scholarly journals Subacute Thyroiditis

2021 ◽  
Vol 41 (1) ◽  
pp. 22-26
Author(s):  
Thomas Ferenc ◽  
Anna Mrzljak ◽  
Irena Tabain ◽  
Tatjana Vilibić-Čavlek
Keyword(s):  
Infectious Disease ◽  
Differential Diagnosis ◽  
Severe Acute Respiratory Syndrome ◽  
Median Time ◽  
Thyroid Function ◽  
Common Cold ◽  
Thyroid Dysfunction ◽  
Clinical Suspicion ◽  
Subacute Thyroiditis ◽  
Routine Assessment

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2). It usually presents with mild common cold-like symptoms. However, it can lead to series of complications with some of them being fatal. One of the rare and potentially neglected manifestations of COVID-19 is subacute thyroiditis (SAT). Viral causes of SAT documented so far include several viruses, but according to the newest reports, SARS-CoV-2 should also be added to the list. The median time between COVID-19 diagnosis and the onset of SAT symptoms is reported to be 29 days. Patients mostly present with triphasic course of symptoms - thyrotoxicosis, followed by hypothyroidism and euthyroidism. Although limited number of SAT cases after SARS-CoV-2 infection are reported, physicians should consider SAT as a differential diagnosis in COVID-19 patients. The routine assessment of thyroid function in patients with clinical suspicion of SAT or with the suspicion of any other thyroid dysfunction is advised.

scholarly journals Early Follow-up of Atypical Thyroiditis Induced by SARS-CoV-2

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A61-A61
Author(s):  
Ilaria Muller ◽  
Daniele Cannavaro ◽  
Davide Dazzi ◽  
Giovanna Mantovani ◽  
Virgilio Longari ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Post Infection ◽  
Thyroid Dysfunction ◽  
Subacute Thyroiditis ◽  
Full Blood Count ◽  
Control Group ◽  
Thyroid Peroxidase ◽  
Follow Up Study ◽  
Serum Tsh

Abstract Background: In Spring 2020 the severe acute respiratory syndrome coronavirus 2 pandemic disease (Covid-19) badly affected Northern Italy. We have described for the first time the occurrence of thyrotoxicosis due to atypical subacute thyroiditis in 15% of patients hospitalised for Covid-19 pneumonia, compared with only 1% among patients hospitalised in the same wards during Spring 2019, thus before the Covid-19 pandemic. The whole group of Covid-19 patients also had median serum TSH concentrations significantly lower compared with the control group. The atypical thyroiditis induced by Covid-19 is not associated with neck pain, affects more men than women and especially those severely ill, thus coexists with non-thyroidal illness syndrome. Subacute thyroiditis is classically followed by subsequent occurrence of permanent thyroid dysfunction and autoimmunity, thus we have started a systematic follow-up program of these patients. Methods: Longitudinal follow-up study of survived Covid-19 patients without previous known history of thyroid disorders and/or medications, assessing serum thyroid function and autoantibodies, C reactive protein (CRP), full blood count (FBC) and thyroid ultrasound (US) every 3 months. Patients showing baseline (at hospitalisation for Covid-19) thyroid dysfunction and/or focal hypoechoic areas suggestive for subacute thyroiditis at US performed 3 months post-infection, also underwent thyroid 99mTc or I123uptake. Results: To date, 53 patients have been included in the follow-up study. At 3 months post-infection, all of them presented with increased median (IQR) serum TSH concentrations compared with baseline: 1.3 (0.9–2.0) mIU/L versus 0.9 (0.5–1.8) mIU/L (p=0.0001). Similarly, serum concentrations of free-thyroxine, free-triiodothyronine, CRP and FBC had normalised compared with baseline. All patients had negative autoantibodies to TSH receptor; autoantibodies to thyroglobulin and to thyroid peroxidase were positive in 6/53 (11%) and 5/53 (9%) of patients, respectively. The thyroid US showed the presence of focal hypoechoic areas of thyroiditis in 16/51 (32%) patients, with thyroid uptake normal in 6/16 (37%), focally reduced in 8/16 (50%) and diffusely reduced in 2/16 (12%). Conclusions: At 3 months after Covid-19 disease all patients had a normalised thyroid function, however imaging findings suggestive for subacute thyroiditis were still present in about one third of cases. The thyroid dysfunction induced by Covid-19 seems not mediated by autoimmunity. It is important to continue to follow these patients since they might develop thyroid dysfunction during the following months.

