Endocrine Abstracts

JOINT2614

The SARS-CoV-2 virus affects the respiratory system and causes pneumonia. However, it also affects other organ systems. As the COVID-19 pandemic swept over humanity it became apparent that it may affect the thyroid gland, as various cases of subacute thyroiditis started to emerge in relationship with the COVID-19 infection. The aim was to describe cases of thyroid disease observed and followed-up over a period of 4 years in a tertiary care facility.

Methods: Over a period of 4 years 6 cases of thyroid disease were diagnosed and follow-up in a tertiary care facility. These 2 cases of subacute thyroiditis, in 2 female patients, aged 45 and 48 years, respectively, 30 and 15 days after a mild COVID-19 infection, 1 case of subacute thyroiditis after the mRNA vaccine in a male patient aged 51 years, 1 case of Graves’ disease after a COVID-19 infection in a female patient aged 33, 1 case of disease aggravation after a COVID-19 infection in a previously quiescent case of Graves’ disease in a female patient aged 48 years and 1 case of hypothyroidism due to Hashimoto thyroiditis 6 weeks after a COVID-19 infection in a female patient aged 56 years.

Results: The patients who developed subacute thyroiditis after a SARS-CoV-2 infection were dealt with by prednisolone administration. However, in one of the patients the disease recurred, and steroids were administered. After remission the patient developed subclinical hypothyroidism and thyroxine was administered. Two years later both patients need 50 μg thyroxine daily to remain euthyroid. The patient who developed subacute thyroiditis following vaccination against COVID-19 received prednisolone and following tapering he is euthyroid. In the patient who developed Graves’ disease and also developed thyroid ophthalmopathy, antithyroid medication was administered followed by subtotal thyroidectomy and ophthalmopathy is stable. The patient who had recurrence of Graves’ disease is now stable on treatment with unimazole and thyroxine on a block and replace regimen. The patient who developed hypothyroidism is stable thyroxine. It appears that the SARS-CoV-2 virus affects the thyroid gland. It is related to the development of subacute thyroiditis, Hashimoto’s thyroiditis, painless thyroiditis and Graves’ disease as well as exacerbation of previously quiescent Graves’ disease. It appears that thyroid cells express the ACE2 enzyme which acts as a receptor for the virus. However, as by now almost the entire population has been infected by COVID-19, thyroid disease in the context of the SARS-CoV-2 infection is relatively uncommon.