Popescu Mihaela, Ghemigian Adina, Vasile Corina Maria, Costache Andrei, Carsote Mara, Ghenea Alice Elena
Department of Endocrinology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Diagnostics (Basel). 2022 Apr 12;12(4):960. doi: 10.3390/diagnostics12040960.
This is a review of full-length articles strictly concerning subacute thyroiditis (SAT) in relation to the SARS-CoV-2 virus infection (SVI) and COVID-19 vaccine (COV) that were published between the 1st of March 2020 and the 21st of March 2022 in PubMed-indexed journals. A total of 161 cases were reported as follows: 81 cases of SAT-SVI (2 retrospective studies, 5 case series, and 29 case reports), 80 respective cases of SAT-COV (1 longitudinal study, 14 case series, 17 case reports; also, 1 prospective study included 12 patients, with 6 patients in each category). To our knowledge, this represents the largest cohort of reported cases until the present time. SAT-SVI was detected in adults aged between 18 and 85 years, mostly in middle-aged females. SAT-COVID-19 timing classifies SAT as viral (synchronous with infection, which is an original feature of SATs that usually follow a viral infection) and post-viral (during the recovery period or after infection, usually within 6 to 8 weeks, up to a maximum 24 weeks). The clinical spectrum has two patterns: either that accompanying a severe COVID-19 infection with multi-organ spreading (most frequent with lung involvement) or as an asymptomatic infection, with SAT being the single manifestation or the first presentation. Either way, SAT may remain unrecognized. Some data suggest that more intense neck pain, more frequent fever, and more frequent hypothyroidism at 3 months are identified when compared with non-SAT-SVI, but other authors have identified similar presentations and outcomes. Post-COVID-19 fatigue may be due to residual post-SAT hypothyroidism. The practical importance of SAT-SVI derives from the fact that thyroid hormone anomalies aggravate the general status of severe infections (particular concerns being tachycardia/arrhythmias, cardiac insufficiency, and ischemic events). If misdiagnosed, SAT results in unnecessary treatment with anti-thyroid drugs or even antibiotics for fever of unknown cause. Once recognized, SAT does not seem to require a particular approach when compared with non-COVID-19 cases, including the need for glucocorticoid therapy and the rate of permanent hypothyroidism. A complete resolution of thyroid hormone anomalies and inflammation is expected, except for cases with persistent hypothyroidism. SAT-COV follows within a few hours to a few weeks, with an average of 2 weeks (no particular pattern is related to the first or second vaccine dose). Pathogenesis includes molecular mimicry and immunoinflammatory anomalies, and some have suggested that this is part of ASIA syndrome (autoimmune/inflammatory syndrome induced by adjuvants). An alternative hypothesis to vaccine-related increased autoimmunity is vaccine-induced hyperviscosity; however, this is supported by incomplete evidence. From what we know so far concerning the risk factors, a prior episode of non-SVI-SAT is not associated with a higher risk of SAT-COV, nor is a previous history of coronavirus infection by itself. Post-vaccine SAT usually has a less severe presentation and a good outcome. Generally, the female sex is prone to developing any type of SAT. HLA susceptibility is probably related to both new types of SATs. The current low level of statistical evidence is expected to change in the future. Practitioners should be aware of SAT-COV, which does not restrict immunization protocols in any case.
这是一篇对2020年3月1日至2022年3月21日期间发表在PubMed索引期刊上的、严格涉及亚急性甲状腺炎（SAT）与严重急性呼吸综合征冠状病毒2型感染（SVI）及新冠疫苗（COV）相关的全文文章的综述。共报告了161例病例，具体如下：81例SAT - SVI（2项回顾性研究、5个病例系列和29例病例报告），80例SAT - COV（1项纵向研究、14个病例系列、17例病例报告；此外，1项前瞻性研究纳入了12例患者，每类6例）。据我们所知，这是截至目前已报告病例的最大队列。SAT - SVI在18至85岁的成年人中被检测到，主要是中年女性。SAT - 新冠病毒感染的时间将SAT分为病毒型（与感染同步，这是SAT的一个原始特征，通常继发于病毒感染）和病毒后型（在恢复期或感染后，通常在6至8周内，最长可达24周）。临床谱有两种模式：一种是伴随严重新冠病毒感染且多器官受累（最常见的是肺部受累），另一种是无症状感染，SAT是唯一表现或首发表现。无论哪种情况，SAT都可能未被识别。一些数据表明，与非SAT - SVI相比，3个月时颈部疼痛更剧烈、发热更频繁、甲状腺功能减退更常见，但其他作者也发现了类似的表现和结果。新冠病毒感染后疲劳可能归因于SAT后残留的甲状腺功能减退。SAT - SVI的实际重要性源于甲状腺激素异常会加重严重感染的总体状况（特别关注心动过速/心律失常、心脏功能不全和缺血性事件）。如果误诊，SAT会导致用抗甲状腺药物甚至抗生素对不明原因发热进行不必要的治疗。一旦被识别，与非新冠病毒感染病例相比，SAT似乎不需要特殊处理，包括糖皮质激素治疗的必要性和永久性甲状腺功能减退的发生率。除了持续性甲状腺功能减退的病例外，预计甲状腺激素异常和炎症会完全消退。SAT - COV在数小时至数周内出现，平均为2周（与第一剂或第二剂疫苗无关的特定模式）。发病机制包括分子模拟和免疫炎症异常，一些人认为这是ASIA综合征（佐剂诱导的自身免疫/炎症综合征）的一部分。与疫苗相关的自身免疫增加的另一种假说是疫苗诱导的血液高黏滞度；然而，这一假说证据不充分。就我们目前所知的危险因素而言，既往非SVI - SAT发作与SAT - COV的较高风险无关，既往冠状病毒感染史本身也无关。疫苗接种后SAT通常表现较轻，预后良好。一般来说，女性更容易发生任何类型的SAT。HLA易感性可能与两种新型SAT都有关。目前统计证据水平较低，预计未来会有所改变。从业者应了解SAT - COV，但这在任何情况下都不限制免疫接种方案。
