Subacute Thyroiditis Research Articles

SARS-CoV-2: Emerging Role in the Pathogenesis of Various Thyroid Diseases.

Coronavirus disease-2019 (COVID-19) is asymptomatic in most cases, but it is impartible and fatal in fragile and elderly people. Heretofore, more than four million people succumbed to COVID-19, while it spreads to every part of the globe. Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) induces various dysfunctions in many vital organs including the thyroid by utilizing ACE2 as a receptor for cellular entry. Emerging reports clearly show the involvement of SARS-CoV-2 in diverse thyroid disorders. Thus, this review article aims to review comprehensively all the recent developments in SARS-CoV-2-induced pathogenesis of thyroid diseases. The review briefly summarizes the recent key findings on the mechanism of SARS-CoV-2 infection, the role of ACE2 receptor in viral entry, SARS-CoV-2-activated molecular signaling in host cells, ACE2 expression in the thyroid, cytokine storm, and its vital role in thyroid dysfunction and long-COVID in relation to thyroid and autoimmunity. Further, it extensively discusses rapidly evolving knowledge on the potential part of SARS-CoV-2 in emerging various thyroid dysfunctions during and post-COVID-19 conditions which include subacute thyroiditis, Graves' diseases, Hashimoto’s thyroiditis, thyrotoxicosis, and other recent advances in further discerning the implications of this virus within thyroid dysfunction. Unraveling the pathophysiology of SARS-CoV-2-triggered thyroid dysfunctions may aid pertinent therapeutic options and management of these patients in both during and post-COVID-19 scenarios.

Post COVID-19 Subacute thyroiditis: A case report

Subacute thyroiditis is a non-suppurative inflammation of the thyroid gland, which usually develops after viral infection to the upper respiratory tract, accompanied by pain in the neck radiated to the jaw and fever. This is a case report study for a 43-year-old woman, who developed subacute thyroiditis 6 weeks following coronavirus disease (COVID-19).

Influence of Thyroid Disorders on Liver Function Tests in –Diyala Governorate

Background: Thyroid diseases may disturb liver function; liver disease modulates thyroid hormone metabolism, and a range of systemic diseases disturb both organs. There are clinical and laboratory relations between thyroid and liver diseases. Patients with chronic liver disease may have thyroiditis, hyperthyroidism, or hypothyroidism.aPatients with subacute thyroiditis or hyperthyroidism may have abnormalities in liver function tests, which return to normal as the thyroid disorder improves. Objective: The present study is designed to investigate the effects of thyroid disorders on liver function tests. Patients and Methods: In this study sixty patients were employed and categorized into two groups, thirty patients with hyperthyroidism (13 male and 17female) with age range of 25-45years, (mean 33.38) and thirty patients with hypothyroidism (11male and 19 female) with age range 25-45 years (mean 36.78),while 30 normal healthy individuals were chosen as a control group (15male and 15 female) in the same age range (mean 34.44) were taken for comparison. Blood samples were collected from the patients at Baqubah Teaching Hospital , between April 2020 to July 2020. Basic serum biochemical parameters including, thyroid stimulation hormone (TSH), triiodothyronine(T3) and thyroxin (T4)were assayed for patients and control groups by Cobas e 411 autoanalyzer within eight weeks. Serum normal values for alanine aminotransferase (ALT). ALT (Alanine Aminotransferase), Aspartate aminotransferase (AST), alkaline phosphatase test (ALP), direct bilirubin (DB) and total bilirubin( TSB) were assayed within four days by Cobas integra 400 plus autoanalyzer. Results: The mean value of ALT, AST, ALP,TSB, and DB in patients with hyperthyroidism, and hypothyroidism was significantly increased when compared with their mean values of healthy control (p <0.05).A significant difference was also found in mean values of T3,T4,TSH in hyperthyroidism and hypothyroidism when compared with their mean values of healthy control(p <0.05). Results of this work revealed a significant negative correlation of TSH with ALP and TSB (p<0.05). Further, T4 showed a significant positive correlation with ALP (P<0.05).The same results revealed that there was a significant positive correlation between T3 and ALP with (p<0.05).There was no significant correlations between ALT,AST,DB with TSH,T3,T4.Further,no significant correlations between TSB and T3,T4 (p >0.05). Conclusion: The current study shows that thyroid disorder might cause significant effect on the metabolism of hepatocytes reflected by an increase in biochemical parameters of liver function test AST, ALT ALP,TSB and DB in both hyperthyroidism and hypothyroidism subjects. Keywords: Thyroid diseases ,Alanine aminotransferase , hyperthyroidism, Tetraiodothyronin ,Thyroid stimulating hormone,hypothyroidism

