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Infectious Diseases

27 May 2020

Coronavirus can infect and inflame the thyroid

An 18-year-old Italian woman's thyroid became sore and enlarged a few weeks after testing positive for the SARS-CoV-2 virus in late February.

An Italian teenager may be the first known case of a painful thyroid infection caused by the new coronavirus, doctors report.

A research team from Pisa, in northern Italy, said the 18-year-old woman's thyroid became sore and enlarged a few weeks after testing positive for the SARS-CoV-2 virus in late February. The condition, called thyroiditis, cleared up completely within a week after she was treated with the steroid prednisone.

Still, the doctors believe that "physicians should be alerted about the possibility of this additional clinical manifestation" tied to the new coronavirus, study leader Dr Francesco Latrofa, an endocrinologist at the University Hospital of Pisa, said in a news release from the Endocrine Society. He and his colleagues published the findings on 21 May in The Journal of Clinical Endocrinology & Metabolism.

"Covid-19 continues to show us many surprises," said thyroid expert Dr David Hiltzik, director of head and neck surgery at Staten Island University Hospital in New York City. "It has been shown to manifest in so many different organ systems throughout the body, so it is not surprising that the thyroid joins the many other areas that have been affected by the disease.

Heart palpitations and neck pain

"Thankfully, thyroiditis can easily be treated and should not be of great concern," added Hiltzik, who wasn't involved in the new research. "That being said, if a patient had the virus and presents with new neck pain they should get that evaluated."

In the Italian woman's case, she first got a nasal swab test for the new coronavirus on 28 February because her father had been hospitalised earlier with Covid-19. The test turned up positive, but she experienced only mild, transient respiratory symptoms at first.

However, by 17 March she revisited the Pisa clinic with fever, heart palpitations and neck pain. The neck pain got worse and her thyroid gland was painful and enlarged, the doctors said.

Tests confirmed thyroiditis. The patient was given prednisone, which relieved the neck pain and fever within two days. Any other remaining symptoms subsided within a week.

Post-viral thyroiditis

Latrofa and his group noted that thyroiditis has been seen with a myriad of infections, including mumps, Epstein-Barr, hepatitis E and HIV, so its appearance with SARS-CoV-2 isn't completely surprising. But to their knowledge, this is the first such case tied to the new coronavirus.

Dr Minisha Sood is an endocrinologist at Lenox Hill Hospital in New York City. Reading over the findings from Italy, she said it was "a classic presentation of post-viral thyroiditis, which is characterised by the onset of neck pain, fever and high thyroid hormone levels".

Sood said because of the intensity of neck pain the woman was experiencing, her doctors prescribed prednisone. However, in milder cases, a nonsteroidal anti-inflammatory pain reliever is often prescribed first, with a steroid prescribed later if needed.

In any case, "as an increasing number of post-viral symptoms are being attributed to Covid-19 or complications of Covid-19 such as thrombotic [clotting] events, the potential of subacute thyroiditis should not be overlooked," Sood said.

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