COVID-19-associated thyroid diseases: Difference between revisions

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__NOTOC__
__NOTOC__
{{COVID-19 thyroid disorders}}
{{CMG}} {{AE}} {{Mitra}}
 
{{CMG}} {{AE}}


==Overview==
==Overview==
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==Differentiating COVID-19-associated thyroid diseases from other Diseases==
==Differentiating COVID-19-associated thyroid diseases from other Diseases==
* Differential diagnosis of [[hyperthyroidism]] in [[COVID-19]] patients may include:  
* Differential diagnosis of [[hyperthyroidism]] in [[COVID-19]] patients may include: <ref name="pmid32436948">{{cite journal| author=Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F| title=Subacute Thyroiditis After Sars-COV-2 Infection. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 7 | pages=  | pmid=32436948 | doi=10.1210/clinem/dgaa276 | pmc=7314004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32436948  }} </ref> <ref name="pmid32843467">{{cite journal| author=Mattar SAM, Koh SJQ, Rama Chandran S, Cherng BPZ| title=Subacute thyroiditis associated with COVID-19. | journal=BMJ Case Rep | year= 2020 | volume= 13 | issue= 8 | pages=  | pmid=32843467 | doi=10.1136/bcr-2020-237336 | pmc=7449350 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32843467  }} </ref> <ref name="pmid32504458">{{cite journal| author=Asfuroglu Kalkan E, Ates I| title=A case of subacute thyroiditis associated with Covid-19 infection. | journal=J Endocrinol Invest | year= 2020 | volume= 43 | issue= 8 | pages= 1173-1174 | pmid=32504458 | doi=10.1007/s40618-020-01316-3 | pmc=7273820 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32504458  }} </ref> <ref name="pmid32780854">{{cite journal| author=Brancatella A, Ricci D, Cappellani D, Viola N, Sgrò D, Santini F | display-authors=etal| title=Is Subacute Thyroiditis an Underestimated Manifestation of SARS-CoV-2 Infection? Insights From a Case Series. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 10 | pages=  | pmid=32780854 | doi=10.1210/clinem/dgaa537 | pmc=7454668 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32780854  }} </ref> <ref name="pmid33370933">{{cite journal| author=Chakraborty U, Ghosh S, Chandra A, Ray AK| title=Subacute thyroiditis as a presenting manifestation of COVID-19: a report of an exceedingly rare clinical entity. | journal=BMJ Case Rep | year= 2020 | volume= 13 | issue= 12 | pages=  | pmid=33370933 | doi=10.1136/bcr-2020-239953 | pmc=7750881 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33370933  }} </ref> <ref name="pmid33005461">{{cite journal| author=Campos-Barrera E, Alvarez-Cisneros T, Davalos-Fuentes M| title=Subacute Thyroiditis Associated with COVID-19. | journal=Case Rep Endocrinol | year= 2020 | volume= 2020 | issue=  | pages= 8891539 | pmid=33005461 | doi=10.1155/2020/8891539 | pmc=7522602 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33005461  }} </ref> <ref name="pmid32668831">{{cite journal| author=Tee LY, Harjanto S, Rosario BH| title=COVID-19 complicated by Hashimoto's thyroiditis. | journal=Singapore Med J | year= 2021 | volume= 62 | issue= 5 | pages= 265 | pmid=32668831 | doi=10.11622/smedj.2020106 | pmc=8801861 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32668831  }} </ref> <ref name="pmid32984743">{{cite journal| author=Dixit NM, Truong KP, Rabadia SV, Li D, Srivastava PK, Mosaferi T | display-authors=etal| title=Sudden Cardiac Arrest in a Patient With Myxedema Coma and COVID-19. | journal=J Endocr Soc | year= 2020 | volume= 4 | issue= 10 | pages= bvaa130 | pmid=32984743 | doi=10.1210/jendso/bvaa130 | pmc=7499619 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32984743  }} </ref> <ref name="pmid32984743">{{cite journal| author=Dixit NM, Truong KP, Rabadia SV, Li D, Srivastava PK, Mosaferi T | display-authors=etal| title=Sudden Cardiac Arrest in a Patient With Myxedema Coma and COVID-19. | journal=J Endocr Soc | year= 2020 | volume= 4 | issue= 10 | pages= bvaa130 | pmid=32984743 | doi=10.1210/jendso/bvaa130 | pmc=7499619 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32984743  }} </ref> <ref name="pmid32738929">{{cite journal| author=Muller I, Cannavaro D, Dazzi D, Covelli D, Mantovani G, Muscatello A | display-authors=etal| title=SARS-CoV-2-related atypical thyroiditis. | journal=Lancet Diabetes Endocrinol | year= 2020 | volume= 8 | issue= 9 | pages= 739-741 | pmid=32738929 | doi=10.1016/S2213-8587(20)30266-7 | pmc=7392564 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32738929  }} </ref> <ref name="pmid32436948">{{cite journal| author=Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F| title=Subacute Thyroiditis After Sars-COV-2 Infection. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 7 | pages=  | pmid=32436948 | doi=10.1210/clinem/dgaa276 | pmc=7314004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32436948  }} </ref>