Two Unusual Cases of Subacute Thyroiditis (SAT) and management

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Pericarditis and sub-acute thyroiditis complicating Pfizer-BioNTech Covid-19 vaccination

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

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.

Subacute Thyroiditis

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2). It usually presents with mild common cold-like symptoms. However, it can lead to series of complications with some of them being fatal. One of the rare and potentially neglected manifestations of COVID-19 is subacute thyroiditis (SAT). Viral causes of SAT documented so far include several viruses, but according to the newest reports, SARS-CoV-2 should also be added to the list. The median time between COVID-19 diagnosis and the onset of SAT symptoms is reported to be 29 days. Patients mostly present with triphasic course of symptoms - thyrotoxicosis, followed by hypothyroidism and euthyroidism. Although limited number of SAT cases after SARS-CoV-2 infection are reported, physicians should consider SAT as a differential diagnosis in COVID-19 patients. The routine assessment of thyroid function in patients with clinical suspicion of SAT or with the suspicion of any other thyroid dysfunction is advised.

Value of Quantitative Contrast-Enhanced Ultrasonography in Distinguishing Asymptomatic Subacute Thyroiditis from Papillary Thyroid Carcinoma

Background: Asymptomatic subacute thyroiditis (aSAT) without inflammatory features is often difficult to distinguish from papillary thyroid carcinoma (PTC), even with ultrasonography. Under certain circumstances, a fine-needle aspiration biopsy (FNAB) is performed, which is known to increase the patient’s physical pain. Objectives: To investigate the value of quantitative contrast-enhanced ultrasonography (CEUS) in discriminating aSAT from PTC nodules. Patients and Methods: A total of 30 aSAT and 23 PTC patients were systematically reviewed. Quantitative CEUS parameters, including the rise time (RT), time to peak (TTP), maximum intensity (IMAX), as well as their extension indicators (ΔRT and ΔTTP), were determined in various nodule areas (total, central, peripheral, and control regions of nodules). Chi-square test and independent-samples t-test were performed to compare significant differences between PTC and aSAT. A receiver operating characteristics (ROC) curve analysis was also performed to assess the diagnostic efficacy of each parameter, as well as diagnostic efficacy indices, including sensitivity and specificity, in discriminating aSAT from PTC nodules. Results: Compared to the PTC group, patients with aSAT had a longer ∆RT1 (RT of the control area − RT of the whole area; 0.12 ± 0.69 vs. -0.2 ± 0.57, P = 0.03) and ∆RT3 (RT of the control area − RT of the central area; 0.43 ± 0.72 vs. 0.04 ± 0.94, P = 0.049). Besides, compared to the PTC group, the aSAT group had a shorter RT in the total area (RT1: 4.05 ± 1.56 vs. 4.91 ± 2.09, P = 0.045); a shorter TTP in the total (TTP1: 4.91 ± 1.76 vs. 7.30 ± 3.92, P = 0.005), peripheral (TTP2: 5.06 ± 1.97 vs. 7.00 ± 3.48, P = 0.01), and central (TTP3: 4.90 ± 1.68 vs. 7.57 ± 4.41, P = 0.004) areas; and a lower IMAX in the peripheral area (IMAX2: 0.74 ± 0.36 vs. 1.09 ± 0.57, P = 0.009). Based on the ROC curve analysis, the area under the curve was significantly larger for TTP1 as compared to RT1 (P = 0.027). Conclusion: Conventional ultrasound and CEUS examinations were inadequate in distinguishing PTC from aSAT. Overall, a quantitative analysis may indicate more biological characteristics of nodules, which can be helpful in the differential diagnosis.

