The scintigraphic diagnosis of subacute thyroiditis in hospitalized patients with acute COVID-19 infection

Document Type : Original Article

Authors

1 Department of Nuclear Medicine, Rasoul Akram General Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Department of Nuclear Medicine, Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

3 Department of Immunology and Infectious Diseases, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

4 Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran

Abstract

Introduction: Extrapulmonary manifestations of COVID-19 must not be neglected during the pandemic. Subacute thyroiditis is one of the possible complications people encounter during post-COVID-19 days. Thyroid scintigraphy and radioiodine uptake test help discriminate hyperthyroidism from destructive thyrotoxicosis. Finding a more precise way to diagnose subacute thyroiditis can help in the early detection and treatment of thyroid-related disorders.
Methods: In this cross-sectional study, we evaluated 69 cases of COVID-19. Patients were divided into moderate and severe groups based on their clinical conditions. A thyroid scintigraphy scan was performed on the discharge day. Imaging was done 15-20 minutes after intravenous administration of 3-5 mCi of [99mTc]TcO4-. Scan findings were compared between moderate and severe groups and other participants' demographic and clinical features.
Results: In 69 patients, according to thyroid scintigraphy, 25 (36%) cases were reported as thyroiditis, and the rest were normal. There was no significant difference between the normal and subacute thyroiditis groups based on age, gender, past medical history, the severity of COVID-19, laboratory values and clinical signs and symptoms. Patients with subacute thyroiditis experienced palpitation and sore throat significantly higher than the normal group (P=0.002 and P=0.009, respectively).
Conclusion: We conclude that patients admitted due to acute COVID-19 infection experiencing palpitation and sore throat can develop subacute thyroiditis more than others. Whereas the severity of the disease and laboratory testing were not diagnostic in subacute thyroiditis, thyroid scintigraphy may help in early detection.

