Abstract
Background: The novel severe-acute-respiratory-syndrome-coronavirus-2 (SARS-CoV-2) virus has led to the pandemic of Coronavirus disease 2019 (COVID-19). COVID-19 has wide range of complications; cases of subacute thyroiditis have been reported post COVID-19.
Aim: To highlight the severity of subacute thyroiditis post COVID-19 infection in comparison to other etiologies and timely intervention with high dose steroids and anti-inflammatory drugs.
Case Description: A 33-year-old woman was referred to endocrinology clinic with swelling and pain of her anterior neck for four weeks duration. She developed her symptoms two weeks after contracting COVID-19 viral infection. Initially, she noticed swelling and pain in her neck, which was radiating toward the right ear. She also had a fever with malaise and myalgia. Her primary care physician prescribed Medrol dose pack twice, but her symptoms resumed as soon as she stopped it.
On physical examination, her temperature, blood pressure and heart rate were normal. She is obese with a BMI of 32. Neck exam revealed thyromegaly and anterior neck tenderness. Laboratory investigation revealed low thyroid-stimulating hormone (TSH) of 0.04mU/L. Free thyroxine (T4) was normal. Thyroid peroxidase antibody and thyroid-stimulating immunoglobulin were negative. Thyroid ultrasound revealed a heterogeneously enlarged thyroid gland with two small 4 mm solid hypoechoic nodules in the isthmus. She was treated with the third round of Medrol dose pack, but her condition relapsed after completing it. Our patient was started on oral prednisone 40 mg per day with Ibuprofen 800 mg once daily. Her symptoms improved within two weeks and steroids were tapered off gradually.
Conclusion: Subacute thyroiditis is a self-limiting complication of various viral infections that generally responds well to short course of steroids. Our case highlights the unusual severity of subacute thyroiditis after COVID-19 infection and the role of early aggressive therapy with high dose steroids to limit morbidity.
