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Hacisahinogullari H, Gunver MG, Yalin GY, Selcukbiricik OS, Uzum AK, Gul N. The role of severity and duration of inflammation and hematological parameters on the outcome of subacute thyroiditis. Biomark Med 2024; 18:459-467. [PMID: 39007839 PMCID: PMC11285350 DOI: 10.1080/17520363.2024.2342240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/05/2024] [Indexed: 07/16/2024] Open
Abstract
Background: The role of severity and duration of inflammatory findings on the development of persistent hypothyroidism and anemia has not been clarified in subacute thyroiditis (SAT). Methods: Demographic data and laboratory parameters of patients with SAT were analyzed retrospectively. Results: Permanent hypothyroidism was observed in 28.1% of patients. Baseline elevated erythrocyte sedimentation rate as defined >74.5 mm/h was found to be associated with permanent hypothyroidism, but the duration of inflammation was not different between the recovered and hypothyroid patients. Baseline hemoglobin values improved without specific therapy in 3.5 months. Conclusion: The initial severity but not the duration of inflammation increases the risk for the development of permanent thyroid dysfunction, and anemia improves with the resolution of inflammation.
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Affiliation(s)
- Hulya Hacisahinogullari
- Department of Internal Medicine, Division of Endocrinology & Metabolism, Istanbul University, Istanbul Faculty of Medicine, Istanbul, 34093, Turkey
| | - Mehmet Guven Gunver
- Department of Medical Statistics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, 34093,Turkey
| | - Gulsah Yenidunya Yalin
- Department of Internal Medicine, Division of Endocrinology & Metabolism, Istanbul University, Istanbul Faculty of Medicine, Istanbul, 34093, Turkey
| | - Ozlem Soyluk Selcukbiricik
- Department of Internal Medicine, Division of Endocrinology & Metabolism, Istanbul University, Istanbul Faculty of Medicine, Istanbul, 34093, Turkey
| | - Ayse Kubat Uzum
- Department of Internal Medicine, Division of Endocrinology & Metabolism, Istanbul University, Istanbul Faculty of Medicine, Istanbul, 34093, Turkey
| | - Nurdan Gul
- Department of Internal Medicine, Division of Endocrinology & Metabolism, Istanbul University, Istanbul Faculty of Medicine, Istanbul, 34093, Turkey
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Akha O, Mazandarani M, Azari S, Daneshfar N, Rasouli K, Heydari K, Tavakolian G, Hoseini A. Subacute thyroiditis after SARS-CoV-2 vaccination: A case report. Clin Case Rep 2024; 12:e8678. [PMID: 38550739 PMCID: PMC10965450 DOI: 10.1002/ccr3.8678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/29/2023] [Accepted: 01/29/2024] [Indexed: 11/11/2024] Open
Abstract
Key Clinical Message Subacute thyroiditis which is typically characterized by cervical pain and fever is caused by viral infection and is seen after SARS-CoV-2 vaccination. Here we report a post-vaccination subacute thyroiditis after SARS-CoV-2 vaccination. Abstract Subacute thyroiditis (SAT) is possibly caused by a viral infection and is typically characterized by cervical pain and fever. SAT associated with SARS-CoV-2 infection or SARS-CoV-2 vaccination has been reported, albeit in limited numbers. A 34-year-old woman was referred to our clinic with typical SAT symptoms. The diagnosis was confirmed through thyroid scintigraphy after receiving the SARS-CoV-2 vaccination, despite testing negative for COVID-19 via RT-PCR. There is a theoretical correlation between SARS-CoV-2 vaccination and SAT. Vaccination may have a direct or indirect impact on the thyroid, but further studies are required to confirm this relationship. A systematic review of the literature of similar cases was performed for comparison. Ultimately, the overall benefits of SARS-CoV-2 vaccination outweigh the potential adverse effects. Therefore, these types of reports should not divert attention from the actual reality.
