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People who get inflammation of the thyroid gland during a hungry COVID-19 disease months later months may still have subacute thyroiditis even though thyroid activity has normalized, a new study suggests.
In addition, thyroiditis appears to be different from thyroid inflammation caused by other viruses, said Ilaria Muller, MD, PhD, when she presented her findings March 21 at the ENDO 2021 virtual meeting .
“SARS-CoV-2 appears to have a multifactorial action on thyroid function,” said Muller, of the University of Milan, Fondazione IRCCS Ca ‘Granda Ospedale Maggiore Policlinico, Italy.
In July 2020, Muller and colleagues described patients who were hospitalized at their institution with true COVID-19, 15% of whom had thyrotoxicosis due to atopic subacute thyroiditis, compared to just 1% of group comparison in the hospital in the same intensive care units in the spring of 2019, as reported by Medscape Medical News.
The “atopic” thyroiditis that occurred in the patients with COVID-19 was not associated with neck pain and affected more men than women. In addition, it was associated with low levels of TSH and free triiodothyronine (T3), and normal or elevated levels of free thyroxine (T4), which is a very different presentation to classic disease syndrome. nonthyroidal (NTIS) commonly seen in very severe patients, she explained.
While mobile T4 elevations may occur in severe disease, this phenomenon is not associated with low TSH. This new condition appears to be a combination of thyrotoxicosis and NTIS, Muller and colleagues made a profit last summer.
Patients with COVID-19 and Thyroid Dysfunction followed for a year
Now, in an evaluation of 51 patients 3 months post-hospitalization for moderate-to-severe COVID-19 reported by Muller at ENDO 2021, both inflammatory symptoms and thyroid function were normalized, but on imaging, one-third of patients were still exhibiting hypoechoic areas of thyroiditis recommendation.
Of those, two-thirds had reduced uptake of thyroid scintigraphy, but few had antithyroid autoantibodies.
“The COVID-19-induced thyroid dysfunction does not appear to be mediated by autoimmunity. It is important to continue to follow these patients since they may develop thyroid dysfunction in the coming months,” Muller stressed.
Asked for comment, session moderator Robert W. Lash, MD, chief professional & clinical affairs officer of the Endocrine Association said. Medscape Medical News: “When you are sick at ICU level, it is not uncommon to have abnormal thyroid tests. Some viruses cause thyroid problems too … What makes it different though is that a lot of thyroid inflammation caused by antibodies, this was not the case. “
“It looks like this [SARS-CoV-2] causing damage to the thyroid gland, which is interesting, ”he noted, adding that the thyroid gland secretes high levels of angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 ( TMPRSS2), which allows SARS-CoV-2 infection of human cells.
“Maybe this is part of that one story,” Lash said.
For patients who have had thyroid dysfunction during COVID-19 starvation disease or develop symptoms that may be related to thyroid afterwards, he advises: “You should monitor for thyroid tests. It just raises your awareness … You could have their thyroid tests checked every 6 months for a year. “
Signs of Focal Thyroiditis despite normal thyroid function
All 51 patients (33 men and 18 women) hospitalized with moderate to severe COVID-19 had no history and had not been taking thyroid medications, amiodarone, or steroids prior to baseline TSH to measure.
From baseline to 3 months, TSH rose from 1.2 to 1.6 mIU / L, while serum concentrations of T4, T3, C-reactive protein, and total blood count were normalized (all P. <0.01 vs. baseline).
Thyroid ultrasound at 3 months in 49 patients showed signs of focal thyroiditis in 16 (33%).
Among 14 patients of those who underwent 99mTc or I123 thyroid uptake scans, four (29%) had normal, eight (57%) had reduced uptake, and two (14%) had reduced uptake .
Of the 16 patients with focal thyroiditis, only three were positive for autoantibodies to thyroglobulin (TgAb) or thyroid peroxidase (TPOAb). They were all negative for TSH autoantibodies.
“Importantly, of the two with reduced uptake, only one was positive for TPOAb or TgAb,” Muller noted, adding, “SARS-CoV-2 infection appears to be develop some dysfunction that is likely to have complex and multifunctional mechanisms. “
In response to a question about the possible role of biopsies and thyroid cytology, Muller replied: “That ‘s definitely the key … So far we’re just making estimates, so are cytological studies or histological is the key to seeing what ‘s really going on in the thyroid. “
“It simply came to our notice then [unlike] classic thyroiditis after viral infections, these patients have a different condition … There may be something going on inside the thyroid with a different mechanism, so it is certain that studies cytology and histology are all we need, “she concluded.
The study was funded by Fondazione IRCCS Ca.” Granda Ospedale Maggiore Policlinico, Milan, Italy. Muller and Lash they did not account for material financial relationships.
ENDO 2021. Summary OR23-2. Presented March 21, 2021.
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