**[[Graves' disease]]
**[[Graves' disease]]
**[[Subacute thyroiditis]]
**[[Subacute thyroiditis]]
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* Data on the exact epidemiology and demographics of [[thyroid diseases]] in [[COVID-19]] patients are lacking.  
* Data on the exact epidemiology and demographics of [[thyroid diseases]] in [[COVID-19]] patients are lacking.  
* Several cases of [[subacute thyroiditis]], [[Hashimoto thyroiditis]], [[myxedema coma]], [[Grave's disease]], [[atypical thyroiditis]], [[thyrotoxicosis]], [[sick euthyroid syndrome]] have been reported in [[COVID-19]] patients worldwide <ref name="pmid32436948">{{cite journal| author=Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F| title=Subacute Thyroiditis After Sars-COV-2 Infection. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 7 | pages=  | pmid=32436948 | doi=10.1210/clinem/dgaa276 | pmc=7314004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32436948  }} </ref> <ref name="pmid32843467">{{cite journal| author=Mattar SAM, Koh SJQ, Rama Chandran S, Cherng BPZ| title=Subacute thyroiditis associated with COVID-19. | journal=BMJ Case Rep | year= 2020 | volume= 13 | issue= 8 | pages=  | pmid=32843467 | doi=10.1136/bcr-2020-237336 | pmc=7449350 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32843467  }} </ref> <ref name="pmid32504458">{{cite journal| author=Asfuroglu Kalkan E, Ates I| title=A case of subacute thyroiditis associated with Covid-19 infection. | journal=J Endocrinol Invest | year= 2020 | volume= 43 | issue= 8 | pages= 1173-1174 | pmid=32504458 | doi=10.1007/s40618-020-01316-3 | pmc=7273820 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32504458  }} </ref> <ref name="pmid32780854">{{cite journal| author=Brancatella A, Ricci D, Cappellani D, Viola N, Sgrò D, Santini F | display-authors=etal| title=Is Subacute Thyroiditis an Underestimated Manifestation of SARS-CoV-2 Infection? Insights From a Case Series. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 10 | pages=  | pmid=32780854 | doi=10.1210/clinem/dgaa537 | pmc=7454668 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32780854  }} </ref> <ref name="pmid33370933">{{cite journal| author=Chakraborty U, Ghosh S, Chandra A, Ray AK| title=Subacute thyroiditis as a presenting manifestation of COVID-19: a report of an exceedingly rare clinical entity. | journal=BMJ Case Rep | year= 2020 | volume= 13 | issue= 12 | pages=  | pmid=33370933 | doi=10.1136/bcr-2020-239953 | pmc=7750881 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33370933  }} </ref> <ref name="pmid33005461">{{cite journal| author=Campos-Barrera E, Alvarez-Cisneros T, Davalos-Fuentes M| title=Subacute Thyroiditis Associated with COVID-19. | journal=Case Rep Endocrinol | year= 2020 | volume= 2020 | issue=  | pages= 8891539 | pmid=33005461 | doi=10.1155/2020/8891539 | pmc=7522602 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33005461  }} </ref> <ref name="pmid32668831">{{cite journal| author=Tee LY, Harjanto S, Rosario BH| title=COVID-19 complicated by Hashimoto's thyroiditis. | journal=Singapore Med J | year= 2021 | volume= 62 | issue= 5 | pages= 265 | pmid=32668831 | doi=10.11622/smedj.2020106 | pmc=8801861 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32668831  }} </ref> <ref name="pmid32984743">{{cite journal| author=Dixit NM, Truong KP, Rabadia SV, Li D, Srivastava PK, Mosaferi T | display-authors=etal| title=Sudden Cardiac Arrest in a Patient With Myxedema Coma and COVID-19. | journal=J Endocr Soc | year= 2020 | volume= 4 | issue= 10 | pages= bvaa130 | pmid=32984743 | doi=10.1210/jendso/bvaa130 | pmc=7499619 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32984743  }} </ref> <ref name="pmid32984743">{{cite journal| author=Dixit NM, Truong KP, Rabadia SV, Li D, Srivastava PK, Mosaferi T | display-authors=etal| title=Sudden Cardiac Arrest in a Patient With Myxedema Coma and COVID-19. | journal=J Endocr Soc | year= 2020 | volume= 4 | issue= 10 | pages= bvaa130 | pmid=32984743 | doi=10.1210/jendso/bvaa130 | pmc=7499619 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32984743  }} </ref> <ref name="pmid32738929">{{cite journal| author=Muller I, Cannavaro D, Dazzi D, Covelli D, Mantovani G, Muscatello A | display-authors=etal| title=SARS-CoV-2-related atypical thyroiditis. | journal=Lancet Diabetes Endocrinol | year= 2020 | volume= 8 | issue= 9 | pages= 739-741 | pmid=32738929 | doi=10.1016/S2213-8587(20)30266-7 | pmc=7392564 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32738929  }} </ref> <ref name="pmid32436948">{{cite journal| author=Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F| title=Subacute Thyroiditis After Sars-COV-2 Infection. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 7 | pages=  | pmid=32436948 | doi=10.1210/clinem/dgaa276 | pmc=7314004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32436948  }} </ref>
