Possible link between COVID-19 and subacute thyroiditis

Subacute thyroiditis and coronavirus
on Thu 23 Jul

 

In May 2020, the University Hospital of Pisa reported on the case of an 18-year old woman who developed COVID-19 having caught it from her Father.

 

She completely recovered , testing negative, but 18 days after her initial infection she started to experience pain in the neck and thyroid; heart palpitations and fever. Her T3 and T4 hormones were elevated and she had high markers of inflammation.

 

Upon returning to hospital she was diagnosed with subacute thyroiditis (also known as De Quervain’s, granulomatous thyroiditis, or giant cell thyroiditis)

 

After being treated with a steroid called prednisone her thyroid pain diminished and within 40 days she was shown to have normal thyroid function.

 

This sequence of events was particularly unusual as this patient had never previously experienced thyroid disease and a month earlier she had had her thyroid tested with normal results.

 

According to the case study’s author – Francesco Latrofa - SARS-CoV-2 was likely to have caused the onset of subacute thyroiditis because of the chronological association and because of the tendency of thyroiditis to occur after viral infection.

 

The case study is described here

 

Subsequent Research

 

In July 2020 a Lancet article discussed further research  by the University of Pisa which had been done to assess the prevalence of thyrotoxicosis (an excess of the thyroid hormone in the body) on COVID-19 patients. 

 

This was done by comparing 93 consecutive patients admitted to High Intensity Care units in 2020 with 101 consecutive patients admitted to HICU’s in 2019. 52 patients with COVID -19 who were admitted to low intensity care units were also studied.

 

Full details of this study can be found here

 

The study took account of age and gender – because thyroiditis is usually seen in women aged 30 to 50 - but despite this the conclusion was that a large proportion of COVID-19 patients in HICU’s  presented with thyrotoxicosis and low serum thyroid stimulating hormone concentrations – which is not typical.

 

Although further research is needed it is currently deemed that this was due to the presence of subacute thyroiditis which had been induced by SARS-CoV-2  in an underlying setting of non-thyroidal illness syndrome.

 

Going Forward

Until further research disproves the link, it is now suggested that there should be a routine assessment of COVID-19 patients in HICU’s. Symptoms of the first phase of acute thyroiditis echo those of hyperthyroidism because the body is producing too much thyroid hormone.

 

If you have had COVID-19 and are still feeling unwell the symptoms to look out for are:

 

  • pain in your thyroid area (which is found at the bottom front of your throat)
  • sweating
  • a fever
  • feeling hungry
  • hyperactivity
  • heart palpitations
  • insomnia
  • weight loss
  • tremors

 

If you are experiencing some of these please consult your GP. Diagnosis can be made by blood tests of thyroid function and tests for acute inflammatory markers.

 

If the results are positive, then a viral thyroiditis may resolve spontaneously but occasionally treatment with steroids may be necessary before almost always a full recovery.

 

I hope this has been helpful.

 

Although every effort is made to ensure that all health advice on this website is accurate and up to date it is for information purposes and should not replace a visit to your doctor or health care professional.

 

As the advice is general in nature rather than specific to individuals Dr Vanderpump cannot accept any liability for actions arising from its use nor can he be held responsible for the content of any pages referenced by an external link

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