October - December 2023, Volume 19, Issue 4

Gherlan GS, Gheorghiu ML, Constantin C, Enyedi M, Baloseanu N, Tanasie DI, Gherlan I

Management of Thyroiditis in the Context of Covid-19: Cause-Effect and Beyond

Acta Endo (Buc) 2023, 19 (4): 471-479
doi: 10.4183/aeb.2023.471

Background. 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. Aim. 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. Patients and Methods. 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. Results. 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. Conclusion. 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

Keywords: COVID-19, subacute thyroiditis, nonthyroidal illness, SARS-CoV-2, vaccine.

Correspondence: Iuliana Gherlan MD, “C.I. Parhon” National Institute of Endocrinology, Pediatric Endocrinology Department, Aviatorilor Blvd. No 34-36, Bucharest, 011863, Romania, E-mail: iuliana.gherlan@umfcd.ro