* Several cases of [[subacute thyroiditis]], [[Hashimoto thyroiditis]], [[myxedema coma]], [[Grave's disease]], [[atypical thyroiditis]], [[thyrotoxicosis]], [[sick euthyroid syndrome]] have been reported in [[COVID-19]] patients worldwide. <ref name="pmid32436948">{{cite journal| author=Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F| title=Subacute Thyroiditis After Sars-COV-2 Infection. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 7 | pages=  | pmid=32436948 | doi=10.1210/clinem/dgaa276 | pmc=7314004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32436948  }} </ref> <ref name="pmid32843467">{{cite journal| author=Mattar SAM, Koh SJQ, Rama Chandran S, Cherng BPZ| title=Subacute thyroiditis associated with COVID-19. | journal=BMJ Case Rep | year= 2020 | volume= 13 | issue= 8 | pages=  | pmid=32843467 | doi=10.1136/bcr-2020-237336 | pmc=7449350 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32843467  }} </ref> <ref name="pmid32504458">{{cite journal| author=Asfuroglu Kalkan E, Ates I| title=A case of subacute thyroiditis associated with Covid-19 infection. | journal=J Endocrinol Invest | year= 2020 | volume= 43 | issue= 8 | pages= 1173-1174 | pmid=32504458 | doi=10.1007/s40618-020-01316-3 | pmc=7273820 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32504458  }} </ref> <ref name="pmid32780854">{{cite journal| author=Brancatella A, Ricci D, Cappellani D, Viola N, Sgrò D, Santini F | display-authors=etal| title=Is Subacute Thyroiditis an Underestimated Manifestation of SARS-CoV-2 Infection? Insights From a Case Series. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 10 | pages=  | pmid=32780854 | doi=10.1210/clinem/dgaa537 | pmc=7454668 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32780854  }} </ref> <ref name="pmid33370933">{{cite journal| author=Chakraborty U, Ghosh S, Chandra A, Ray AK| title=Subacute thyroiditis as a presenting manifestation of COVID-19: a report of an exceedingly rare clinical entity. | journal=BMJ Case Rep | year= 2020 | volume= 13 | issue= 12 | pages=  | pmid=33370933 | doi=10.1136/bcr-2020-239953 | pmc=7750881 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33370933  }} </ref> <ref name="pmid33005461">{{cite journal| author=Campos-Barrera E, Alvarez-Cisneros T, Davalos-Fuentes M| title=Subacute Thyroiditis Associated with COVID-19. | journal=Case Rep Endocrinol | year= 2020 | volume= 2020 | issue=  | pages= 8891539 | pmid=33005461 | doi=10.1155/2020/8891539 | pmc=7522602 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33005461  }} </ref> <ref name="pmid32668831">{{cite journal| author=Tee LY, Harjanto S, Rosario BH| title=COVID-19 complicated by Hashimoto's thyroiditis. | journal=Singapore Med J | year= 2021 | volume= 62 | issue= 5 | pages= 265 | pmid=32668831 | doi=10.11622/smedj.2020106 | pmc=8801861 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32668831  }} </ref> <ref name="pmid32984743">{{cite journal| author=Dixit NM, Truong KP, Rabadia SV, Li D, Srivastava PK, Mosaferi T | display-authors=etal| title=Sudden Cardiac Arrest in a Patient With Myxedema Coma and COVID-19. | journal=J Endocr Soc | year= 2020 | volume= 4 | issue= 10 | pages= bvaa130 | pmid=32984743 | doi=10.1210/jendso/bvaa130 | pmc=7499619 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32984743  }} </ref> <ref name="pmid32984743">{{cite journal| author=Dixit NM, Truong KP, Rabadia SV, Li D, Srivastava PK, Mosaferi T | display-authors=etal| title=Sudden Cardiac Arrest in a Patient With Myxedema Coma and COVID-19. | journal=J Endocr Soc | year= 2020 | volume= 4 | issue= 10 | pages= bvaa130 | pmid=32984743 | doi=10.1210/jendso/bvaa130 | pmc=7499619 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32984743  }} </ref> <ref name="pmid32738929">{{cite journal| author=Muller I, Cannavaro D, Dazzi D, Covelli D, Mantovani G, Muscatello A | display-authors=etal| title=SARS-CoV-2-related atypical thyroiditis. | journal=Lancet Diabetes Endocrinol | year= 2020 | volume= 8 | issue= 9 | pages= 739-741 | pmid=32738929 | doi=10.1016/S2213-8587(20)30266-7 | pmc=7392564 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32738929  }} </ref> <ref name="pmid32436948">{{cite journal| author=Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F| title=Subacute Thyroiditis After Sars-COV-2 Infection. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 7 | pages=  | pmid=32436948 | doi=10.1210/clinem/dgaa276 | pmc=7314004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32436948  }} </ref>