S1614 Idiopathic Pancreatitis, Newly Diagnosed Diabetes Mellitus I, and Hypothyroidism in a Young Patient With Recent COVID-19 Infection

Introduction: We present a young male who was diagnosed with pancreatitis, found to have diabetic ketoacidosis, and later diagnosed with hypothyroidism. Our case presents the relationship between COVID-19 and autoimmunity. Coronavirus has been linked to autoimmune diseases. Pancreatic involvement in autoimmunity is poorly studied. Pancreatic involvement in autoimmunity is poorly studied. Case Description/Methods: The patient is a 22-year-old male who presented to ER with nausea, vomiting, and abdominal pain. He reported a recent COVID-19 pneumonia. Pertinent history included weight loss, polyuria, polydipsia, for the 3 months. Vital signs were normal. Oxygen saturation was normal. Physical exam showed epigastric tenderness. Labs were consistent with ketoacidosis. Lipase was 2,322 Units/L, triglycerides were 387 mg/dL, hemoglobin A1c of 10.7%. Patient was on an insulin drip and intravenous hydration. TSH found to be 11.7 mUnits/L. Free T4 and free T3 were at 0.4 ng/dL and 0.8 pg/mL, respectively. Patient was discharged on levothyroxine and insulin. On further evaluation, C-peptide level was 0.3 ng/mL. Glutamic acid decarboxylase and thyroid peroxidase antibodies were positive, confirming the diagnosis of type I diabetes and thyroiditis. Discussion: Covid 19 affects the respiratory tract, gastrointestinal involvement has been reported. The patient's pancreatitis and thyroiditis could have been due to direct cytopathic effects of SARS-COV-2 replication, or indirectly by systemic immune response. In a case series of 52 patients with COVID-19, serum lipase was found elevated in 17% of patients without symptoms. Another case series of 67 patients with COVID-19 pneumonia, reported a 17% incidence rate of pancreatitis, although only 7% of patients had significant pancreatic damage. Regarding thyroidal disease, direct damage causes subacute thyroiditis. As the disease process progresses, hypothyroidism may last, especially in those with avidity to autoimmune disease. Type I diabetes may arise in patients who have the antibodies, especially after a viral infection. In rare cases, the virus can infect the islet cells directly and destroy them permanently. Coxsackie virus has been studied in connection to developing type I diabetes, due to molecular mimicry. This phenomenon is poorly studied in covid-19 but it would be of no surprise if it is present. It would be beneficial to monitor for autoimmune processes in patients who survived coronavirus disease as such processes can increase their morbidity if left unrecognized.

Subacute thyroiditis as evidence of SARS-CoV2 related autoimmune disorders and case descriptions

Context: Subacute thyroiditis has been classified as an auto inflammatory condition and occurs mainly due to a viral infection. According to the pathogenesis of SARS-CoV2 infection, which is mainly based on the uncontrolled inflammatory immune response, several studies have investigated the possible association between SARS-CoV2 and subacute thyroiditis. In this regard, we aimed to review and organize these studies. Evidence Acquisition: First, we observed and provided evidence on the possible roles and mechanisms of SARS-CoV2 in inflammatory and autoimmune diseases, and then we discussed the findings on the association between subacute thyroiditis and SARS-CoV2 infection. Results: Regarding other autoimmune and inflammatory disorders, together with previous experience on the role of viruses in the pathogenesis of subacute thyroiditis, as well as studies on the inflammatory mechanism of SARS-CoV2 infection, support this hypothesis that SARS-CoV2 may initiate subacute thyroiditis. Conclusions: Evidence so far suggests that subacute thyroiditis should be considered as a later symptom of covid-19.

