Department of Clinical and Experimental Medicine, Unit of Endocrinology, "Gaetano Martino" University Hospital, University of Messina, 98125, Messina, Italy.
Department of Biomedical Sciences and Morphological and Functional Images, Unit of Nuclear Medicine, University of Messina, Messina, Italy.
Hormones (Athens). 2021 Mar;20(1):219-221. doi: 10.1007/s42000-020-00230-w. Epub 2020 Jul 16.
Subacute thyroiditis (SAT) is an inflammatory thyroid disorder of viral origin, generally preceded by an upper respiratory tract infection. Since the disorder is self-limiting, it is frequently underdiagnosed. However, the disease should not be overlooked since the associated thyrotoxicosis may worsen the clinical course of concomitant disorders (e.g., respiratory distress) and long-term sequelae, such as autoimmune hypothyroidism, have been reported.
Here we describe a woman who developed SAT with thyrotoxicosis after SARS-COV-2 infection. Coronavirus disease (COVID-19) symptoms were mild and the patient was managed with no specific treatment and recovered rapidly.
Six weeks after the onset of the upper respiratory tract infection, the patient developed pain and tenderness in the anterior cervical region, fatigue, tremors, and palpitations. Physical examination revealed mild tremors of the extremities, a diffuse and painful goiter, and enlarged and tender cervical and submandibular lymph nodes. At biochemical evaluation, TSH was suppressed, FT3 and FT4 were high, and serum thyroglobulin was markedly increased (188 pg/mL; n.v. 0-40). Thyroid scintigraphy showed markedly reduced Tc-perthecnetate uptake in the gland. All findings were consistent with SAT, and treatment with oral prednisone (25 mg/day as the starting dose, gradually tapered) was started. Under the corticosteroid therapy, there was progressive resolution of symptoms and signs, and, within 4 weeks, all thyroid functional tests and inflammatory indexes normalized.
Clinicians should be aware of thyroid manifestations potentially associated with COVID-19.
亚急性甲状腺炎（SAT）是一种病毒性炎症性甲状腺疾病，通常在上呼吸道感染之前发生。由于该病具有自限性，因此经常被漏诊。但是，不应忽视该疾病，因为伴随的甲状腺毒症可能会使合并疾病（例如呼吸困难）的临床病程恶化，并且已经报道了长期后遗症，例如自身免疫性甲状腺功能减退症。
在这里，我们描述了一例在 SARS-COV-2 感染后发生 SAT 伴甲状腺毒症的女性患者。冠状病毒病（COVID-19）症状较轻，患者接受非特异性治疗并迅速康复。
在上呼吸道感染发作后 6 周，患者出现前颈部疼痛和压痛、疲劳、震颤和心悸。体格检查显示四肢轻度震颤、弥漫性疼痛性甲状腺肿、颈前和颌下淋巴结肿大和触痛。生化评估显示 TSH 受抑制，FT3 和 FT4 升高，血清甲状腺球蛋白明显增加（188 pg/mL；n.v. 0-40）。甲状腺闪烁显像显示甲状腺对 Tc-perthecnetate 的摄取明显减少。所有发现均符合 SAT，开始给予口服泼尼松（起始剂量 25 mg/天，逐渐减量）治疗。在皮质类固醇治疗下，症状和体征逐渐缓解，4 周内所有甲状腺功能试验和炎症指标均恢复正常。
临床医生应注意 COVID-19 可能相关的甲状腺表现。
