Subacute Thyroiditis Research Articles

The association of subacute thyroiditis with viral diseases: a comprehensive review of literature

Subacute thyroiditis (SAT), also known as de Quatrain's thyroiditis or granulomatous thyroiditis, is an inflammatory disease of the thyroid. Most of the time, it manifests in the thirties to fifties and is more common in women. SAT can have either viral or post-viral origin. Some viruses, like influenza, COVID-19, Epstein-Barr virus, cytomegalovirus, hepatitis, coxsackievirus 16, and mumps virus, have been linked to SAT development. The COVID-19 pandemic has affected people's lives all around the world and has changed our attitude toward the treatment of many diseases. It has also made us look deeper into the subject in a way that we would be able to treat this sort of disease with a newer insight. Regarding the importance of this issue, we decided to summarize our extensive searches from online databases, including PubMed, Google Scholar, Medline, Web of Science, and Scopus until February 2023, which we found effective in elucidating the association of subacute thyroiditis and viral diseases. Different online databases were searched for narrative review articles, systemic review articles, and original articles, which were published until February 2023. According to the included studies, we found that there is a correlation between SAT and several viruses such as Epstein-Barr virus, influenza virus, human immunodeficiency virus, cytomegalovirus, oral and cervical virus, hepatitis, dengue virus, and SARS-COV-2. The effect of each of the viral diseases mentioned in the SAT is given in the text. According to the results mentioned in the text, because SAT may be challenging for early diagnosis, due to the potential of classic symptoms as well as the interference of similar clinical symptoms between thyrotoxicosis and viral reactions, the correlation between SAT and viral diseases should be considered so that we can avoid misdiagnosis and lateness.

Subakut Tiroiditte Prognoz Öngörülebilir mi?

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

Subacute THYROiditis Related to SARS-CoV-2 VAccine and Covid-19 (THYROVAC Study): A Multicenter Nationwide Study.

The aims of the study are to compare characteristics of subacute thyroiditis (SAT) related to different aetiologies, and to identify predictors of recurrence of SAT and incident hypothyroidism. This nationwide multicenter retrospective cohort study included 53 endocrinology centers in Turkey. The study participants were divided into either coronavirus disease-2019 (COVID-19)-related SAT (Cov-SAT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine-related SAT (Vac-SAT), or control SAT (Cont-SAT). Of the 811 patients, 258 (31·8%) were included in the Vac-SAT group, 98 (12·1%) in the Cov-SAT group, and 455 (56·1%) in the Cont-SAT group. No difference was found between the groups with regard to laboratory and imaging findings. The aetiology of SAT was not an independent predictor of recurrence or hypothyroidism. In the entire cohort, steroid therapy requirement and younger age were statistically significant predictors for SAT recurrence. C-reactive protein (CRP) measured during SAT onset, female gender, absence of anti-thyroid peroxidase (TPO) positivity, and absence of steroid therapy were statistically significant predictors of incident (early) hypothyroidism, irrespective of SAT aetiology. On the other hand, probable predictors of established hypothyroidism differed from that of incident hypothyroidism. Since there is no difference in terms of follow-up parameters and outcomes, COVID-19- and SARS-CoV-2- vaccine related SATs can be treated and followed up like classical SATs. The recurrence was determined by the younger age and steroid therapy requirement. Steroid therapy independently predict incident hypothyroidism that may sometimes be transient in overall SATs and is also associated with lower risk of established hypothyroidism.

Development of SARS-CoV-2 atypical thyroiditis in a patient with severe COVID-19

The novel coronavirus infection SARS-CoV-2 (COVID-19) has gone down in history as one of the deadliest pandemics in history. Since the first reports of SARS-CoV-2 infection, a lot of data has appeared regarding the features of the COVID-19 pathogenesis and the effect of the virus on various organs and tissues. It is known that SARS-CoV-2 can cause both pulmonary and systemic inflammation, causing multiple organ dysfunction. In addition, since the beginning of the pandemic, reports of the relationship between COVID-19 and thyroid dysfunction have continued to emerge. Numerous studies have demonstrated that the thyroid gland and the entire hypothalamus-pituitary-thyroid axis can be significant targets for the pathogenic effects of SARS-CoV-2.The classic thyroid dysfunctions in infectious diseases, also described in COVID-19, are subacute thyroiditis and secondary hypothyroidism. Of particular interest is the development of atypical thyroiditis-SARS-CoV-2 against the background of COVID-19, a condition first recorded during COVID-19, associated with formidable cardiovascular complications and high mortality in patients with COVID-19, not previously encountered in other viral infections.This article describes a clinical case of SARS-CoV-2 atypical thyroiditis in a patient with bilateral viral pneumonia in the acute period of COVID-19.