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Affiliation(s)
- Ozra Akha
- Department of Internal Medicine, Diabetes Research Center, Faculty of MedicineMazandaran University of Medical SciencesSariIran
| | - Mahdi Mazandarani
- Endocrinology and Metabolism Research CenterTehran University of Medical SciencesTehranIran
| | - Soroush Azari
- Student Research Committee, Faculty of MedicineMazandaran University of Medical SciencesSariIran
| | | | - Kimia Rasouli
- Student Research Committee, Faculty of MedicineMazandaran University of Medical SciencesSariIran
| | - Keyvan Heydari
- Student Research Committee, Faculty of MedicineMazandaran University of Medical SciencesSariIran
- Gastrointestinal Cancer Research Center, Non‐Communicable Diseases InstituteMazandaran University of Medical SciencesSariIran
| | - Golvash Tavakolian
- Student Research Committee, Faculty of MedicineMazandaran University of Medical SciencesSariIran
| | - Aref Hoseini
- Student Research Committee, Faculty of MedicineMazandaran University of Medical SciencesSariIran
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Shekarian A, Fakhrolmobasheri M, Mazaheri-Tehrani S, Yousefian A, Heidarpour M. The prevalence of positive thyroid autoantibodies in patients with subacute thyroiditis: a systematic review and meta-analysis. Endocrine 2024; 84:29-41. [PMID: 38147263 DOI: 10.1007/s12020-023-03655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE Subacute thyroiditis (SAT) is a transient inflammatory disorder of the thyroid gland with a possible viral etiology. We conducted this study to estimate the pooled prevalence of thyroid autoantibodies in SAT patients. This question arose due to the varying reports on the positivity rates of thyroid autoantibodies among SAT patients. METHODS We searched PubMed, Embase, Scopus, and Web of Science from their inception until March 25th, 2023. Observational studies reporting the positivity rate of thyroid autoantibodies for more than ten patients were included. We used the Joanna Briggs Institute's (JBI) critical appraisal checklist to assess the quality of the included studies. Pooled prevalence estimates with 95% confidence intervals were calculated using the random effects model. Subgroup analyses were performed to find sources of heterogeneity. RESULTS Out of 1373 identified records, 32 studies involving 2348 SAT patients were included in our study. Thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) were positive in 22.8% and 12.2% of patients, respectively. The Study design, mean erythrocyte sedimentation rate and mean thyroid-stimulating hormone of patients were identified as sources of heterogeneity. As our secondary objectives, we found a recurrence rate of 14.7% and permanent hypothyroidism in 11.6% of patients. CONCLUSION The results of our study revealed a low TPOAb positivity rate in SAT patients, consistent with its non-autoimmune etiology. The TgAb positivity rate in SAT patients was higher than that of the general population, possibly explained by the transient release of thyroglobulin into the bloodstream during the thyrotoxic phase, leading to subsequent TgAb production. Furthermore, our findings demonstrate a notable recurrence rate and permanent hypothyroidism among SAT patients, highlighting the importance of ongoing follow-up care.
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Affiliation(s)
- Arman Shekarian
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Fakhrolmobasheri
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sadegh Mazaheri-Tehrani
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhossein Yousefian
- Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Heidarpour
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Abstract
Importance Overt hyperthyroidism, defined as suppressed thyrotropin (previously thyroid-stimulating hormone) and high concentration of triiodothyronine (T3) and/or free thyroxine (FT4), affects approximately 0.2% to 1.4% of people worldwide. Subclinical hyperthyroidism, defined as low concentrations of thyrotropin and normal concentrations of T3 and FT4, affects approximately 0.7% to 1.4% of people worldwide. Untreated hyperthyroidism can cause cardiac arrhythmias, heart failure, osteoporosis, and adverse pregnancy outcomes. It may lead to unintentional weight loss and is associated with increased mortality. Observations The most common cause of hyperthyroidism is Graves disease, with a global prevalence of 2% in women and 0.5% in men. Other causes of hyperthyroidism and thyrotoxicosis include toxic nodules and the thyrotoxic phase of thyroiditis. Common symptoms of thyrotoxicosis include anxiety, insomnia, palpitations, unintentional weight loss, diarrhea, and heat intolerance. Patients with Graves disease may have a diffusely enlarged thyroid gland, stare, or exophthalmos on examination. Patients with toxic nodules (ie, in which thyroid nodules develop autonomous function) may have symptoms from local compression of structures in the neck by the thyroid gland, such as dysphagia, orthopnea, or voice changes. Etiology can typically be established based on clinical presentation, thyroid function tests, and thyrotropin-receptor antibody status. Thyroid scintigraphy is recommended if thyroid nodules are present or the etiology is unclear. Thyrotoxicosis from thyroiditis may be observed if symptomatic or treated with supportive care. Treatment options for overt hyperthyroidism from autonomous thyroid nodules or Graves disease include antithyroid drugs, radioactive iodine ablation, and surgery. Treatment for subclinical hyperthyroidism is recommended for patients at highest risk of osteoporosis and cardiovascular disease, such as those older than 65 years or with persistent serum thyrotropin level less than 0.1 mIU/L. Conclusions and Relevance Hyperthyroidism affects 2.5% of adults worldwide and is associated with osteoporosis, heart disease, and increased mortality. First-line treatments are antithyroid drugs, thyroid surgery, and radioactive iodine treatment. Treatment choices should be individualized and patient centered.
