However, active debate continues about managing such side effects and the safety of repeat or booster doses of the vaccines in such cases.ObjectivesThis study aims to present long-term clinical follow-up of SARS-CoV-2 vaccine–induced SAT or GD cases and provide data regarding the safety of revaccinations.MethodsPatients diagnosed with SARS-CoV-2 vaccine–induced SAT or GD were included. Data regarding the long-term clinical follow-up of SARS-CoV-2 vaccine–induced SAT and GD cases and outcomes of repeat or booster SARS-CoV-2 vaccinations were documented. The literature, including cases of SARS-CoV-2 vaccine–induced SAT or GD, was reviewed.ResultsFifteen patients with SARS-CoV-2 vaccine–induced SAT and 4 with GD were included. Pfizer/BioNTech COVID-19 vaccine (BNT162b2) was associated with symptoms in a majority of cases with SAT and all with GD. Median time from vaccination to symptom onset was 7 and 11.5 days, respectively, while 7 and 2 patients required medical treatment in SAT and GD groups, respectively. Remission was documented in 10 SAT patients, with a median time to remission of 11.5 weeks. No exacerbation/recurrence of SAT occurred in 7 of 9 patients who received a repeat vaccination dose, while symptoms of SAT worsened following the second vaccination in 2 cases. None of the patients experienced severe side effects that could be associated with revaccinations.ConclusionsRevaccinations appear to be safe in patients with SARS-CoV-2 vaccine–induced SAT cases, while more evidence is needed regarding SARS-CoV-2 vaccine–induced GD.

Subacute thyroiditis during the COVID-19 pandemic: a prospective study.

PurposeSubacute thyroiditis(SAT) is a destructive thyroiditis associated with viral infections. Several SAT cases associated with SARS-CoV-2 infection/vaccination were recently reported. We aimed to evaluate prospectively all cases applied to our tertiary center and their relationship with SARS-CoV-2 during 16 months of the pandemic. Cases during similar pre-pandemic period were recorded for numeric comparison.MethodsProspective study took place between March 2020 and July 2021. SAT was diagnosed by classical criteria. Swabs for SARS-CoV-2 and a wide respiratory viral panel (RV-PCR) were taken. Previous COVID-19 was assessed by SARS-CoV-2 IgM&IgG levels. Study group was divided into three as: CoV-SAT, patients who had or still have COVID-19, Vac-SAT, patients diagnosed within three months after SARS-CoV-2 vaccination and NonCoV-SAT, those not associated with COVID-19 or vaccination.ResultsOut of 64 patients, 18.8% (n = 12) was classified as CoV-SAT, 9.3% (n = 6) as Vac-SAT and 71.9% as (n = 46) NonCoV-SAT. SARS-CoV-2 RT-PCR tests on the diagnosis of SAT were negative in all, but two patients tested positive five days later, in second testing, performed upon clinical necessity. CoV-SAT and NonCoV-SAT groups were similar in terms of clinical, laboratory, and treatment characteristics. However, symptoms were milder and treatment was easier in Vac-SAT group (p = 0.006).ConclusionsTotal number of SAT cases during the pandemic period was comparable to pre-pandemic period. However, a considerable rate of SARS-CoV-2 exposure in SAT patients was established. COVID-19 presented with SAT, as the first manifestation in three cases. Vaccine-related cases developed in a shorter time period, clinical presentation was milder, and only a few required corticosteroids.

Subacute Thyroiditis During the SARS-CoV-2 Pandemic.

ContextAcute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been related to subacute thyroiditis (SAT).ObjectiveWe compared SAT cases during the SARS-CoV-2 pandemic to those observed in the previous years.MethodsA cross-sectional, retrospective study was conducted at the Endocrinology Unit of University Hospital of Pisa, Italy. We included all patients observed from January 2016 to December 2020 because of an untreated SAT, who had developed the disease within 15 days prior to the visit. SAT cases from 2016 to 2019 (N = 152) are referred to as pre-SARS-CoV-2, while 2020 SAT patients are classified as pos-SARS-CoV-2 (N = 18) or neg-SARS-CoV-2 (N = 28), according to positive or negative SARS-CoV-2 testing performed up to 45 days from SAT onset.ResultsWhile during 2016-2019, most SAT cases were observed in the third quarter, in 2020, 2 peaks were seen, superimposable to the SARS-CoV-2 outbreaks in the second and the fourth quarters. In the second and fourth quarters of 2020, we observed higher levels of free thyroxine (FT4), C-reactive protein (CRP), and thyroglobulin (Tg) compared with the same quarters of the years 2016-2019. Pos-SARS-CoV-2 patients had higher FT4 (28.4 vs 24.1 nmol/L), CRP (8.5 vs 3.6 mg/L), and Tg (155 vs 60 µg/L) (P < 0.05 for all) and more frequently had hypothyroidism (13/15 vs 30/152 at 3 months) (P < 0.001) than pre-SARS-CoV-2 patients. Neg-SARS-CoV-2 patients showed a clinical picture intermediate between the other 2 groups.ConclusionThe SARS-CoV-2 pandemic has caused a shift in the annual timing and severity of SAT cases.