Could the Systemic Immune Inflammation Index Predict Diagnosis, Recovery Time, Hypothyroidism, and Recurrence Rates in Subacute Thyroiditis?

Subacute thyroiditis (SAT) is a non-infectious inflammatory disease of the thyroid. The Systemic Immune-Inflammation Index (SII), also known as an easy economical marker, correlates with the severity of inflammatory responses. We aimed to evaluate the clinical significance of the SII and to compare it to other inflammatory markers in terms of diagnosis, recovery time, and recurrence of SAT. The current non-interventional observational prospective study was performed at Outpatient Department of Endocrinology, Erzurum Training and Research Hospital. Sixty-nine patients with SAT and fifty-nine healthy individuals in total were enrolled in our study. The follow-up period was 6-12 months for all patients regarding treatment response, recurrence, and hypothyroidism. The SII level was found to be significantly higher at the time of diagnosis in the SAT group compared to the control group (p=0.000). There was a significant positive correlation between the SII and SAT recovery time (p=0.000), particularly in patients receiving methyl prednisolone treatment (p=0.002). SII was not found to be significantly associated with hypothyroidism and recurrence in patients with SAT (p=0.261, p=0.568). However, compared to the ones without recurrence, thyroid stimulating hormone (TSH) and erythrocyte sedimentation rate levels at the time of diagnosis were found to be higher in those patients with recurrence (p=0.035, p=0.046). SII is a low-cost, widely available, universal indicator of inflammatory processes in SAT. It could provide many benefits in the follow-up process and the selection of aggressive anti-inflammatory treatment by estimating recovery time. SII, as a practical biomarker, may be a new diagnostic and prognostic tool for SAT.

КЛИНИЧЕСКИЙ СЛУЧАЙ «ЛОНГ-КОВИДА» С ПОРАЖЕНИЕМ ЭНДОКРИННОЙ, СЕРДЕЧНО-СОСУДИСТОЙ И ЛЕГОЧНОЙ СИСТЕМ

Introduction. Coronavirus infection caused by the SARS-CoV-2 virus is characterized by a large range of clinical manifestations, which is associated with the presence of angiotensin-converting enzyme-2 receptors in many organs and tissues of the body. Subacute thyroiditis induced by COVID-19 is difficult to recognize due to the frequent absence of classical symptoms of thyroiditis. Aim. Demonstrate the features of the clinical course of a new coronavirus infection complicated by subacute thyroiditis and pericarditis in the distant period. Material and Methods. A clinical case of patient K., 56 years old, with damage to the pulmonary, cardiovascular and endocrine systems as a result of a new coronavirus infection was presented. Results and discussion. Subacute thyroiditis as a result of SARS-CoV-2 infection may have an atypical course. A pathognomonic feature of subacute thyroiditis is the high rate of erythrocyte sedimentation. The treatment of subacute thyroiditis in most cases requires the prescription of glucocorticoids. In some patients, prescribing nonsteroidal anti-inflammatory drugs may be sufficient to relieve symptoms. There was no clear association of cardiovascular symptoms in long-term COVID-19 with pre-existing cardiovascular pathology.. Conclusion. In the case of subacute thyroiditis developed as a result of SARS-CoV-2 infection, it is necessary to prescribe anti-inflammatory therapy in a timely manner. From a practical point of view, it is important to recognize cardiorespiratory symptoms in time as a non-specific manifestation of the long-term COVID-19 syndrome and the manifestation of cardiovascular pathology.

Evaluation of the diagnostic performance of thyroid-stimulating immunoglobulin and thyrotropin receptor antibodies for Graves' disease.