==Risk Factors==
==Risk Factors==
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==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
A number of observational studies have shown that [[COVID-19]] infection may be linked to some [[thyroid diseases]], including:
A number of observational studies have shown that [[COVID-19]] infection may be linked to some [[thyroid diseases]], including: <ref name="pmid32436948">{{cite journal| author=Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F| title=Subacute Thyroiditis After Sars-COV-2 Infection. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 7 | pages=  | pmid=32436948 | doi=10.1210/clinem/dgaa276 | pmc=7314004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32436948  }} </ref> <ref name="pmid32843467">{{cite journal| author=Mattar SAM, Koh SJQ, Rama Chandran S, Cherng BPZ| title=Subacute thyroiditis associated with COVID-19. | journal=BMJ Case Rep | year= 2020 | volume= 13 | issue= 8 | pages=  | pmid=32843467 | doi=10.1136/bcr-2020-237336 | pmc=7449350 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32843467  }} </ref> <ref name="pmid32504458">{{cite journal| author=Asfuroglu Kalkan E, Ates I| title=A case of subacute thyroiditis associated with Covid-19 infection. | journal=J Endocrinol Invest | year= 2020 | volume= 43 | issue= 8 | pages= 1173-1174 | pmid=32504458 | doi=10.1007/s40618-020-01316-3 | pmc=7273820 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32504458  }} </ref> <ref name="pmid32780854">{{cite journal| author=Brancatella A, Ricci D, Cappellani D, Viola N, Sgrò D, Santini F | display-authors=etal| title=Is Subacute Thyroiditis an Underestimated Manifestation of SARS-CoV-2 Infection? Insights From a Case Series. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 10 | pages=  | pmid=32780854 | doi=10.1210/clinem/dgaa537 | pmc=7454668 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32780854  }} </ref> <ref name="pmid33370933">{{cite journal| author=Chakraborty U, Ghosh S, Chandra A, Ray AK| title=Subacute thyroiditis as a presenting manifestation of COVID-19: a report of an exceedingly rare clinical entity. | journal=BMJ Case Rep | year= 2020 | volume= 13 | issue= 12 | pages=  | pmid=33370933 | doi=10.1136/bcr-2020-239953 | pmc=7750881 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33370933  }} </ref> <ref name="pmid33005461">{{cite journal| author=Campos-Barrera E, Alvarez-Cisneros T, Davalos-Fuentes M| title=Subacute Thyroiditis Associated with COVID-19. | journal=Case Rep Endocrinol | year= 2020 | volume= 2020 | issue=  | pages= 8891539 | pmid=33005461 | doi=10.1155/2020/8891539 | pmc=7522602 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33005461  }} </ref> <ref name="pmid32668831">{{cite journal| author=Tee LY, Harjanto S, Rosario BH| title=COVID-19 complicated by Hashimoto's thyroiditis. | journal=Singapore Med J | year= 2021 | volume= 62 | issue= 5 | pages= 265 | pmid=32668831 | doi=10.11622/smedj.2020106 | pmc=8801861 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32668831  }} </ref> <ref name="pmid32984743">{{cite journal| author=Dixit NM, Truong KP, Rabadia SV, Li D, Srivastava PK, Mosaferi T | display-authors=etal| title=Sudden Cardiac Arrest in a Patient With Myxedema Coma and COVID-19. | journal=J Endocr Soc | year= 2020 | volume= 4 | issue= 10 | pages= bvaa130 | pmid=32984743 | doi=10.1210/jendso/bvaa130 | pmc=7499619 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32984743  }} </ref> <ref name="pmid32984743">{{cite journal| author=Dixit NM, Truong KP, Rabadia SV, Li D, Srivastava PK, Mosaferi T | display-authors=etal| title=Sudden Cardiac Arrest in a Patient With Myxedema Coma and COVID-19. | journal=J Endocr Soc | year= 2020 | volume= 4 | issue= 10 | pages= bvaa130 | pmid=32984743 | doi=10.1210/jendso/bvaa130 | pmc=7499619 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32984743  }} </ref> <ref name="pmid32738929">{{cite journal| author=Muller I, Cannavaro D, Dazzi D, Covelli D, Mantovani G, Muscatello A | display-authors=etal| title=SARS-CoV-2-related atypical thyroiditis. | journal=Lancet Diabetes Endocrinol | year= 2020 | volume= 8 | issue= 9 | pages= 739-741 | pmid=32738929 | doi=10.1016/S2213-8587(20)30266-7 | pmc=7392564 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32738929  }} </ref> <ref name="pmid32436948">{{cite journal| author=Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F| title=Subacute Thyroiditis After Sars-COV-2 Infection. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 7 | pages=  | pmid=32436948 | doi=10.1210/clinem/dgaa276 | pmc=7314004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32436948  }} </ref>
 
