engleski

Is subacute thyroiditis an underestimated clinical feature of COVID-19?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel, highly transmissible virus that has led to the ongoing coronavirus disease 2019 (COVID-19) global pandemic. It emerged in late 2019 in Wuhan, China and since then virus has been rapidly spreading worldwide. The World Health Organization (WHO) officially declared it a pandemic in March 2020. Clinical features of COVID-19 vary from asymptomatic or mild common cold-like symptoms to more severe multi-organ manifestations. Emerging evidence suggests that subacute thyroiditis (SAT) is one of the rare and potentially neglected manifestations of COVID-19. SAT is a self-limiting inflammatory thyroid disease thought to be linked to a viral infection or post-viral inflammatory reaction. According to recent reports, SARS-CoV-2, amongst several other familiar viruses, may also precipitate development of SAT. It is often characterized by anterior cervical pain, transient abnormalities in thyroid function and systemic symptoms such as fever, fatigue, myalgia and anorexia. Diagnosis is usually based on clinical presentation, physical examination, thyroid hormones analysis and imaging. Until 28th November 2020, there are 13 published studies of SAT in 28 patients with COVID-19. Median age at the time of diagnosis was 41 years and 75% of patients were females. The median between COVID-19 diagnosis and the onset of SAT symptoms is reported to be 29 days. Common clinical symptoms were palpitations (80%), fever (65%), fatigue (50%) and anterior cervical pain radiating to jaw (50%). The median follow-up was 40 days (range 10-70 days) and 71% of patients regained normal thyroid function within that period. However, 11% of patients presented with subclinical hypothyroidism, 11% with hypothyroidism and 7% of them with hyperthyroidism. 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.

subacute thyroiditis ; COVID-19 ; SARS-CoV-2

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