To evaluate thyroid-stimulating immunoglobulin (TSI) and thyrotropin receptor antibodies (TRAb) diagnostic performance for Graves' disease (GD) and determine clinical cut-off value for diagnosing GD. Of 1369 retrospectively enrolled subjects, 1364 had a definitive diagnosis of untreated GD (GD-UT, n = 87); treated GD (GD-T, n = 206); autoimmune thyroid disease (AIT, n = 241); thyroid nodules (TN, n = 677); subacute thyroiditis (ST, n = 28); healthy subjects (HS, n = 125); other diseases with serological hyperthyroidism (n = 5) and were grouped into the following: UT-GD and control groups (AIT, TN, ST, and HS); and UT-GD and non-GD hyperthyroidism groups. Diagnostic performance of TSI and TRAb was evaluated using area under the curve (AUC) of receiver-operating characteristic (ROC) curve, and optimal clinical cut-off value was determined using maximization of Youden index. TRAb AUC and clinical cut-off value for diagnosing GD were 0.981 and 1.245 IU/L (sensitivity, 96.6%; specificity, 97.1%; positive predictive value [PPV], 71.8%; negative predictive value [NPV], 99.9%; positive likelihood ratio [PLR], 33.31; negative likelihood ratio [NLR, 0.035), respectively, for the GD-UT and control groups. Those for TSI were 0.992 and 0.467 IU/L (sensitivity 98.8%; specificity, 96.4%; PPV, 68.8%; NPV, 99.9%; PLR, 27.472; NLR, 0.011). Those for TRAb in GD-UT and non-GD hyperthyroidism groups were 0.923 and 1.78 IU/L (sensitivity, 92.0%; specificity, 89.1%; PPV, 93%; NPV, 87.5%; PLR, 8.44; NLR, 0.089), respectively. For TSI, these were 0.92 and 0.545 IU/L (sensitivity, 97.7%; specificity, 83.6%; PPV, 90.4%; NPV, 95.8%; PLR27.472, NLR, 0.011), respectively. TSI diagnostic performance for GD was excellent and had better sensitivity than TRAb.

A rare presentation of amyloid goiter with renal amyloidosis in a young female

Amyloidosis is a rare systemic disorder caused by abnormal folding of normal soluble proteins leading to fibril formation in one or more body organs, systems or soft tissues. Amyloid goiter is characterized by deposits of amyloid protein in the thyroid tissue. Amyloid infiltration of thyroid gland with development of secondary goiter is rare. Here we report a case of 36-year-old female presented with progressive painless swelling over neck. Thyroid profile was normal. Ultrasound neck showed enlarged bilateral thyroid gland and isthmus. Fine needle aspiration cytology suggestive of subacute thyroiditis (granulomatous thyroiditis). Total thyroidectomy was done and biopsy sample revealed amyloid goiter.

Emerging trends and hot spots in subacute thyroiditis research from 2001 to 2022: A bibliometric analysis.

Subacute thyroiditis (SAT) is the most prevalent self-limiting thyroid disease that causes pain, accounting for about 5% of all clinical thyroid disorders. Numerous clinically noteworthy results have been published in this area over the last 20 years. However, no article has comprehensively assessed the relevant literature yet. We conducted a bibliometric analysis of SAT to provide light on the dynamic nature of scientific advancement and aid researchers in gaining a global perspective while examining research core themes and hotspots. SAT-related articles and reviews from 2001 to 2022 were retrieved from the Science Citation Index-Expanded of Web of Science Core Collection (WoSCC). We analyzed current research trends and hotspots in this area using CiteSpace and Vosviewer. A total of 568 studies associated with SAT research were published in 282 academic journals by 2,473 authors in 900 institutions from 61 countries/regions. The United States was a crucial link in inter-country/region collaboration and was the most frequently involved country in international cooperation. The University of Missouri System was the top organization, and Braley-Mullen H. was the most productive researcher. Thyroid published the most papers, with 36 publications. The most co-cited article was "Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study" (by Fatourechi V., 2003). The clustered network and timeline view of keywords showed that the prevalence, diagnosis, and treatment of SAT were the research core themes during the past 20 years. Analysis of keyword bursts indicated that the clinical characteristic and the influence of COVID-19 on SAT appeared to be the current research hotspots. This bibliometric analysis conducted a thorough review of the SAT research. The clinical characteristics and the genetic background of SAT under the influence of COVID-19 are current research hotspots. However, there is still a need for further study and global collaboration. Our findings can aid researchers in understanding the current status of SAT research and immediately pinpoint new directions for further investigation.