*[[Subacute thyroiditis]]
*[[Subacute thyroiditis]]
*[[Graves’ disease]]
*[[Graves’ disease]]
Line 61: Line 60:
*[[Hashimoto’s thyroiditis]]
*[[Hashimoto’s thyroiditis]]


*Prognosis has generally been good in most cases of COVID-19 patients with hyperthyroidism/hypotheyroidism.  
*[[Prognosis]] has generally been good in most cases of [[COVID-19]] patients with [[hyperthyroidism]]/[[hypothyroidism]].  
**In a patient with subacute thyroiditis, the thyroid function and inflammatory markers normalized in 40 days. <ref name="pmid32436948">{{cite journal| author=Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F| title=Subacute Thyroiditis After Sars-COV-2 Infection. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 7 | pages=  | pmid=32436948 | doi=10.1210/clinem/dgaa276 | pmc=7314004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32436948  }} </ref>
**In a patient with subacute thyroiditis, the thyroid function and inflammatory markers normalized in 40 days. <ref name="pmid32436948">{{cite journal| author=Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F| title=Subacute Thyroiditis After Sars-COV-2 Infection. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 7 | pages=  | pmid=32436948 | doi=10.1210/clinem/dgaa276 | pmc=7314004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32436948  }} </ref>
*In a study on 154 COVID-19 patients, Low fT3 (i.e., Sick euthyroid syndrome) was associated with death and increased IL-6, suggesting poor prognosis in these patients. <ref name="pmid34760673">{{cite journal| author=Dabas A, Singh H, Goswami B, Kumar K, Dubey A, Jhamb U | display-authors=etal| title=Thyroid Dysfunction in COVID-19. | journal=Indian J Endocrinol Metab | year= 2021 | volume= 25 | issue= 3 | pages= 198-201 | pmid=34760673 | doi=10.4103/ijem.ijem_195_21 | pmc=8547402 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34760673  }} </ref>
*In a study on 154 COVID-19 patients, Low fT3 (i.e., euthyroid sick syndrome) was associated with higher mortality and increased [[IL-6]], suggesting poor [[prognosis]] in these patients. <ref name="pmid34760673">{{cite journal| author=Dabas A, Singh H, Goswami B, Kumar K, Dubey A, Jhamb U | display-authors=etal| title=Thyroid Dysfunction in COVID-19. | journal=Indian J Endocrinol Metab | year= 2021 | volume= 25 | issue= 3 | pages= 198-201 | pmid=34760673 | doi=10.4103/ijem.ijem_195_21 | pmc=8547402 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34760673  }} </ref>


==Diagnosis==
==Diagnosis==
Line 140: Line 139:
===Laboratory Findings===
===Laboratory Findings===
The laboratory findings in '''[[hyperthyroidism]]''' are:
The laboratory findings in '''[[hyperthyroidism]]''' are:
*Elevated levels of [[serum thyroxine]] ([[T4]]) and [[triiodothyronine]] ([[T3]]).
*Elevated levels of serum [[thyroxine]] ([[T4]]) and [[triiodothyronine]] ([[T3]]).
*Undetectable serum TSH.
*Undetectable serum TSH.
*Total T4 and T3 measurements are influenced by multiple conditions affecting serum thyroxine-binding globulin (TBG). Thus, measurement of free thyroid hormone; free T4 (FT4) and free T3 (fT3), is the gold standard for the diagnosis of Graves' disease.<ref name="pmid17673120">{{cite journal |vauthors=Dufour DR |title=Laboratory tests of thyroid function: uses and limitations |journal=Endocrinol. Metab. Clin. North Am. |volume=36 |issue=3 |pages=579–94, v |year=2007 |pmid=17673120 |doi=10.1016/j.ecl.2007.04.003 |url=}}</ref>
*Total [[T4]] and [[T3]] measurements are influenced by multiple conditions affecting serum [[thyroxine-binding globulin]] ([[TBG]]). Thus, the measurement of free thyroid hormones; [[free T4]] ([[FT4]]) and [[free T3]] ([[fT3]]), is the gold standard for the diagnosis of [[Graves' disease]].<ref name="pmid17673120">{{cite journal |vauthors=Dufour DR |title=Laboratory tests of thyroid function: uses and limitations |journal=Endocrinol. Metab. Clin. North Am. |volume=36 |issue=3 |pages=579–94, v |year=2007 |pmid=17673120 |doi=10.1016/j.ecl.2007.04.003 |url=}}</ref>
* Antibodies against the TSH receptor (TRAbs) are pathognomonic for Graves' disease. They are detectable in the serum of about 98% of untreated patients.<ref name="pmid20594972">{{cite journal |vauthors=Zöphel K, Roggenbuck D, Schott M |title=Clinical review about TRAb assay's history |journal=Autoimmun Rev |volume=9 |issue=10 |pages=695–700 |year=2010 |pmid=20594972 |doi=10.1016/j.autrev.2010.05.021 |url=}}</ref> Detection of TRAbs rules out other causes of thyrotoxicosis.<ref name="pmid23539719">{{cite journal |vauthors=Barbesino G, Tomer Y |title=Clinical review: Clinical utility of TSH receptor antibodies |journal=J. Clin. Endocrinol. Metab. |volume=98 |issue=6 |pages=2247–55 |year=2013 |pmid=23539719 |pmc=3667257 |doi=10.1210/jc.2012-4309 |url=}}</ref>
* Antibodies against the [[TSH]] receptor ([[TRAbs]]) are pathognomonic for [[Graves' disease]]. They are detectable in the serum of about 98% of untreated patients.<ref name="pmid20594972">{{cite journal |vauthors=Zöphel K, Roggenbuck D, Schott M |title=Clinical review about TRAb assay's history |journal=Autoimmun Rev |volume=9 |issue=10 |pages=695–700 |year=2010 |pmid=20594972 |doi=10.1016/j.autrev.2010.05.021 |url=}}</ref> Detection of TRAbs rules out other causes of thyrotoxicosis.<ref name="pmid23539719">{{cite journal |vauthors=Barbesino G, Tomer Y |title=Clinical review: Clinical utility of TSH receptor antibodies |journal=J. Clin. Endocrinol. Metab. |volume=98 |issue=6 |pages=2247–55 |year=2013 |pmid=23539719 |pmc=3667257 |doi=10.1210/jc.2012-4309 |url=}}</ref>
* Anti-thyroid peroxidase (TPO) and antithyroglobulin (Tg) antibodies are also detectable in many patients with Graves' disease, but it is not recommended to measure these antibodies for diagnosis in all patients.
* Anti-thyroid peroxidase (TPO) and antithyroglobulin (Tg) antibodies are also detectable in many patients with Graves' disease, but it is not recommended to measure these antibodies for diagnosis in all patients.