SARS-COV-2 INFECTION AND THYROID DISEASES

The severe acute respiratory syndrome-coronavirus-2 (SARSCoV-2) virus, was identified as the cause of a pandemic of respiratory illness in Wuhan, China one year ago. The Coronavirus disease 2019 (COVID-19), may cause mild disease with nonspecific signs and symptoms such as fever, cough, myalgia, and fatigue, or severe pneumonia with respiratory failure and sepsis. However, endocrinological manifestations are yet to be established, in patients with COVID-19. The effect of COVID-19 on thyroid function is unknown at this time. Evidence support that patients with COVID-19 who are followed up in intensive care units may develop thyroid dysfunction as a non-thyroidal illness syndrome. Until now, twenty-two cases with subacute thyroiditis and five cases with Graves’ Diseases potentially associated with SARS-CoV-2 infection have been reported in literature. Physicians should be aware of possible relationships between thyroid dysfunction and COVID-19. This study aimed to review thyroid dysfunction in patients with COVID-19, and to overview thyroid diseases that are probably related to COVID-19.

COVID-19: новый этиологический фактор развития болезни Грейвса?

Коронавирусная инфекция SARS-CoV-2 быстро приобрела статус пандемии и поразила миллионы людей по всему миру. Несмотря на то что основной мишенью коронавируса является дыхательная система, ученых все больше беспокоит проблема поражения COVID-19 других органов и систем. Поскольку рецепторы к ангиотензинпревращающему ферменту 2-го типа, через которые коронавирус попадает в клетки, были обнаружены на щитовидной железе, существует вероятность поражения данного органа. В последнее время поступает все больше сообщений о развитии подострого тиреоидита и болезни Грейвса после перенесенного COVID-19. В нашей клинической практике мы столкнулись со случаем впервые возникшей болезни Грейвса и манифестного тиреотоксикоза после перенесенного коронавируса, который удалось купировать только назначением тиреостатиков и глюкокортикостероидов. Через полгода у пациентки произошла реинфекция COVID-19, после чего развился рецидив болезни Грейвса с манифестацией тиреотоксикоза и развитием эндокринной офтальмопатии. Авторы предполагают, что, поскольку коронавирус изменяет иммунологическую толерантность в организме человека, он обладает способностью запускать аутоиммунные механизмы, что провоцирует аутоагрессию против различных органов и систем. Одним из таких проявлений и является болезнь Грейвса, начало и манифестация которой может возникать после инфицирования или реинфицирования COVID-19. Клинический случай описывает пациентку без предварительной тиреоидной патологии, у которой коронавирусная инфекция стала триггером для развития болезни Грейвса с манифестным тиреотоксикозом тяжелого течения, что требовало назначения глюкокортикостероидов. Повторное инфицирование COVID-19 через полгода после первого заражения привело к рецидиву аутоиммунного заболевания и необходимости усиления антитиреоидной терапии. Кроме того, реинфекция вызвала развитие эндокринной офтальмопатии, которой не было в начале болезни Грейвса.

Subacute thyroid and SARS-CoV-2 relationship

Background: This study aims to research the relationship of subacute thyroiditis with SARS-CoV-2. The prevailing risks of predisposition to certain diseases or organ dysfunctions even after surviving the disease are discussed more frequently each day. Aim: Could SARS-CoV-2 be considered as a triggering factor in patients diagnosed with subacute thyroiditis? Investigating the relationship between subacute thyroiditis and SARS-CoV-2. Methods: Thirty-three patients diagnosed with subacute thyroiditis between 01.11.2020 and 01.04.2020 were included in the study. Patients who tested positive for SARS-CoV-2 throughout the examinations performed at the time of the diagnosis for subacute thyroiditis and patients who were previously diagnosed with Covid-19, who tested positive for SARS-CoV-2, and subsequently diagnosed with subacute thyroiditis within 30 days have been included in the study. Clinical evaluation of the patient, thyroid hormone values, CRP values, sedimentation levels, and thyroid ultrasonography images were considered to diagnose subacute thyroiditis; patients whose results were compatible with subacute thyroiditis were diagnosed with subacute thyroiditis, and they were included in the study. Results: It was found that 5 (15%) of the 33 patients included in the study had Covid-19 disease before the diagnosis of subacute thyroiditis and were isolated for the SARS-CoV-2 virus. Conclusion: The SARS-CoV-2 virus can be considered a triggering factor for subacute thyroiditis. We believe that researching this relationship on a broader patient population will bring more clarity to the subject. Although encountered in only one of our cases, the Coronavirus vaccine and SAT relationship may shed light on future studies. Keywords: Subacute thyroiditis, SARS-CoV-2, COVID-19

Early and late endocrine complications of COVID-19.