Subacute thyroiditis-an unusual endocrine cause of pyrexia of unknown origin: Case report with review of literature

We report a case of a 58-year-old male who presented with high grade fever of 45 days duration. He had presented with a dry cough and right ear pain. His initial clinical evaluation and diagnostic tests were unremarkable. During the hospital stay, he developed palpitation for which tests for thyroid functions were done which revealed subacute thyroiditis. He recovered fully with the treatment. Subacute thyroiditis is one of the rarely mentioned causes of Pyrexia of Unknown origin. A high index of suspicion and appropriate imaging is required for early diagnosis and management.

Thyroglobulin levels in COVID-19-positive patients: Correlations with thyroid function tests, inflammatory markers, and glucocorticoid use.

COVID-19 often results in generalized inflammation and affects various organs and systems. Endocrine research focused on the possible sequelae of COVID-19, with special interest given to the thyroid gland. Clinical problems such as thyroid function in non-thyroidal illness (NTI), autoimmune thyroiditis, and COVID-19-related subacute thyroiditis (SAT) quickly gained wide coverage. Thyrotoxicosis of various origins leads to the release of peripheral thyroid hormones and thyroglobulin (TG), the main glycoprotein contained within the thyroid follicular lumen. In our study, we evaluated TG levels in COVID-19-positive patients and investigated the possible relationships between TG, thyroid function tests (TFTs), and inflammatory markers. Our approach included separate subanalyses of patients who received and those who did not receive glucocorticoids (GCs). In the entire population studied, the concentration of TG tended to decrease with time (p<0.001; p1,2 = 0.025, p1,3 = 0.001, p2,3 = 0.003), and this pattern was especially clear among patients treated with GCs (p<0.001; p1,2=<0.001; p1,3=<0.001; p 2,3=<0.001). The concentration of TG differed significantly between patients treated and those not treated with GC at the second and third time points of observation (p=0.033 and p=0.001, consecutively). TG concentration did not differ between the patients with normal and abnormal TFTs. The correlations between TG, TFTs, and inflammatory markers were very limited. 19 patients had elevated TG levels, but a TFT pattern suggestive of thyrotoxicosis was not common in this group. There were no statistically significant differences between patients who met and those who did not meet the predefined combined primary endpoint.

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.

HLA typing of patients who developed subacute thyroiditis and Graves’ disease after SARS-CoV-2 vaccination: a case report

BackgroundCases of subacute thyroiditis (SAT) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination have been reported. A human leukocyte antigen (HLA) allele, HLA-B*35, appears to be involved in the pathogenesis of SAT.Case presentationWe conducted HLA typing of one patient with SAT and another with both SAT and Graves’ disease (GD), which developed after SARS-CoV-2 vaccination. Patient 1, a 58-year-old Japanese man, was inoculated with a SARS-CoV-2 vaccine (BNT162b2; Pfizer, New York, NY, USA). He developed fever (38 °C), cervical pain, palpitations, and fatigue on day 10 after vaccination. Blood chemistry tests revealed thyrotoxicosis and elevated serum C-reactive protein (CRP) and slightly increased serum antithyroid-stimulating antibody (TSAb) levels. Thyroid ultrasonography revealed the characteristic findings of SAT. Patient 2, a 36-year-old Japanese woman, was inoculated twice with a SARS-CoV-2 vaccine (mRNA-1273; Moderna, Cambridge, MA, USA). She developed fever (37.8 °C) and thyroid gland pain on day 3 after the second vaccination. Blood chemistry tests revealed thyrotoxicosis and elevated serum CRP, TSAb, and antithyroid-stimulating hormone receptor antibody levels. Fever and thyroid gland pain persisted. Thyroid ultrasonography revealed the characteristic findings of SAT (i.e., slight swelling and a focal hypoechoic area with decreased blood flow). Prednisolone treatment was effective for SAT. However, thyrotoxicosis causing palpitations relapsed thereafter, for which thyroid scintigraphy with 99mtechnetium pertechnetate was conducted, and the patient was diagnosed with GD. Thiamazole treatment was then initiated, which led to improvement in symptoms.ConclusionHLA typing revealed that both patients had the HLA-B*35:01, -C*04:01, and -DPB1*05:01 alleles. Only patient 2 had the HLA-DRB1*11:01 and HLA-DQB1*03:01 alleles. The HLA-B*35:01 and HLA-C*04:01 alleles appeared to be involved in the pathogenesis of SAT after SARS-CoV-2 vaccination, and the HLA-DRB1*11:01 and HLA-DQB1*03:01 alleles were speculated to be involved in the postvaccination pathogenesis of GD.