Line 149: Line 148:
*Increased [[Thyroid-stimulating hormone]] (TSH)
*Increased [[Thyroid-stimulating hormone]] (TSH)
*Decreased Free [[T3]] and Free [[T4]]
*Decreased Free [[T3]] and Free [[T4]]
*[[TSH]] may be decreased in the transient hyperthyroid state<ref>{{cite journal|last=Simmons|first=PJ|title=Antigen-presenting dendritic cells as regulators of the growth of thyrocytes: a role of interleukin-1beta and interleukin-6|journal=Endocrinology|year=1998|volume=139|issue=7|pages=3158–3186|pmid=9645688|doi=10.1210/en.139.7.3148}}</ref>
*[[TSH]] may be decreased in the transient hyperthyroid state <ref>{{cite journal|last=Simmons|first=PJ|title=Antigen-presenting dendritic cells as regulators of the growth of thyrocytes: a role of interleukin-1beta and interleukin-6|journal=Endocrinology|year=1998|volume=139|issue=7|pages=3158–3186|pmid=9645688|doi=10.1210/en.139.7.3148}}</ref>
* Thyroid antibodies are usually positive in patients with Hashimoto's thyroiditis:
* Thyroid antibodies are usually positive in patients with [[Hashimoto's thyroiditis]]:
** [[thyroid peroxidase|Anti-thyroid peroxidase]] antibodies (anti-TPO) (correlates with the disease severity)
** [[thyroid peroxidase|Anti-thyroid peroxidase]] antibodies (anti-[[TPO]]) (correlates with the disease severity)
** [[thyroglobulin|Anti-thyroglobulin]] antibodies (anti-Tg)
** [[thyroglobulin|Anti-thyroglobulin]] antibodies (anti-Tg)
** [[Antimicrosomal antibody|Anti-microsomal antibodies]] can help obtain an accurate diagnosis<ref>{{cite book |last1= Giannini |first1= AJ |authorlink1= |title= The Biological Foundations of Clinical Psychiatry |url=  |year= 1986 |publisher= Medical Examination Publishing Company |location= New Hyde Park, NY |language= |isbn= 0-87488-449-7 |oclc= |doi= |id= |page= |pages= 193–198 |quote= |ref= |bibcode= }}</ref>
** [[Antimicrosomal antibody|Anti-microsomal antibodies]] can help obtain an accurate diagnosis <ref>{{cite book |last1= Giannini |first1= AJ |authorlink1= |title= The Biological Foundations of Clinical Psychiatry |url=  |year= 1986 |publisher= Medical Examination Publishing Company |location= New Hyde Park, NY |language= |isbn= 0-87488-449-7 |oclc= |doi= |id= |page= |pages= 193–198 |quote= |ref= |bibcode= }}</ref>


The laboratory findings in '''[[euthyroid sick syndrome]]''' are:
The laboratory findings in '''[[euthyroid sick syndrome]]''' are:
Line 169: Line 168:
'''(90 to 350'''pg/mL)
'''(90 to 350'''pg/mL)
|-
|-
|Mild euthyroid sick syndrome
|Mild [[euthyroid sick syndrome]]
|↓
|↓
|N
|N
Line 176: Line 175:
|'''↑'''
|'''↑'''
|-
|-
|Moderate euthyroid sick syndrome
|Moderate [[euthyroid sick syndrome]]
|↓
|↓
|N
|N
Line 183: Line 182:
|'''↑'''
|'''↑'''
|-
|-
|Severe euthyroid sick syndrome
|Severe [[euthyroid sick syndrome]]
|↓
|↓
|↓
|↓
Line 235: Line 234:
===Other Diagnostic Studies===
===Other Diagnostic Studies===
====Radioactive iodine uptake====
====Radioactive iodine uptake====
* 24-hr radioactive iodine uptake (RAIU) is a diagnostic measure for Graves' disease, which shows increased homogeneous uptake.<ref>{{Cite journal
* 24-hr [[radioactive iodine uptake]] ([[RAIU]]) is a diagnostic measure for [[Graves' disease]], which shows increased homogeneous uptake.<ref>{{Cite journal
  | author = [[Terry J. Smith]] & [[Laszlo Hegedus]]
  | author = [[Terry J. Smith]] & [[Laszlo Hegedus]]
  | title = Graves' Disease
  | title = Graves' Disease
Line 247: Line 246:
  | pmid = 27797318
  | pmid = 27797318
}}</ref>
}}</ref>
* RAIU is generally increased in Graves' disease because of the action of stimulating TRAbs.  
* [[RAIU]] is generally increased in [[Graves' disease]] because of the action of stimulating [[TRAbs]].  
* Normal values for RAIU 24 h after the administration of a tracer dose of radioiodine are 20% in iodine sufficient and 40% in iodine-deficient areas.
* Normal values for [[RAIU]] 24 h after the administration of a tracer dose of radioiodine are 20% in iodine sufficient and 40% in iodine-deficient areas.