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Affiliation(s)
- Sun Y. Lee
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Elizabeth N. Pearce
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
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Henke K, Odermatt J, Ziaka M, Rudovich N. Subacute Thyroiditis Complicating COVID-19 Infection. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231181560. [PMID: 37351465 PMCID: PMC10280117 DOI: 10.1177/11795476231181560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
Subacute thyroiditis (SAT) is a self-limited inflammatory disease and a rare cause of thyrotoxicosis. Although the exact etiology of SAT is not sufficiently understood, it is generally associated to viral infections. Current evidence highlights that SAT may be a potentially uncommon manifestation of ongoing Coronavirus disease 2019 (COVID-19) infection or a post-viral complication of the disease. Despite that SAT is a rare manifestation associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease both in ongoing and resolved COVID-19 infection, the ever-increasing numbers of COVID-19 patients strengthens the possibility that this particular disease entity will be of more immediate concern in the future. The current work aims to summarize the approach of SARS-CoV-2-associated SAT, present its pathophysiology, outline current research evidence found in the literature, and discuss potential differential diagnoses and diagnostic dilemmas through an illustrative case.
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Affiliation(s)
- Katrin Henke
- Department of Medicine, Thun Hospital, Thun, Switzerland
| | - Jonas Odermatt
- Department of Medicine, Thun Hospital, Thun, Switzerland
| | - Mairi Ziaka
- Department of Medicine, Thun Hospital, Thun, Switzerland
| | - Natalia Rudovich
- Department of Medicine, Thun Hospital, Thun, Switzerland
- University of Zurich, Zurich, Switzerland
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Meftah E, Rahmati R, Zari Meidani F, Khodadadi S, Chitzan-Zadeh K, Esfahanian F, Afshar S. Subacute thyroiditis following COVID-19: A systematic review. Front Endocrinol (Lausanne) 2023; 14:1126637. [PMID: 37091856 PMCID: PMC10115182 DOI: 10.3389/fendo.2023.1126637] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
Background Subacute thyroiditis (SAT) is a self-limiting thyroid inflammatory disease occurring specifically after upper respiratory tract infections. Since COVID-19 is a respiratory disease leading to multi-organ involvements, we aimed to systematically review the literature regarding SAT secondary to COVID-19. Methods We searched Scopus, PubMed/MEDLINE, Cochrane, Web of Science, ProQuest, and LitCovid databases using the terms "subacute thyroiditis" and "COVID-19" and their synonyms from inception to November 3, 2022. We included the original articles of the patients with SAT secondary to COVID-19. Studies reporting SAT secondary to COVID-19 vaccination or SAT symptoms' manifestation before the COVID-19 infection were not included. Results Totally, 820 articles were retained. Having removed the duplicates, 250 articles remained, out of which 43 articles (40 case reports and three case series) with a total of 100 patients, were eventually selected. The patients aged 18-85 years (Mean: 42.70, SD: 11.85) and 68 (68%) were women. The time from the onset of COVID-19 to the onset of SAT symptoms varied from zero to 168 days (Mean: 28.31, SD: 36.92). The most common symptoms of SAT were neck pain in 69 patients (69%), fever in 54 (54%), fatigue and weakness in 34 (34%), and persistent palpitations in 31 (31%). The most common ultrasonographic findings were hypoechoic regions in 73 (79%), enlarged thyroid in 46 (50%), and changes in thyroid vascularity in 14 (15%). Thirty-one patients (31%) were hospitalized, and 68 (68%) were treated as outpatients. Corticosteroids were the preferred treatment in both the inpatient and outpatient settings (25 inpatients (81%) and 44 outpatients (65%)). Other preferred treatments were nonsteroidal anti-inflammatory drugs (nine inpatients (29%) and 17 outpatients (25%)) and beta-blockers (four inpatients (13%) and seven outpatients (10%)). After a mean duration of 61.59 days (SD: 67.07), 21 patients (23%) developed hypothyroidism and thus, levothyroxine-based treatment was used in six of these patients and the rest of these patients did not receive levothyroxine. Conclusion SAT secondary to COVID-19 seems to manifest almost similarly to the conventional SAT. However, except for the case reports and case series, lack of studies has limited the quality of the data at hand.
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Affiliation(s)
- Elahe Meftah
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahem Rahmati
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Fatemeh Zari Meidani
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Sanaz Khodadadi
- Students Research Committee, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Kosar Chitzan-Zadeh
- Students Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Esfahanian
- Department of Endocrinology, Vali-Asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shiva Afshar
- School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
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