An exuberant manifestation of subacute thyroiditis SARS-CoV-2-related

Abstract

A variety of clinical manifestations attributable to SARS-CoV-2 has been described, including subacute thyroiditis (SAT). Here we describe an atypical case of SAT SARS-CoV-2-related. A 34-year-old previously healthy woman presented to the emergency room complaining of intense cervical pain, non-responsive to ibuprofen, 12 days after being diagnosed with infection with SARS-CoV-2. Clinical, laboratory, and imaging features were compatible with SAT. She was discharged with prednisolone 40 mg/day. After reducing prednisolone, cervical pain recurred, and she experienced intense thyrotoxicosis symptoms and fever. Due to persistent high fever and absence of improvements with treatment, the patient was hospitalized. Imaging did not show abscesses. Clinical improvement was seen when prednisolone was increased to 60 mg/day. Ten weeks after the initial symptoms, she was asymptomatic, with normal free T3 and T4. SAT is a possible complication of SARS-CoV-2 infection. Clinicians should be alerted to this diagnosis and to potentially refractoriness to standard treatment, and more exuberant and long-lasting forms of SAT, even in the presence of mild forms of COVID-19.