Endocrine system plays a vital role in controlling human homeostasis. Understanding the possible effects of COVID-19 on endocrine glands is crucial to prevent and manage endocrine disorders before and during hospitalization in COVID-19-infected patients as well as to follow them up properly upon recovery. Many endocrine glands such as pancreas, hypothalamus and pituitary, thyroid, adrenal glands, testes, and ovaries have been found to express angiotensin-converting enzyme 2 receptors, the main binding site of the virus. Since the pandemic outbreak, various publications focus on the aggravation of preexisting endocrine diseases by COVID-19 infection or the adverse prognosis of the disease in endocrine patients. However, data on endocrine disorders both during the phase of the infection (early complications) and upon recovery (late complications) are scarce. The aim of this review is to identify and discuss early and late endocrine complications of COVID-19. The majority of the available data refer to glucose dysregulation and its reciprocal effect on COVID-19 infection with the main interest focusing on the presentation of new onset of diabetes mellitus. Thyroid dysfunction with low triiodothyronine, low thyroid stimulating hormone, or subacute thyroiditis has been reported. Adrenal dysregulation and impaired spermatogenesis in affected men have been also reported. Complications of other endocrine glands are still not clear. Considering the recent onset of COVID-19 infection, the available follow-up data are limited, and therefore, long-term studies are required to evaluate certain effects of COVID-19 on the endocrine glands.

Subacute Thyroiditis Secondary to Moderna COVID-19 Vaccine: A Case Report of a Rare Manifestation

The SARS-CoV-2 led to a global pandemic, infecting millions of lives within only a short period of time. The symptoms of the disease vary with a subset of the population developing debilitating sequelae. Through the emergency use authorization (EUA), multiple vaccines have been released against the novel virus in record time. Long term and rare sequelae from the vaccine are poorly understood. DeQuervain’s subacute thyroiditis is a self-limiting and painful inflammation of the thyroid gland usually associated with viral infections. We report a rare case of subacute thyroiditis in a healthy 46-year-old woman presenting with a painful swelling in the neck after receiving the Moderna mRNA-1273 SARS-CoV-2 vaccine. We seek to elucidate a better understanding of rare vaccine side effects by documenting one of the first reported cases of subacute thyroiditis induced by the SARS-CoV-2 vaccine.

Incidence of De Quervain\u2019s thyroiditis during the COVID-19 pandemic in an area heavily affected by Sars-CoV-2 infection

PurposeTo evaluate the possible association between Covid-19 infection and subacute thyroiditis.MethodsWe reviewed the medical and imaging records of patients referred to our Department’s outpatient setting dedicated to ‘thyroid emergency’ (records with a ‘bollino verde’—green sticker, classifed as urgent) from April 2020 to October 2020. This outpatient clinic is devoted to patients requiring evaluation for severe hypothyroidism, thyrotoxicosis and neck discomfort or pain. All patients with a newly-diagnosed subacute thyroiditis were selected. The data of all patients receiving a diagnosis of subacute thyroiditis was collected retrospectively, taking into account the same period of time (April–October) and starting from 2016.ResultsDuring the COVID-19 outbreak in our region (April 2020 to October 2020) 396 patients attended the outpatient emergency clinic. Among them, 10 (2.5%) patients received a diagnosis of subacute thyroiditis. In a single patient, a 44-year-old man, a COVID-19 pulmonary infection had been diagnosed 7 weeks before the diagnosis of subacute thyroiditis. All of the remaining patients were and remain COVID-19 free as confirmed by telephone interview. The percentage of patients who received a diagnosis of subacute thyroiditis in the same period starting from 2016 was very similar (2.9%, 2.9%, 2.6% and 3.0% in 2016, 2017, 2018 and 2019, respectively).ConclusionsOur data do not show an increase in the incidence of subacute thyroiditis in the Brescia area, a region with the highest prevalence of COVID-19 in Italy during the period of the pandemic outbreak.