Keywords

Main Subjects

References

  1. Naguib R. Potential relationships between COVID-19 and the thyroid gland: an update. J Int Med Res. 2022 Feb;50(2):3000605221082898. 
  2. Desailloud R, Hober D. Viruses and thyroiditis: an update. Virol J. 2009 Jan 12;6:5.
  3. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, Ma K, Xu D, Yu H, Wang H, Wang T, Guo W, Chen J, Ding C, Zhang X, Huang J, Han M, Li S, Luo X, Zhao J, Ning Q. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020 Mar 26;368:m1091
  4. Marazuela M, Giustina A, Puig-Domingo M. Endocrine and metabolic aspects of the COVID-19 pandemic. Rev Endocr Metab Disord. 2020 Dec;21(4):495-507.
  5. Scappaticcio L, Pitoia F, Esposito K, Piccardo A, Trimboli P. Impact of COVID-19 on the thyroid gland: an update. Rev Endocr Metab Disord. 2021 Dec;22(4):803-815.
  6. Lazartigues E, Qadir MMF, Mauvais-Jarvis F. Endocrine Significance of SARS-CoV-2's Reliance on ACE2. Endocrinology. 2020 Sep 1;161(9):bqaa108.
  7. Li MY, Li L, Zhang Y, Wang XS. Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infect Dis Poverty. 2020 Apr 28;9(1):45
  8. Mazziotti G, Sorvillo F, Piscopo M, Morisco F, Cioffi M, Stornaiuolo G, Gaeta GB, Molinari AM, Lazarus JH, Amato G, Carella C. Innate and acquired immune system in patients developing interferon-alpha-related autoimmune thyroiditis: a prospective study. J Clin Endocrinol Metab. 2005 Jul;90(7):4138-44.
  9. Farzati B, Mazziotti G, Cuomo G, Ressa M, Sorvillo F, Amato G, La Montagna G, Carella C, Valentini G. Hashimoto's thyroiditis is associated with peripheral lymphocyte activation in patients with systemic sclerosis. Clin Exp Rheumatol. 2005 Jan-Feb;23(1):43-9.
  10. Kristensen B, Hegedüs L, Madsen HO, Smith TJ, Nielsen CH. Altered balance between self-reactive T helper (Th)17 cells and Th10 cells and between full-length forkhead box protein 3 (FoxP3) and FoxP3 splice variants in Hashimoto's thyroiditis. Clin Exp Immunol. 2015 Apr;180(1):58-69. 
  11. Trovato M, Ruggeri RM, Sciacchitano S, Vicchio TM, Picerno I, Pellicanò G, Valenti A, Visalli G. Serum interleukin-6 levels are increased in HIV-infected patients that develop autoimmune disease during long-term follow-up. Immunobiology. 2018 Mar;223(3):264-268.
  12. Dalugama C. Asymptomatic thyroiditis presenting as pyrexia of unknown origin: a case report. J Med Case Rep. 2018 Feb 23;12(1):51.
  13. Stasiak M, Michalak R, Stasiak B, Lewinski A. Clinical characteristics of subacute thyroiditis is different than it used to be - current state based on 15 years own material. Neuro Endocrinol Lett. 2019 Feb;39(7):489-495.
  14. Stasiak M, Lewiński A. New aspects in the pathogenesis and management of subacute thyroiditis. Rev Endocr Metab Disord. 2021 Dec;22(4):1027-1039. 
  15. Bahçecioğlu AB, Karahan ZC, Aydoğan BI, Kalkan IA, Azap A, Erdoğan MF. Subacute thyroiditis during the COVID-19 pandemic: a prospective study. J Endocrinol Invest. 2022 Apr;45(4):865-874.
  16. Wu D, Yang XO. TH17 responses in cytokine storm of COVID-19: An emerging target of JAK2 inhibitor Fedratinib. J Microbiol Immunol Infect. 2020 Jun;53(3):368-370. 
  17. Leow MK, Kwek DS, Ng AW, Ong KC, Kaw GJ, Lee LS. Hypocortisolism in survivors of severe acute respiratory syndrome (SARS). Clin Endocrinol (Oxf). 2005 Aug;63(2):197-202.
  18. De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet. 2016 Aug 27;388(10047):906-918. 
  19. Bradley BT, Maioli H, Johnston R, Chaudhry I, Fink SL, Xu H, Najafian B, Deutsch G, Lacy JM, Williams T, Yarid N, Marshall DA. Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series. Lancet. 2020 Aug 1;396(10247):320-332. 
  20. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020 May;46(5):846-848. 
  21. Barton LM, Duval EJ, Stroberg E, Ghosh S, Mukhopadhyay S. COVID-19 autopsies, Oklahoma, USA. Am J Clin Pathol. 2020 May 5;153(6):725-733.
  22. Caron P. Thyroid disorders and SARS-CoV-2 infection: From pathophysiological mechanism to patient management. Ann Endocrinol (Paris). 2020 Oct;81(5):507-510.
  23. Yao XH, Li TY, He ZC, Ping YF, Liu HW, Yu SC, Mou HM, Wang LH, Zhang HR, Fu WJ, Luo T, Liu F, Guo QN, Chen C, Xiao HL, Guo HT, Lin S, Xiang DF, Shi Y, Pan GQ, Li QR, Huang X, Cui Y, Liu XZ, Tang W, Pan PF, Huang XQ, Ding YQ, Bian XW. [A pathological report of three COVID-19 cases by minimal invasive autopsies]. Zhonghua Bing Li Xue Za Zhi. 2020 May 8;49(5):411-417. [Chinese]
  24. Lania A, Sandri MT, Cellini M, Mirani M, Lavezzi E, Mazziotti G. Thyrotoxicosis in patients with COVID-19: the THYRCOV study. Eur J Endocrinol. 2020 Oct;183(4):381-387.
  25. Muller I, Cannavaro D, Dazzi D, Covelli D, Mantovani G, Muscatello A, Ferrante E, Orsi E, Resi V, Longari V, Cuzzocrea M, Bandera A, Lazzaroni E, Dolci A, Ceriotti F, Re TE, Gori A, Arosio M, Salvi M. SARS-CoV-2-related atypical thyroiditis. Lancet Diabetes Endocrinol. 2020 Sep;8(9):739-741.

Files

Share

How to cite

Statistics