{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Thyroid Disease}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Thyroid Disease}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|TSH receptor antibodies}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|TSH receptor antibodies}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Thyroid US}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Thyroid Ultrasound}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Color flow Doppler}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Color flow Doppler}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Radioactive iodine uptake/Scan}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Radioactive iodine uptake/Scan}}
Line 263: Line 262:
| style="padding: 5px 5px; background: #F5F5F5;" | ↑
| style="padding: 5px 5px; background: #F5F5F5;" | ↑
| style="padding: 5px 5px; background: #F5F5F5;" | ↑
| style="padding: 5px 5px; background: #F5F5F5;" | ↑
| style="padding: 5px 5px; background: #F5F5F5;" | Ophthalmopathy, dermopathy, acropachy
| style="padding: 5px 5px; background: #F5F5F5;" | [[Ophthalmopathy]], [[dermopathy]]
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic nodular goiter}}
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Toxic nodular goiter}}
Line 284: Line 283:
| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
| style="padding: 5px 5px; background: #F5F5F5;" | ↓
| style="padding: 5px 5px; background: #F5F5F5;" | ↓
| style="padding: 5px 5px; background: #F5F5F5;" | Neck pain, fever, and<br> elevated inflammatory index
| style="padding: 5px 5px; background: #F5F5F5;" | Neck pain, fever, and elevated inflammatory markers
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Painless thyroiditis}}
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Painless thyroiditis}}
Line 291: Line 290:
| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
| style="padding: 5px 5px; background: #F5F5F5;" | Reduced/absent flow
| style="padding: 5px 5px; background: #F5F5F5;" | ↓
| style="padding: 5px 5px; background: #F5F5F5;" | ↓
| style="padding: 5px 5px; background: #F5F5F5;" | Symptoms and signs of hypothyroidism
| style="padding: 5px 5px; background: #F5F5F5;" | Symptoms and signs of [[hypothyroidism]]
|-
|-
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Hashimoto's thyroiditis}}
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Hashimoto's thyroiditis}}
Line 318: Line 317:


==References==
==References==
[[Category:Needs english review]]

Latest revision as of 14:59, 17 August 2022

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mitra Chitsazan, M.D.[2]

Overview

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus named for the similarity of its symptoms to those caused by the severe acute respiratory syndrome. Coronavirus disease 2019 (COVID-19) has been considered a global pandemic since its first emergence in Wuhan, China. On March 12, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic.COVID-19 has been found to affect several organs and body systems, including the endocrine system, with short-term and possible long-term consequences. Recent data shows that COVID-19 patients have experienced a range of thyroid diseases.

Historical Perspective

Classification

There is no established system for the classification of COVID-19-associated thyroid disorders.

Pathophysiology

The exact pathogenesis of COVID-19-associated thyroid diseases is not fully understood. However, the following hypotheses have been suggested for the development of thyroid dysfunction in COVID-19 patients. [3] [4] [5] [6] [7] [8]

Causes

Coronavirus disease 2019 (COVID-19) caused by a novel coronavirus called SARS-CoV-2 is the cause of COVID-19-associated thyroid diseases. To read more click here

Differentiating COVID-19-associated thyroid diseases from other Diseases

Epidemiology and Demographics

Risk Factors

There are no established risk factors for COVID-19-associated thyroid diseases.

Screening

There is insufficient evidence to recommend routine screening for COVID-19-associated thyroid diseases.

Natural History, Complications, and Prognosis

A number of observational studies have shown that COVID-19 infection may be linked to some thyroid diseases, including: [2] [9] [10] [11] [12] [13] [14] [15] [15] [16] [2]

  • Prognosis has generally been good in most cases of COVID-19 patients with hyperthyroidism/hypothyroidism.
    • In a patient with subacute thyroiditis, the thyroid function and inflammatory markers normalized in 40 days. [2]
  • In a study on 154 COVID-19 patients, Low fT3 (i.e., euthyroid sick syndrome) was associated with higher mortality and increased IL-6, suggesting poor prognosis in these patients. [17]

Diagnosis

Diagnostic Study of Choice

The diagnosis of COVID-19-associated thyroid diseases is made based on the thyroid function test (TFT), which measures serum levels of triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH).