Evaluation of the hematologic indices in patients with thyrotoxicosis with distinct etiologies: a case-control study

Aim: Thyrotoxicosis is a clinical state of inappropriately high levels of free T4 (thyroxine) and/or free T3 (tri-iodothyronine) in the body caused by distinct etiologies including Graves’ disease (GD), subacute thyroiditis (SAT), toxic adenoma and toxic multinodular goiter (TMNG). Simple hematologic indices such as neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) and mean platelet volume (MPV) have increasingly been mentioned as measures of presence and severity of thyrotoxicosis. In this study, we aimed to analyze whether there is a link between these peripheral blood parameters and the presence of thyrotoxicosis.&#x0D; Material and Methods: A total of 46 GD, 46 TMNG, 39 TA and 45 SAT patients and 45 control subjects were studied. Laboratory parameters in all patients were recorded and NLR, PLR and MPV values were recorded from peripheral blood complete blood cell counts. &#x0D; Results: This study showed that NLR and PLR levels are elevated in patients with SAT in comparison with other thyrotoxic patient groups and controls. The post hoc analysis of comparison of NLR and PLR in each study groups revealed that NLR and PLR were statistically different in the SAT group in comparison to the GD, TMNG, TA, and healthy controls. A significant decrease in the level of MPV was demonstrated in thyrotoxicosis patients (p

Subacute Thyroiditis during the COVID-19 Pandemic: Searching for a Clinical Association with SARS-CoV-2.

Purpose To search for a clinical potential link between subacute thyroiditis (SAT) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a series of patients diagnosed with SAT during the COVID-19 pandemic, by retrospective evaluation of (1) clinical symptoms and (2) contact tracing. Methods SAT patients diagnosed from March to December 2020 were enrolled. The presence of typical clinical presentation of SARS-CoV-2, diagnostic tests for SARS-CoV-2, and contact with other individuals proven to be positive for SARS-CoV-2 were searched. Results Ten SAT cases were included. Fever was recorded in four patients. Cough, dyspnea, and headache were rarely reported. No patient had diagnosis of pneumonia. Two patients had moderate to severe fatigue after SAT. One patient experienced loss of smell and taste and had persistent fatigue over the following five months. No patient had positive SARS-CoV-2 diagnostic tests. At contact-tracing evaluation, only one patient had a contact with people who were diagnosed with SARS-CoV-2. Conclusions Patients diagnosed with SAT during COVID-19 pandemic rarely experienced SARS-CoV-2-related symptomatology. The contact tracing did not show close contact with SARS-CoV-2 individuals in 9/10 cases.

Efficacy and safety of Xiaochaihu decoction for subacute thyroiditis: A protocol of systematic review and meta-analysis.

Background:Subacute thyroiditis (SAT) is a transient and self-limiting inflammatory thyroid disease. There is no clear evidence for specific etiology, but it is generally thought to occur after viral infection. Characteristics of SAT include severe pain of the anterior neck, enlarged firm thyroid, disordered thyroid function, elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), typical ultrasound findings (hypoechoic areas) and low thyroid uptake of radioactive iodine or technetium-99 m because of the destructive etiology of the hyperthyroidism. Evidences showed Xiaochaihu decoction (XCHD) has a significant effect on improving the symptoms of SAT patients. The purpose of this study is to assess the safety and effectiveness of XCHD for patients with SAT.Methods and analysis:The literature that has been identified via searching 6 Chinese electronic databases and eight English electronic databases from inception to September 21, 2020 will be included in the study. Research selection, data extraction as well as research quality assessment will be completed by 2 experienced researchers independently. The primary outcome is remission rate. Data analysis will be conducted by the RevMan 5 software, and GRADE will help to assess the level of evidence. The heterogeneity of data will be investigated by a heterogeneity x2 test, as well as the Higgins I2 test. A subgroup analyses and sensitivity analysis will be conducted to explore the sources of heterogeneity.Results:The results of this study will be published in a peer-reviewed journal.Conclusion:This study will draw a conclusion about whether XCHD is safe and effective in treating SAT on the basis of evidence-based medicine. This conclusion will provide areliable scientific evidence for the alternative treatment for the management of SAT.OSF registration number:https://osf.io/8hbue.