The Influence of SARS-CoV-2 Infection on the Thyroid Gland

It is important to acknowledge the impact that COVID-19 has on the thyroid gland and how the thyroid gland status before and during infection affects SARS-CoV-2 severity. To this day those dependencies are not fully understood. It is known that the virus uses angiotensin-converting enzyme-2 as the receptor for cellular entry and it can lead to multiple organ failures due to a cytokine storm. Levels of proinflammatory molecules (such as cytokines and chemokines) which are commonly elevated during infection were significantly higher in observed SARS-CoV-2-positive patients. In terms of hypothyroidism, hyperthyroidism, and autoimmune thyroid diseases, there is no proof that those dysfunctions have a direct impact on the more severe courses of COVID-19. Regarding hyper- and hypothyroidism there was no consequential dependency between the frequency of SARS-CoV-2 infection morbidity and more severe post-infectious complications. When it comes to autoimmune thyroid diseases, more evaluation has to be performed due to the unclear relation with the level of antibodies commonly checked in those illnesses and its binding with the mentioned before virus. Nonetheless, based on analyzed works we found that COVID-19 can trigger the immune system and cause its hyperactivity, sometimes leading to the new onset of autoimmune disorders. We also noticed more acute SARS-CoV-2 courses in patients with mainly reduced free triiodothyronine serum levels, which in the future, might be used as a mortality indicating factor regarding SARS-CoV-2-positive patients. Considering subacute thyroiditis (SAT), no statistically important data proving its direct correlation with COVID-19 infection has been found. Nevertheless, taking into account the fact that SAT is triggered by respiratory tract viral infections, it might be that SARS-CoV-2 can cause it too. There are many heterogenous figures in the symptoms, annual morbidity distribution, and frequency of new cases, so this topic requires further evaluation.

A case Report of Simultaneous Subacute Thyroiditis and COVID-19 Infection. A Rare Presentation or Mere Coincidence?

Subacute thyroiditis is an uncommon thyroid disease which usually occurs after a viral infection. During COVID-19 pandemics, several subacute thyroiditis cases were identified during or after COVID-19. Due to their similar manifestations and high prevalence of COVID-19, subacute thyroiditis might be neglected if the clinicians do not keep it in mind. In this care report, we present a missing patient with SARS-COV-2 infection and subacute thyroiditis which was not suspected until the latent phase of the disease. The patient report can be a re-emphasis on the importance of clinical examination and especially paying attention to palpation of the thyroid gland.

Subacute Thyroiditis Developing Within 2 Days of Vaccination Against COVID-19 with BNT162b2 mRNA

A 32-year-old woman presented to the outpatient clinic with persistent fever, anterior neck pain, and palpitations over the past week which developed 2 days after she had received the first dose of the Pfizer/BioNTech SARS-CoV-2 mRNA vaccine. On examination, the patient’s heart rate was 140 beats per minute and the thyroid gland was tender on palpation. Laboratory studies showed a low serum TSH level with elevated free thyroxine. Thyroid ultrasound revealed low-echoic lesions compatible with the site of tenderness. The patient was diagnosed with subacute thyroiditis and treatment was initiated with acetaminophen and propranolol, which resulted in symptom resolution within 2 weeks. Clinicians should be aware that subacute thyroiditis may occur within a few days following COVID-19 vaccination, especially in patients with anterior cervical pain with no significant abnormal pharyngeal findings and/or severe palpitations, because differentiating them from early non-specific adverse reactions can be challenging.

SUBACUTE THYROIDITIS FOLLOWING SARS-COV-2 VACCINATION: AN AUTOIMMUNE/INFLAMMATORY SYNDROME INDUCED BY ADJUVANTS (ASIA SYNDROME).

Subacute thyroiditis, a manifestation of Autoimmune/inflammatory syndrome induced by adjuvants that may develop after vaccination. The aim of this study is to determine the importance of vaccination against COVID-19 in the etiology of subacute thyroiditis. This case reports/series is an observational, descriptive research design. Five of the thirty patients who applied to our clinic with subacute thyroiditis in the last 6 months had a history of inactivated and mRNA vaccines in the last four weeks, after exclusion of infection and comorbidities. We present three cases of mRNA-based vaccination and two cases of inactive SARS-CoV-2 vaccination that met ASIA criteria. Our findings suggest that subacute thyroiditis may be a complication of vaccination against COVID-19. Vaccine administration may led to autoimmune manifestation induction as well as autoantibody production. Adjuvant-induced autoimmune/inflammatory syndrome, an abnormal autoimmune response as a result of exposure to an adjuvant such as vaccine, appears likely in our cases.