Thyroid problems

2018 ◽  
Vol 11 (4) ◽  
pp. 206-211
Author(s):  
Elizabeth Grove
Keyword(s):  
Primary Care ◽  
Thyroid Hormone ◽  
Thyroid Function ◽  
Secondary Care ◽  
Thyroid Dysfunction ◽  
Clinical Suspicion ◽  
Thyroid Disorders ◽  
Thyroid Function Tests ◽  
Significant Morbidity ◽  
Hormone Production

Thyroid disorders are the most-common endocrine conditions managed within primary care. Such disorders can present insidiously, but are associated with significant morbidity, and therefore, a high index of clinical suspicion is required for diagnosis. GPs need to be able to interpret the results of thyroid function tests, manage thyroid dysfunction and refer appropriately to secondary care. This article aims to provide an overview of disorders of thyroid hormone production including hyperthyroidism, hypothyroidism and thyroid emergencies, and to consider problems of thyroid anatomy including goitres and nodules.

Dynamics of immune-mediated thyroid dysfunction in patients with advanced renal cell carcinoma receiving checkpoint inhibitor therapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16071-e16071
Author(s):  
Juan Carlos Osorio ◽  
Sujata Patil ◽  
Devyn Taylor Coskey ◽  
Maria Isabel Carlo ◽  
Darren R. Feldman ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Replacement Therapy ◽  
Median Time ◽  
Thyroid Function ◽  
Renal Cell ◽  
Thyroid Dysfunction ◽  
Objective Response ◽  
Cancer Center ◽  
Thyroid Function Tests

e16071 Background: Checkpoint inhibitors (CPI) are quickly gaining relevance in the management of metastatic renal cell carcinoma (RCC). Treatment is generally well tolerated, but immune-induced thyroid dysfunction (TD) is reported in up to 10% of patients (pts) across trials. The dynamics of this phenomenon are undefined; hence there are no proposed standards for endocrine surveillance on therapy. Here we report on a cohort of RCC pts treated with CPI at Memorial Sloan Kettering Cancer Center with serial prospective assessment of thyroid function on therapy. Methods: Thyroid function tests (TFT) were assessed at baseline and serially on therapy. We recorded trends for hyper- and hypothyroidism and determined median time to development of TD by standard statistical methods. T4 replacement therapy was investigated by individual chart review. The association of TD with outcomes on CPI therapy was assessed by non-parametric tests. Results: Of 59 pts with serial TFT assessment, 20 were hypothyroid and 39 were euthyroid at baseline. 50% of previously hypothyroid pts required adjustment of T4 dosage. Thirteen of 39 euthyroid pts (36%) developed new TD requiring thyroid replacement. TD occurred early (median time to onset: 1.4 months, range 0.9-9.6), and in six of the 13 pts (46%), transient thyroiditis preceded hypothyroidism. None of the pts with thyroiditis required treatment, and the median duration from onset of thyroiditis to development of hypothyroidism was 1.5 months (range 0.7-2.8). All pts with hypothyroidism required replacement therapy; none required discontinuation of immunotherapy due to TD. TD was not associated with difference in objective response rate (fisher’s exact, p = 0.163), regression in target lesions (wilcoxon rank-sum, p = 0.135), or PFS (log rank p = 0.8214). Conclusions: TD is common in RCC pts receiving CPI therapy. In this cohort, onset of TD was early, thyroiditis was always transient, and no new cases were detected beyond 10 months. Confirming these findings in larger cohorts will provide meaningful data to guide management of TD when using this new class of agents outside of clinical trials.

scholarly journals Subacute thyroiditis associated with COVID-19

2020 ◽  
Vol 13 (8) ◽  
pp. e237336 ◽  
Author(s):  
Shaikh Abdul Matin Mattar ◽  
Samuel Ji Quan Koh ◽  
Suresh Rama Chandran ◽  
Benjamin Pei Zhi Cherng
Keyword(s):  
Differential Diagnosis ◽  
Neck Pain ◽  
Thyroid Function ◽  
Subacute Thyroiditis ◽  
Thyroid Function Tests ◽  
Anterior Neck ◽  
Clinical Resolution ◽  
Function Tests ◽  
Hospitalised Patient

We report a case of a hospitalised patient with COVID-19 who developed subacute thyroiditis in association with SARS-COV-2 infection. The patient presented with tachycardia, anterior neck pain and thyroid function tests revealing hyperthyroidism together with consistent ultrasonographic evidence suggesting subacute thyroiditis. Treatment with corticosteroids resulted in rapid clinical resolution. This case illustrates that subacute thyroiditis associated with viruses such as SARS-CoV-2 should be recognised as a complication of COVID-19 and considered as a differential diagnosis when infected patients present with tachycardia without evidence of progression of COVID-19 illness.

Reconsidering NMIHBA Core Features: Macrocephaly Is Not a So Unusual Sign in PRUNE1-Related Encephalopathy

2020 ◽  
Author(s):  
Roberta Battini ◽  
Enrico Bertini ◽  
Roberta Milone ◽  
Chiara Aiello ◽  
Rosa Pasquariello ◽  
...  
Keyword(s):  
Nervous System ◽  
Differential Diagnosis ◽  
Clinical Features ◽  
Neurodevelopmental Disorder ◽  
Recurrent Mutation ◽  
Clinical Suspicion ◽  
Alexander Disease ◽  
Brain Anomalies ◽  
Progressive Encephalopathy ◽  
Core Features

Abstract PRUNE1-related disorders manifest as severe neurodevelopmental conditions associated with neurodegeneration, implying a differential diagnosis at birth with static encephalopathies, and later with those manifesting progressive brain damage with the involvement of both the central and the peripheral nervous system.Here we report on another patient with PRUNE1 (p.Asp106Asn) recurrent mutation, whose leukodystrophy, inferior olives hyperintensity, and macrocephaly led to the misleading clinical suspicion of Alexander disease. Clinical features, together with other recent descriptions, suggest avoiding the term “microcephaly” in defining this disorder that could be renamed “neurodevelopmental disorder with progressive encephalopathy, hypotonia, and variable brain anomalies” (NPEHBA).

SUBACUTE THYROIDITIS

1960 ◽  
Vol XXXIII (III) ◽  
pp. 457-472 ◽  
Author(s):  
B.-A. Lamberg ◽  
G. Hintze ◽  
R. Jussila ◽  
M. Berlin
Keyword(s):  
Thyroid Function ◽  
Early Phase ◽  
Radioactive Iodine ◽  
Serum Proteins ◽  
Conversion Ratio ◽  
Subacute Thyroiditis ◽  
Synthetic Analogues ◽  
The Third ◽  
Thyroid Uptake ◽  
Iodine Metabolism

ABSTRACT A series of cases of clinically diagnosed subacute thyroiditis comprising 11 patients is reported. Studies on the iodine metabolism, electrophoretic distribution of the serum proteins and the responsiveness to TSH were carried out. The patients were observed for periods up to 16 months from the onset of the disease. In the early phase there was an elevation of the serum PBI in a few cases and hyperthyroid signs in some, accompanied by depressed thyroid uptake of radioactive iodine and a fairly good response to TSH. Later, the thyroid grew hard and the iodine metabolism changed. In several cases there was a marked increase in the conversion ratio and the serum PB131I level. The responses to TSH was variable for different parameters of thyroid function, suggesting a state of »low thyroid reserve« as defined by Jefferies et al. (1956). Hypothyroidism developed in 3 cases; in two of them there was a response to exogenous TSH, in the third no response was seen at this stage of the disease. Cortisone and synthetic analogues seem to be of great benefit in the treatment of the acute symptoms of the disease.

THYROID DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: THE STATE OF THE PROBLEM AND THE WAYS OF SOLVING

2018 ◽  
Vol 22 (4) ◽  
pp. 40-49 ◽  
Author(s):  
A. R. Volkova ◽  
O. D. Dygun ◽  
B. G. Lukichev ◽  
S. V. Dora ◽  
O. V. Galkina
Keyword(s):  
Chronic Kidney Disease ◽  
Thyroid Gland ◽  
Kidney Disease ◽  
Thyroid Hormones ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
The Body ◽  
Type I ◽  
Low T3 ◽  
Iodine Excretion

