Thyroid
Noreen H. Shaaban, MD, PhD (she/her/hers)
Endocrinology Fellow Physician
Larkin Community Hospital
Miami, Florida, United States
Is well known at this point that Covid-19 virus affects several systems
causing inflammation, Cases of endocrine involvement like autoinmine thyroiditis,
Guillan Barre syndrome and pediatrics multisystem inflammatory syndrome, has been
reported. This is a case report about a patient developing in atypical manifestation.
Subclinical Autoinmune Thyroiditis.
Case(s) Description :
Case presentation: 32 year old female with no medical history of Thyroiditis presented
to the ED 4 weeks post Covid-19 infection with palpitations, fever and tenderness on
her neck. On admission her HR 108 TSH 0.015, Free T3 22.4, Free T4 5.12, NTBNP
220, Troponin <0.012 CRP 12, ESR 78. Us thyroid done in ED reported a nodule in right
midlobe measuring 1.5 x 1.0 x 0.9cm category TI-RADS TR3. Patient was started on
Propanolol 40mg twice a day and a short course of steroids which improved her pain on
neck. Patient was discharged and ordered a Thyroid uptake and scan. On later outpatient visit, her thyroid profile showed TSH 0.005 Free T4 4.31, Free T3 8.1 exhibiting features of
Hyperthyroidism and Anti thyroglobulin 21 Anti-TPO 29 TSI 1. Despite beta blockers
in the 3 months follow up she was still presenting HR 100 She then starts methimazole 5mg twice daily. On the six month follow up patient stated she was doing fine; she stopped
the methimazole one week before and was gaining weight. And she experienced
occasional episodes of racing heart overnight. On her new laboratory it reported TSH
11.63 Free T4 1.1, Free T3 4.1, Thyroglobulin Abs <1, TPO Abs 247 TRAB <1 and TSI
<89, Patient went to a chemically and clinically hypothyroid state and Abs suggesting
autoimmune thyroiditis. Patient stopped methimazole and 2 months follow up lab shows TSH 27, free T4 1.1 and her TPO antibodies dropped to 53.
Discussion :
Prompt recognition and treatment are vital to avoid cardiac complications.
In addition, this case demonstrates COVID-19 virus infection could initiate an
autoimmune response. The autoimmunity took the role of inducing hyperthyroidism
independent of regulation by TSH. This suggests the need to investigate the exact
mechanism of COVID-19 virus affecting the thyroid.