Asymmetric diffuse thyroid uptake on 18F-FDG PET/CT in patient with subacute thyroiditis: Case report and literature review.

A 48-year-old man with an intermittent fever of 39.0oC for more than three weeks underwent computed tomography (CT) and blood testing, which revealed no clues. Antibiotics wereadministered, but his condition did not improve. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) showed right-lobe-dominant diffuse thyroid uptake. On technetium-99m (99mTc) pertechnetate scintigraphy, the thyroid gland could not be visualized, and he was diagnosed with subacute thyroiditis (SAT). When asymmetric 18F-FDG diffuse thyroid uptake on PET/CT is observed in a patient with a fever of unknown origin (FUO), SAT may need to be considered.

A case of subacute thyroiditis after influenza vaccination.

A 40-year-old Japanese woman presented to the outpatient clinic with fever and palpitations 2 days after receiving the influenza vaccine (Influenza HA Vaccine 'KMB'®) following the second dose of coronavirus disease 2019 (COVID-19) vaccine (COVID-19 vaccine Moderna intramuscular injection®). At the first visit, the patient presented with a swollen thyroid gland with mild tenderness, and she was diagnosed with subacute thyroiditis (SAT) based on the presence of thyrotoxicosis (free T3: 5.42 pg/mL; free T4: 2.34 ng/dL; and thyroid-stimulating hormone (TSH): <0.01 μIU/mL), a high C-reactive protein level (5.77 mg/dL), a negative TSH receptor antibody, and characteristic ultrasound findings. The patient's human leukocyte antigen types were A2, A11, B35, B51, DR4, and DR1403. Prednisolone (15 mg/day) was given as an initial dose, after which the fever subsided, and the dose was tapered and discontinued after 6 weeks. The patient was thought to have developed SAT due to influenza vaccination. SAT after influenza vaccination may be overlooked. For patients with SAT, it is necessary to obtain information regarding their vaccination history. After influenza vaccination, subacute thyroiditis (SAT) may develop. If persistent fever, anterior neck pain, swelling, tenderness of the thyroid gland, and symptoms of thyrotoxicosis are observed immediately after vaccination for several viruses, including influenza, an examination to rule out the onset of SAT is recommended. Human leukocyte antigen type A2 (HLA-A2) and HLA-B35 may be linked to the development of SAT following influenza vaccination. The two doses of the coronavirus disease 2019 (COVID-19) vaccine given before the influenza vaccine may affect the onset of SAT.

Management of thyroiditis in the context of Covid-19: cause-effect and beyond.

The COVID-19 pandemic hit the world in late 2019, and by 2020, everyone was affected. Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) belongs to the beta-coronavirus genre and uses the angiotensin-converting enzyme 2 (ACE2) receptor to penetrate cells. Thyroid cells are rich in such receptors. Therefore, this gland is frequently involved alongside other organs in the COVID-19 disease. To describe COVID-19 inflammation and, eventually, dysregulations of normal thyroid function in a case series of patients diagnosed in a tertiary endocrinology care centre. We described subacute thyroiditis cases related to COVID-19 infection or vaccination against SARS-CoV2 infection (clinical manifestations and evolution). We also reviewed the literature data regarding COVID-19 infection or vaccination implications in thyroid pathology. The literature describes two types of thyroid involvement in SARS-CoV2 infection or vaccination: subacute thyroiditis (SAT) and non-thyroidal illness syndrome (NTIS). In our case series, 5 patients (3 males), aged 41-54 years, developed the classical clinical manifestation of SAT related to COVID-19 infection (3 patients, concomitantly to upper respiratory infection or a few weeks apart) or anti-SARS-CoV2 ARNm vaccination (1-2 weeks after the vaccine administration). Clinical, laboratory and imaging findings and the evolution (steroid anti-inflammatory treatment used in 4/5 cases) were unremarkable compared to other SAT etiologies. We found no differences between the "typical" viral and post-COVID-19 SAT regarding clinical presentation, severity, response to treatment, and thyroid function alteration. The only remarkable difference is the association of SAT with anti-SARS-CoV2 ARNm vaccination.