Ganie Mohammad Ashraf, Rashid Haroon, Qadir Ajaz, Koul Parvaiz A
Endocrinology and Metabolism, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND.
Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND.
Cureus. 2024 Jan 20;16(1):e52611. doi: 10.7759/cureus.52611. eCollection 2024 Jan.
Subacute thyroiditis (SAT) is a self-limiting inflammatory condition of the thyroid gland with distinct symptoms and a predictable outcome. During the current COVID-19 pandemic, there have been multiple isolated reports of SAT either during the active viral illness or following recovery. Here, we report two such cases of COVID-19 infection presenting with SAT. A 65-year-old male presented with a two-week history of anterior neck pain, odynophagia, high-grade fever (38.9°C), sweating, palpitations, and tremulousness. At physical examination, the patient presented with a slightly increased heart rate and a tender and enlarged thyroid on palpation. Laboratory examination showed high C-reactive protein levels, with elevated erythrocyte sedimentation rate, and thyroid function tests were suggestive of thyrotoxicosis. Ultrasonography showed a heterogeneous thyroid gland with ill-defined hypoechoic areas, and thyroid scintigraphy showed reduced uptake, confirming the diagnosis of SAT. In another case, a 52-year-old male presented with fever, cough, and myalgias, and was diagnosed with mild COVID-19 pneumonia, and managed conservatively. After two weeks, the patient had a recurrence of high-grade fever, odynophagia, palpitations, and tremors. Examination revealed tachycardia, hyperhidrosis, and a tender and enlarged thyroid on palpation. Thyroid function tests revealed low thyroid-stimulating hormone, with normal total T4 and total T3. Ultrasonography examination showed a heterogeneous thyroid gland with bilateral ill-defined hypoechoic areas. In our systematic review, including 103 SAT cases, it has been suggested that SAT should be recognized as an uncommon extra-pulmonary clinical manifestation of COVID-19 infection and clinicians need to be aware of the association. Pending larger multicentric studies, management of the condition has to be on a case-by-case basis.
亚急性甲状腺炎（SAT）是一种甲状腺的自限性炎症性疾病，具有明显的症状和可预测的转归。在当前的新冠疫情期间，有多项关于在病毒感染活跃期或康复后出现SAT的孤立报道。在此，我们报告两例新冠感染并发SAT的病例。一名65岁男性，有两周的前颈部疼痛、吞咽痛、高热（38.9℃）、出汗、心悸和震颤病史。体格检查时，患者心率略有增加，触诊甲状腺有压痛且肿大。实验室检查显示C反应蛋白水平升高，红细胞沉降率升高，甲状腺功能检查提示甲状腺毒症。超声检查显示甲状腺不均匀，有边界不清的低回声区，甲状腺闪烁扫描显示摄取减少，确诊为SAT。另一例，一名52岁男性，出现发热、咳嗽和肌痛，被诊断为轻度新冠肺炎，并接受保守治疗。两周后，患者再次出现高热、吞咽痛、心悸和震颤。检查发现心动过速、多汗，触诊甲状腺有压痛且肿大。甲状腺功能检查显示促甲状腺激素降低，总T4和总T3正常。超声检查显示甲状腺不均匀，双侧有边界不清的低回声区。在我们纳入103例SAT病例的系统评价中，提示SAT应被视为新冠感染一种不常见的肺外临床表现，临床医生需要意识到这种关联。在等待更大规模的多中心研究结果期间，该病的治疗必须个案化。
