COVID-19 后亚急性甲状腺炎：系统评价。

Subacute thyroiditis following COVID-19: A systematic review.

机构信息

Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran.

出版信息

Front Endocrinol (Lausanne). 2023 Apr 5;14:1126637. doi: 10.3389/fendo.2023.1126637. eCollection 2023.

DOI:10.3389/fendo.2023.1126637

PMID:37091856

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10115182/

Abstract

BACKGROUND

Subacute thyroiditis (SAT) is a self-limiting thyroid inflammatory disease occurring specifically after upper respiratory tract infections. Since COVID-19 is a respiratory disease leading to multi-organ involvements, we aimed to systematically review the literature regarding SAT secondary to COVID-19.

METHODS

We searched Scopus, PubMed/MEDLINE, Cochrane, Web of Science, ProQuest, and LitCovid databases using the terms "subacute thyroiditis" and "COVID-19" and their synonyms from inception to November 3, 2022. We included the original articles of the patients with SAT secondary to COVID-19. Studies reporting SAT secondary to COVID-19 vaccination or SAT symptoms' manifestation before the COVID-19 infection were not included.

RESULTS

Totally, 820 articles were retained. Having removed the duplicates, 250 articles remained, out of which 43 articles (40 case reports and three case series) with a total of 100 patients, were eventually selected. The patients aged 18-85 years (Mean: 42.70, SD: 11.85) and 68 (68%) were women. The time from the onset of COVID-19 to the onset of SAT symptoms varied from zero to 168 days (Mean: 28.31, SD: 36.92). The most common symptoms of SAT were neck pain in 69 patients (69%), fever in 54 (54%), fatigue and weakness in 34 (34%), and persistent palpitations in 31 (31%). The most common ultrasonographic findings were hypoechoic regions in 73 (79%), enlarged thyroid in 46 (50%), and changes in thyroid vascularity in 14 (15%). Thirty-one patients (31%) were hospitalized, and 68 (68%) were treated as outpatients. Corticosteroids were the preferred treatment in both the inpatient and outpatient settings (25 inpatients (81%) and 44 outpatients (65%)). Other preferred treatments were nonsteroidal anti-inflammatory drugs (nine inpatients (29%) and 17 outpatients (25%)) and beta-blockers (four inpatients (13%) and seven outpatients (10%)). After a mean duration of 61.59 days (SD: 67.07), 21 patients (23%) developed hypothyroidism and thus, levothyroxine-based treatment was used in six of these patients and the rest of these patients did not receive levothyroxine.

CONCLUSION

SAT secondary to COVID-19 seems to manifest almost similarly to the conventional SAT. However, except for the case reports and case series, lack of studies has limited the quality of the data at hand.

摘要

背景

亚急性甲状腺炎（SAT）是一种自限性甲状腺炎症性疾病，专门发生在上呼吸道感染后。由于 COVID-19 是一种导致多器官受累的呼吸道疾病，我们旨在系统地综述关于 COVID-19 继发 SAT 的文献。

方法

我们使用术语“亚急性甲状腺炎”和“COVID-19”及其同义词，从成立到 2022 年 11 月 3 日，在 Scopus、PubMed/MEDLINE、Cochrane、Web of Science、ProQuest 和 LitCovid 数据库中进行了搜索。我们纳入了 COVID-19 继发 SAT 的患者的原始文章。未纳入 COVID-19 疫苗接种后继发 SAT 或 COVID-19 感染前出现 SAT 症状的报告。

结果

共保留了 820 篇文章。去除重复项后，仍有 250 篇文章，其中最终选择了 43 篇文章（40 例病例报告和 3 例病例系列），共 100 例患者。患者年龄 18-85 岁（平均值：42.70，标准差：11.85），68 例（68%）为女性。从 COVID-19 发病到 SAT 症状发病的时间从 0 至 168 天不等（平均值：28.31，标准差：36.92）。SAT 最常见的症状是 69 例（69%）颈部疼痛、54 例（54%）发热、34 例（34%）疲劳和虚弱以及 31 例（31%）持续性心悸。最常见的超声表现是 73 例（79%）低回声区、46 例（50%）甲状腺肿大和 14 例（15%）甲状腺血管变化。31 例（31%）患者住院，68 例（68%）为门诊患者。皮质类固醇是住院和门诊患者的首选治疗方法（25 例住院患者（81%）和 44 例门诊患者（65%））。其他首选治疗方法是非甾体抗炎药（9 例住院患者（29%）和 17 例门诊患者（25%））和β受体阻滞剂（4 例住院患者（13%）和 7 例门诊患者（10%））。在平均 61.59 天（SD：67.07）后，21 例（23%）患者出现甲状腺功能减退症，因此，其中 6 例患者使用左旋甲状腺素治疗，其余患者未使用左旋甲状腺素。