With Leann Poston MD
Just a few months ago, the world knew almost nothing about COVID-19, which is caused by the virus SARS-CoV-2. We knew that the symptoms seemed at first to mimic a bad cold or the flu (its main symptoms include cough, shortness of breath, fever, chills, aches, and sore throat), and we knew that people across the globe were dying.
As the weeks progressed, though, researchers and epidemiologists started putting more and more of the disease’s puzzle pieces together, discovering at-risk demographics (such as patients with obesity and diabetes), and strange symptoms (such loss of taste and smell, red toes, and sudden rashes).
Many Americans are heading into their third month of quarantine, with an estimated three million cases reported globally, but the research around the infection continues to grow, illuminating the very real health risks that COVID-19 presents. Understanding the nature of a pandemic of this magnitude means saving lives and knowing how to prevent further infection.
Recently, The Journal of Clinical Endocrinology and Metabolism published an article abstract that explored the connection between SARS-CoV-2 and thyroid health, stating that a patient (who did not previously live with thyroid disease) was found to have developed subacute thyroiditis, a thyroid disease of viral or post-viral origin, after having been diagnosed with COVID-19. Subacute thyroiditis also goes by the names De Quervain’s, granulomatous thyroiditis, or giant cell thyroiditis.
In this case, it was an 18-year-old woman who had been previously diagnosed with COVID-19. It wasn’t until 18 days after she was infected with (and completely recovered from) Covid-19 that she began experiencing the symptoms of subacute thyroiditis, including heart palpitations as well as neck and thyroid pain. Her thyroid’s T3 and T4 hormones were also elevated, and she had high markers of inflammation.
She was the first patient reported to have post-COVID-19 triggered-thyroiditis, the article stated. The authors of the study also noted that a month earlier, the patient had her thyroid tested, and her results were normal.
The patient was then treated with prednisone, a steroid. Her thyroid pain got better within two days. Within 40 days, her thyroid tests showed normal functioning.
It seems the link between COVID-19 and the thyroid disease is clear. The study’s author, Francesco Latrofa MD of the University Hospital of Pisa in Italy wrote, “Because of the chronological association, SARS-CoV-2 may be considered accountable for the onset of subacute thyroiditis.”
The article’s main goal was to let doctors know that this disease could occur after COVID-19 infection. With time and research, there could be other patients who have or will develop subacute thyroiditis as well.
According to Leann Poston MD, “Subacute thyroiditis is an inflammation of the thyroid gland that follows an upper respiratory viral infection. Viruses that infect the upper respiratory tract include influenza, adenovirus, mumps, enteroviruses, and others.” It’s easy to see why COVID-19 and subacute thyroiditis are linked, considering its tendency to occur after viral infections.
These sorts of viruses — like the flu — typically cause inflammation of the nose, throat, or trachea, and they tend to clear up within a week or two. Dr. Poston explains, “Inflammation means that there is increased blood flow to the organ carrying cells to fight infection. Symptoms of inflammation include swelling, pain, redness, and warmth.”
The viral infection sets off the inflammation, causing swelling and pain in the thyroid area. Hoarseness and difficulty swallowing may also occur due to compression in the throat.
This may sound like a cold, but it’s not just throat pain. Dr. Poston says that subacute thyroiditis can begin to alter the body’s thyroid hormone production in a roller-coaster sort of way.
It starts by affecting the thyroid’s follicles and hormone storage sacs, which can actually cause an initial surge in hormone production. This then leads to an under-release of thyroid hormones as the body’s follicles attempt to repair themselves, desperately trying to store the hormones that were being over-produced. It’s a vicious cycle.
If you live with hyperthyroidism, you’ll know that it occurs when your hormones are over-released. This can lead to all sorts of frustrating symptoms, such as anxiety, hair loss, weight loss, sweating, and gut issues. When your body doesn’t release enough hormone, however, it can lead to hypothyroidism — which can then cause weight gain, extreme fatigue, and even brain fog.
But what’s at the root of the connection between COVID-19 and subacute thyroiditis? The fact is, more research is still needed. “It is still unclear if the virus causes the destruction of the body's inflammatory reaction to the virus,” Dr. Poston offers.
Still, she says, the findings are vital to understanding COVID-19. “The importance of this paper is that it shows a timeline correlation between infection with COVID 19 and the development of subacute thyroiditis.”
“It is important to recognize the symptoms of neck pain and symptoms of hyperthyroidism after a presumed infection with COVID-19, so the patient can be appropriately treated,” Dr. Poston says.
If you find yourself experiencing:
These symptoms could be a sign that you’re in the first phase of subacute thyroiditis, and that that your body is making too much hormone. This could then be followed by a reduction of thyroid hormones.
Now, some people are more at risk — due to genetic disposition — for developing subacute thyroiditis or developing a recurrence of it, according to a 2019 study in the International Journal of Molecular Sciences. People with the Human Leukocyte Antigen (HLA) variants HLA-B*18:01 and HLA-B*35 tend to be more at-risk. Your doctor may have already tested you for certain HLA variants if you have other endocrine conditions.
The disease is usually diagnosed with blood tests and imaging (such as an ultrasound). Your healthcare provider may also run thyroid function tests to understand your T3, T4, and TSH hormone levels. Additionally, you may be tested for inflammatory markers called erythrocyte sedimentation rate and C-reactive protein. Both of these markers will be increased if you have early stages of subacute thyroiditis. Patients are generally prescribed steroids and other hormone medications to treat these symptoms.
Be sure to speak with your doctor about any of the above signs or symptoms — especially if you had or think you’ve had COVID-19. Luckily, recovery is possible, meaning the issue doesn’t have to stick around. It could last a few weeks to a few months, but “the prognosis is excellent for full recovery from subacute thyroiditis,” Dr. Poston says.
The National Library of Medicine: Subacute Thyroiditis After SARS-CoV-2 Infection:
Symptoms of Coronavirus:
The Risk of Recurrence of Subacute Thyroiditis Is HLA-Dependent:
Subacute Thyroiditis is Associated with HLA-B*18:01, -DRB1*01 and -C*04:01—The Significance of the New Molecular Background: