COVID-19-associated thyroid diseases: Difference between revisions
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==Historical Perspective== | ==Historical Perspective== | ||
*[[Coronavirus]] disease 2019 ([[COVID-19]]) has been considered as a global [[pandemic]] since its first emergence in Wuhan,China.<ref name="urlWHO Western Pacific | World Health Organization">{{cite web |url=https://www.who.int/westernpacific/emergencies/covid-19 |title=WHO Western Pacific | World Health Organization |format= |work= |accessdate=}}</ref> | *[[Coronavirus]] disease 2019 ([[COVID-19]]) has been considered as a global [[pandemic]] since its first emergence in Wuhan,China.<ref name="urlWHO Western Pacific | World Health Organization">{{cite web |url=https://www.who.int/westernpacific/emergencies/covid-19 |title=WHO Western Pacific | World Health Organization |format= |work= |accessdate=}}</ref> | ||
* On March 12, 2020, the [[World Health Organization]] declared the [[COVID-19]] outbreak a [[pandemic]]. | *On March 12, 2020, the [[World Health Organization]] declared the [[COVID-19]] outbreak a [[pandemic]]. | ||
* In March 2020, the first case of subacute thyroiditis in an 18-year-old woman with COVID-19 was described. <ref name="pmid32436948">{{cite journal| author=Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F| title=Subacute Thyroiditis After Sars-COV-2 Infection. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 7 | pages= | pmid=32436948 | doi=10.1210/clinem/dgaa276 | pmc=7314004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32436948 }} </ref> | *In March 2020, the first case of subacute thyroiditis in an 18-year-old woman with COVID-19 was described. <ref name="pmid32436948">{{cite journal| author=Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F| title=Subacute Thyroiditis After Sars-COV-2 Infection. | journal=J Clin Endocrinol Metab | year= 2020 | volume= 105 | issue= 7 | pages= | pmid=32436948 | doi=10.1210/clinem/dgaa276 | pmc=7314004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32436948 }} </ref> | ||
==Classification== | ==Classification== | ||
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The exact pathogenesis of COVID-19-associated thyroid diseases is not fully understood. However, the following hypotheses have been suggested for the development of thyroid dysfunction in COVID-19 patients. | The exact pathogenesis of COVID-19-associated thyroid diseases is not fully understood. However, the following hypotheses have been suggested for the development of thyroid dysfunction in COVID-19 patients. | ||
* Angiotensin-converting enzyme 2 (ACE2) receptors are essentially involved in SARS-CoV-2 internalization into host cells. the thyroid gland is amongst the organs which have the highest levels of ACE2 expression and activity. Therefore, following SARS-CoV-2 infection, thyroid damage could result from either a direct or immune-mediated injury. | *Angiotensin-converting enzyme 2 (ACE2) receptors are essentially involved in SARS-CoV-2 internalization into host cells. the thyroid gland is amongst the organs which have the highest levels of ACE2 expression and activity. Therefore, following SARS-CoV-2 infection, thyroid damage could result from either a direct or immune-mediated injury. | ||
* COVID-19 may also cause an immune system imbalance and in severe cases a cytokine storm, which may break immunotolerance in susceptible patients, leading to new onset of immune-mediated thyroiditis, exacerbating a previous thyroid disease, or inducing a recurrence of thyroid disease. | *COVID-19 may also cause an immune system imbalance and in severe cases a cytokine storm, which may break immunotolerance in susceptible patients, leading to new onset of immune-mediated thyroiditis, exacerbating a previous thyroid disease, or inducing a recurrence of thyroid disease. | ||
==Causes== | ==Causes== | ||
Revision as of 16:07, 16 July 2022
Template:COVID-19 thyroid disorders
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus named for the similarity of its symptoms to those caused by the severe acute respiratory syndrome. Coronavirus disease 2019 (COVID-19) has been considered a global pandemic since its first emergence in Wuhan, China. On March 12, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic.COVID-19 has been found to affect several organs and body systems, including the endocrine system, with short-term and possible long-term consequences. Recent data shows that COVID-19 patients have experienced a range of thyroid diseases.
Historical Perspective
- Coronavirus disease 2019 (COVID-19) has been considered as a global pandemic since its first emergence in Wuhan,China.[1]
- On March 12, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic.
- In March 2020, the first case of subacute thyroiditis in an 18-year-old woman with COVID-19 was described. [2]
Classification
There is no established system for the classification of COVID-19-associated thyroid disorders.
Pathophysiology
The exact pathogenesis of COVID-19-associated thyroid diseases is not fully understood. However, the following hypotheses have been suggested for the development of thyroid dysfunction in COVID-19 patients.
- Angiotensin-converting enzyme 2 (ACE2) receptors are essentially involved in SARS-CoV-2 internalization into host cells. the thyroid gland is amongst the organs which have the highest levels of ACE2 expression and activity. Therefore, following SARS-CoV-2 infection, thyroid damage could result from either a direct or immune-mediated injury.
- COVID-19 may also cause an immune system imbalance and in severe cases a cytokine storm, which may break immunotolerance in susceptible patients, leading to new onset of immune-mediated thyroiditis, exacerbating a previous thyroid disease, or inducing a recurrence of thyroid disease.
Causes
Coronavirus disease 2019 (COVID-19) caused by a novel coronavirus called SARS-CoV-2 is the cause of COVID-19-associated thyroid diseases. To read more click here
Differentiating COVID-19-associated thyroid diseases from other Diseases
- Differential diagnosis of hyperthyroidism in general may include:
- Differential diagnosis of hypothyroidism in general may include:
- For a complete list of differential diagnoses of hyperthyroidism, please click here.
- For a complete list of differential diagnoses of hypothyroidism, please click here.
- For a complete list of differential diagnoses of euthyroid sick syndrome, please click here.
Epidemiology and Demographics
Several cases of subacute thyroiditis, Hashimoto thyroiditis, myxedema coma, Grave's disease, atypical thyroiditis, thyrotoxicosis have been reported in COVID-19 patients worldwide [2] [3] [4] [5] [6] [7] [8] [9] [9] [10] [2]
Risk Factors
There are no established risk factors for COVID-19-associated thyroid diseases.
Screening
There is insufficient evidence to recommend routine screening for COVID-19-associated thyroid diseases.
Natural History, Complications, and Prognosis
A number of observational studies have shown that COVID-19 infection may be linked to some thyroid diseases, including:
- Subacute thyroiditis
- Graves’ disease
- Non-thyroidal illness or euthyroid sick syndrome
- Thyrotoxicosis
- Hashimoto’s thyroiditis
Diagnosis
Diagnostic Study of Choice
The diagnosis of COVID-19-associated thyroid diseases is made based on the thyroid function test (TFT), which measures serum levels of triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH).
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
- There are no ECG findings associated with COVID-19-associated thyroid disease.
- However, the following findings may be seen on ECG in patients with [[hyperthyroidism)) and thyrotoxicosis:
- Sinus tachycardia
- Atrial fibrillation (often in elderly patients)
- Complete heart block (rare)
- Changes in QT interval
- The following findings may be seen on ECG in patients with hypothyroidism:
- Sinus bradycardia
- Prolonged QTc interval
- Changes in the morphology of the T-wave and QRS duration
- Low voltage.
X-ray
There are no x-ray findings associated with COVID-19-associated thyroid diseases.
Echocardiography or Ultrasound
- There are no echocardiographyfindings associated with COVID-19-associated thyroid diseases.
- Thyroid ultrasoongraphy
CT scan
- There are no CT scan findings associated with COVID-19-associated thyroid diseases.
MRI
There are no MRI findings associated with COVID-19-associated thyroid diseases.
Other Imaging Findings
Other Diagnostic Studies
24-Hour iodine-123 uptake is helpful in differentiating Hashimoto's thyroiditis from other thyroid conditions. The uptake of iodine-123 is decreased in Hashimoto's thyroiditis.[1]
Radioactive iodine uptake
24-hr radioactive iodine uptake (RAIU) is a diagnostic measure for Graves' disease which shows increased homogeneous uptake.[11]
- RAIU is generally increased in Graves' disease because of the action of stimulating TRAbs.
- Normal values for RAIU 24 h after the administration of a tracer dose of radioiodine are 20% in iodine sufficient and 40% in iodine deficient areas.
Thyroid ultrasound
- Thyroid ultrasound may help diagnose Graves's disease. Typically, the thyroid pattern in Graves' disease is hypoechoic. Thyroid ultrasound gives an accurate estimation of the thyroid size, which is important in planning the therapeutic management, and allows the detection of thyroid nodules that may not be palpable on physical examination.
Color flow Doppler
- Color flow Doppler (CFD) estimates the blood flow which, in hyperthyroid Graves' disease patients is typically increased within the thyroid gland.
- CFD can be useful in the differential diagnosis of Graves' disease and other causes of thyrotoxicosis characterized by a low blood flow to the thyroid, such as factitious thyrotoxicosis, painless and subacute thyroiditis, and type 2 amiodarone-induced thyrotoxicosis.[12]
- To view other diagnostic studies for COVID-19, click here.
Treatment
Medical Therapy
- Treatment of COVID-19-associated thyroid diseases generally depends on the presentation of thyroid disease.
- No specific treatment has been reported for COVID-19-associated thyroid disease.
Surgery
Surgery is not a treatment option for patients with COVID-19-associated thyroid diseases.
Primary Prevention
There are no established measures for the primary prevention of COVID-19-associated thyroid diseases.
Secondary Prevention
There are no established measures for the secondary prevention of COVID-19-associated thyroid diseases.
References
- ↑ "WHO Western Pacific | World Health Organization".
- ↑ 2.0 2.1 2.2 Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F (2020). "Subacute Thyroiditis After Sars-COV-2 Infection". J Clin Endocrinol Metab. 105 (7). doi:10.1210/clinem/dgaa276. PMC 7314004 Check
|pmc=value (help). PMID 32436948 Check|pmid=value (help). - ↑ Mattar SAM, Koh SJQ, Rama Chandran S, Cherng BPZ (2020). "Subacute thyroiditis associated with COVID-19". BMJ Case Rep. 13 (8). doi:10.1136/bcr-2020-237336. PMC 7449350 Check
|pmc=value (help). PMID 32843467 Check|pmid=value (help). - ↑ Asfuroglu Kalkan E, Ates I (2020). "A case of subacute thyroiditis associated with Covid-19 infection". J Endocrinol Invest. 43 (8): 1173–1174. doi:10.1007/s40618-020-01316-3. PMC 7273820 Check
|pmc=value (help). PMID 32504458 Check|pmid=value (help). - ↑ Brancatella A, Ricci D, Cappellani D, Viola N, Sgrò D, Santini F; et al. (2020). "Is Subacute Thyroiditis an Underestimated Manifestation of SARS-CoV-2 Infection? Insights From a Case Series". J Clin Endocrinol Metab. 105 (10). doi:10.1210/clinem/dgaa537. PMC 7454668 Check
|pmc=value (help). PMID 32780854 Check|pmid=value (help). - ↑ Chakraborty U, Ghosh S, Chandra A, Ray AK (2020). "Subacute thyroiditis as a presenting manifestation of COVID-19: a report of an exceedingly rare clinical entity". BMJ Case Rep. 13 (12). doi:10.1136/bcr-2020-239953. PMC 7750881 Check
|pmc=value (help). PMID 33370933 Check|pmid=value (help). - ↑ Campos-Barrera E, Alvarez-Cisneros T, Davalos-Fuentes M (2020). "Subacute Thyroiditis Associated with COVID-19". Case Rep Endocrinol. 2020: 8891539. doi:10.1155/2020/8891539. PMC 7522602 Check
|pmc=value (help). PMID 33005461 Check|pmid=value (help). - ↑ Tee LY, Harjanto S, Rosario BH (2021). "COVID-19 complicated by Hashimoto's thyroiditis". Singapore Med J. 62 (5): 265. doi:10.11622/smedj.2020106. PMC 8801861 Check
|pmc=value (help). PMID 32668831 Check|pmid=value (help). - ↑ 9.0 9.1 Dixit NM, Truong KP, Rabadia SV, Li D, Srivastava PK, Mosaferi T; et al. (2020). "Sudden Cardiac Arrest in a Patient With Myxedema Coma and COVID-19". J Endocr Soc. 4 (10): bvaa130. doi:10.1210/jendso/bvaa130. PMC 7499619 Check
|pmc=value (help). PMID 32984743 Check|pmid=value (help). - ↑ Muller I, Cannavaro D, Dazzi D, Covelli D, Mantovani G, Muscatello A; et al. (2020). "SARS-CoV-2-related atypical thyroiditis". Lancet Diabetes Endocrinol. 8 (9): 739–741. doi:10.1016/S2213-8587(20)30266-7. PMC 7392564 Check
|pmc=value (help). PMID 32738929 Check|pmid=value (help). - ↑ Terry J. Smith & Laszlo Hegedus (2016). "Graves' Disease". The New England journal of medicine. 375 (16): 1552–1565. doi:10.1056/NEJMra1510030. PMID 27797318. Unknown parameter
|month=ignored (help) - ↑ Kahaly GJ, Bartalena L, Hegedüs L (2011). "The American Thyroid Association/American Association of Clinical Endocrinologists guidelines for hyperthyroidism and other causes of thyrotoxicosis: a European perspective". Thyroid. 21 (6): 585–91. doi:10.1089/thy.2011.2106.ed3. PMID 21663420.