High frequency ultrasound combined with ultrasound-guided core needle biopsy for the diagnosis of primary thyroid lymphoma

Objective: To investigate the sonographic features of primary thyroid lymphoma (PTL) and to evaluate the clinical significance of ultrasound-guided core needle biopsy (US-CNB) in PTL. Methods: A total of 24 patients with suspected PTL in Sir Run Run Shaw Hospital from January 2013 to June 2018 were analyzed retrospectively. All cases were confirmed by pathology, of them 23 patients received US-CNB and 1 patient chose operation without US-CNB, including 5 males and 19 females, aged from 39 to 75 years old. The effectiveness and safety of 23 patients with US-CNB were evaluated, and the sonographic features of 20 patients with PTL diagnosed by pathology were analyzed. Descriptive statistical methods were used in the study. Results: In the 23 patients with suspected PTL underwent US-CNB, 18 patients were diagnosed as PTL, 4 patients were respectively diagnosed as subacute thyroiditis, anaplastic carcinoma, Hashimoto's thyroiditis, and fibro thyroiditis, and the another patient was hard to diagnose by US-CNB and then was diagnosed as PTL by surgical biopsy. The success rate of US-CNB for diagnosis of PTL was 18/19, and no severe complications occurred in the patients with US-CNB. The other case was diagnosed as PTL by surgical biopsy without US-CNB. Sonographic features of 20 cases with PTL (18 cases diagnosed by US-CNB and 2 cases by surgery or surgery biopsy) were as follows: (1) Most nodules had irregular shapes and unsmooth margins; (2) Hypoechoic or markedly hypoechoic nodules with honeycombed or cord structures were observed in most cases; (3) Calcification was rare; (4) Multiple lesions were common; (5) Abundant intralesional vascularization was commonly observed; (6) Most cases had intensification of posterior acoustic enhancement; (7) Thyroid gland enlargement or with irregular shape; and (8) PTL often accompanied with lymph nodes enlargement in lateral neck or central region. Conclusion: PTL has certain sonographic features, with assistance of US-CNB, more accurate diagnosis of PTL can be obtained.

28412 A rare association of Sweet syndrome with autoimmune thyroiditis: Case report and review of literature

A 45-year-old previously healthy African American woman was admitted for fever and new onset rash. Physical exam revealed crusted papules and nodules, vesicles, and large bullae on the face, arms, and legs. She also had erosions on the soft palate and tender nodules on the bilateral lower extremities. Work up was consistent with Sweet syndrome in the setting of a myeloproliferative neoplasm, as well as erythema nodosum. Interestingly, this patient had an associated subacute thyroiditis due to Sweet syndrome.

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.

C-reactive protein and thyroid-stimulating hormone levels as risk factors for hypothyroidism in patients with subacute thyroiditis.

ObjectiveThis study was designed to explore the relationships between the clinical characteristics and outcomes of patients with subacute thyroiditis (SAT).DesignThis is a single-center retrospective study.PatientsEighty-nine patients with SAT who were hospitalized in the Sir Run Run Shaw Hospital in Zhejiang, China, from October 2014 to September 2020 were included.MethodsThe Mann–Whitney U-test, chi-square test, and Cox regression analysis were conducted to identify the relationships between clinical characteristics and outcomes. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff levels of C-reactive protein (CRP) and thyroid-stimulating hormone (TSH).ResultsThe hypothyroidism and recurrence rates were 15.7 and 16.9%, respectively. CRP (≥72.0 mg/L), TSH (<0.02 mIU/L), and free triiodothyronine (fT3) (≥4.10 pg/mL) were associated with hypothyroidism. The cutoff level was 97.80 mg/L for CRP (area under the curve (AUC), 0.717, P = 0.014; sensitivity, 57.1%; specificity, 84.0%) and 0.10 mIU/L for TSH (AUC, 0.752, P = 0.004; sensitivity, 100%; specificity, 46.0%) by ROC curve analysis for hypothyroidism. The factors under study were not associated with recurrence.ConclusionCRP and TSH were risk factors for hypothyroidism in SAT. Thyroid functions should be monitored closely for the early detection of hypothyroidism, especially in patients with CRP levels of more than 97.80 mg/L and TSH levels of less than 0.10 mIU/L.