History and Symptoms

The symptoms of clinical hyperthyroidism in COVID-19 patients are similar to hyperthyroidism in the general population. The most common symptoms include:

The symptoms of clinical hypothyroidism in COVID-19 patients are similar to hypothyroidism in the general population. The most common symptoms include:

If accompanied by thyroiditis:

Physical Examination

The most common physical examination findings in patients with hyperthyroidism include: [18]

The most common physical examination findings in patients with hypothyroidism include:

Laboratory Findings

The laboratory findings in hyperthyroidism are:

  • Elevated levels of serum thyroxine (T4) and triiodothyronine (T3).
  • Undetectable serum TSH.
  • Total T4 and T3 measurements are influenced by multiple conditions affecting serum thyroxine-binding globulin (TBG). Thus, the measurement of free thyroid hormones; free T4 (FT4) and free T3 (fT3), is the gold standard for the diagnosis of Graves' disease.[19]
  • Antibodies against the TSH receptor (TRAbs) are pathognomonic for Graves' disease. They are detectable in the serum of about 98% of untreated patients.[20] Detection of TRAbs rules out other causes of thyrotoxicosis.[21]
  • Anti-thyroid peroxidase (TPO) and antithyroglobulin (Tg) antibodies are also detectable in many patients with Graves' disease, but it is not recommended to measure these antibodies for diagnosis in all patients.

The laboratory findings in hypothyroidism are:

The laboratory findings in euthyroid sick syndrome are:

Euthyroid sick syndrome T3

(80-180 ng/dl)

T4

(4.6-12 ug/dl)

FT4

(0.7-1.9 ng/dl)

TSH

(0.4 to 4.0mIU/L)

Reverse T3

(90 to 350pg/mL)

Mild euthyroid sick syndrome N N N
Moderate euthyroid sick syndrome N N/↓ N/↓
Severe euthyroid sick syndrome N/↓
Recovery N/↓ N N N N/

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

  • There are no CT scan findings associated with COVID-19-associated thyroid diseases.

MRI

  • There are no MRI findings associated with COVID-19-associated thyroid diseases.

Other Imaging Findings

Thyroid ultrasound

  • Thyroid ultrasound may help diagnose Graves's disease. Typically, the thyroid pattern in Graves' disease is hypoechoic. Thyroid ultrasound gives an accurate estimation of the thyroid size, which is important in planning the therapeutic management and allows the detection of thyroid nodules that may not be palpable on physical examination.

Color flow Doppler

  • Color flow Doppler (CFD) estimates the blood flow which, in hyperthyroid Graves' disease patients, is typically increased within the thyroid gland.
  • CFD can be useful in the differential diagnosis of Graves' disease and other causes of thyrotoxicosis characterized by a low blood flow to the thyroid, such as factitious thyrotoxicosis, painless and subacute thyroiditis. [24]

Other Diagnostic Studies

Radioactive iodine uptake

Thyroid Disease TSH receptor antibodies Thyroid Ultrasound Color flow Doppler Radioactive iodine uptake/Scan Other features
Graves' disease + Hypoechoic pattern Ophthalmopathy, dermopathy
Toxic nodular goiter - Multiple nodules - Hot nodules at thyroid scan -
Toxic adenoma - Single nodule - Hot nodule -
Subacute thyroiditis - Heterogeneous hypoechoic areas Reduced/absent flow Neck pain, fever, and elevated inflammatory markers
Painless thyroiditis - Hypoechoic pattern Reduced/absent flow Symptoms and signs of hypothyroidism
Hashimoto's thyroiditis - Diffusely enlarged thyroid gland with a heterogeneous echotexture Normal early stages: may show increased uptake, late stages: single or multiple areas of reduced uptake (cold spots) -
  • To view other diagnostic studies for COVID-19, click here.

Treatment

Medical Therapy

  • Treatment of COVID-19-associated thyroid diseases generally depends on the presentation of thyroid disease.
  • No specific treatment has been reported for COVID-19-associated thyroid disease.

Surgery

Surgery is not a treatment option for patients with COVID-19-associated thyroid diseases.

Primary Prevention

There are no established measures for the primary prevention of COVID-19-associated thyroid diseases.

Secondary Prevention

There are no established measures for the secondary prevention of COVID-19-associated thyroid diseases.

References

  1. "WHO Western Pacific | World Health Organization".
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F (2020). "Subacute Thyroiditis After Sars-COV-2 Infection". J Clin Endocrinol Metab. 105 (7). doi:10.1210/clinem/dgaa276. PMC 7314004 Check |pmc= value (help). PMID 32436948 Check |pmid= value (help).
  3. Lisco G, De Tullio A, Jirillo E, Giagulli VA, De Pergola G, Guastamacchia E; et al. (2021). "Thyroid and COVID-19: a review on pathophysiological, clinical and organizational aspects". J Endocrinol Invest. 44 (9): 1801–1814. doi:10.1007/s40618-021-01554-z. PMC 7992516 Check |pmc= value (help). PMID 33765288 Check |pmid= value (help).
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  5. Scappaticcio L, Pitoia F, Esposito K, Piccardo A, Trimboli P (2021). "Impact of COVID-19 on the thyroid gland: an update". Rev Endocr Metab Disord. 22 (4): 803–815. doi:10.1007/s11154-020-09615-z. PMC 7688298 Check |pmc= value (help). PMID 33241508 Check |pmid= value (help).
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