Disturbance of the thyroid function is often detected in patients with different profiles. A special feature of patients with chronic kidney  disease is the higher incidence of various thyroid function  disturbances, especially hypothyroidism. It is known that in patients  with chronic kidney disease (CKD) iodine excretion from the body is  violated, since normally 90% of iodine is excreted in urine.  Accumulation of high concentrations of inorganic iodine leads to the  formation of the Wolf-Chaikoff effect: suppression of iodine  organization in the thyroid gland and disruption of the thyroid  hormones synthesis. Peripheral metabolism of thyroid hormones is  also disturbed, namely, deiodinase type I activity is suppressed and  peripheral conversion of T4 into T3 is inhibited (so-called low T3  syndrome). Therefore, patients with CKD are often diagnosed with  hypothyroidism, and the origin of hypothyroidism is not always  associated with the outcome of autoimmune thyroiditis. The article  presents an overview of a large number of population studies of  thyroid gland dysfunction in patients with CKD, as well as  experimental data specifying the pathogenetic mechanisms of  thyroid dysfunction in patients with CKD. Therapeutic tactics are still  not regulated. However, in a number of studies, replacement therapy with thyroid hormones in patients with CKD had some advantages.

COVID-19: how nuclear medicine can provide a differential diagnosis in very dubious case

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Maria Silvia De Feo ◽  
Viviana Frantellizzi ◽  
Giuseppe De Vincentis
Keyword(s):  
Infectious Disease ◽  
Differential Diagnosis ◽  
Ct Scan ◽  
Imaging Technique ◽  
False Negative ◽  
Clinical Signs ◽  
Negative Results ◽  
Infectious Disease Department ◽  
False Negative Results ◽  
99Mtc Hmpao

Background: We present the case of a 55-year-old woman, admitted to the Infectious Disease Department of Policlinico Umberto I, Rome, in mid-March 2020, with suspicion of COVID-19 infection. Objective: The rRT-PCR was negative and the following CT scan, performed to exclude false-negative results and help diagnosis, was inconclusive. Methods: It was decided to submit the patient to 99mTc-HMPAO-labelled leukocyte scan. Results: This exam led to the diagnosis of infective endocarditis. Conclusion: In the present pandemic scenario, 99mTc-HMPAO-labelled leukocyte scan represents a reliable imaging technique for differential diagnosis with COVID-19 in patients with confusing clinical signs, possible false-negative rRT-PCR results and inconclusive CT scan.

scholarly journals Thyroid dysfunction is associated with the loss of hepatitis B surface antigen in patients with chronic hepatitis B undergoing treatment with α-interferon

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110251
Author(s):  
Wenfan Luo ◽  
Shuai Wu ◽  
Hongjie Chen ◽  
Yin Wu ◽  
Jie Peng
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Hepatitis B Surface Antigen ◽  
Hbv Dna ◽  
Interferon Treatment ◽  
Normal Thyroid ◽  
Normal Thyroid Function ◽  
Hbsag Loss

Objective To investigate the influence of thyroid dysfunction on the antiviral efficacy of α-interferon in adult patients with chronic hepatitis B (CHB). Methods We performed a retrospective study of 342 patients with CHB who underwent interferon treatment for >12 weeks. Patients with thyroid dysfunction before or during treatment were defined as the thyroid dysfunction group (n = 141) and those with normal thyroid function were defined as the normal thyroid function group (n = 201). The prevalences of hepatitis B virus (HBV) DNA undetectability, low hepatitis B surface antigen (HBsAg) titre (<250 IU/mL), HBsAg loss, and hepatitis B envelope antigen loss were compared. Results During interferon treatment, 69 of 270 (25.6%) participants with normal thyroid function at baseline developed thyroid dysfunction, whereas 11 of 72 (15.3%) with thyroid dysfunction at baseline regained normal thyroid function. The thyroid dysfunction group had significantly higher prevalences of low HBsAg titre (29.8% vs. 18.9%) and HBV DNA undetectability (66.0% vs. 40.3%). Multivariate logistic regression analysis showed that thyroid dysfunction was associated with HBsAg loss (odds ratio 4.945, 95% confidence interval 1.325–18.462). Conclusions These results suggest that thyroid dysfunction is not an absolute contraindication, but is associated with HBsAg loss, in patients with CHB undergoing α-interferon treatment.

scholarly journals Sample Timing, Diagnosis of Subclinical Thyroid Dysfunction and Mortality in Acute Myocardial Infarction: ThyrAMI1 Study

2019 ◽  
Vol 105 (4) ◽  
pp. e1299-e1306 ◽  
Author(s):  
Salman Razvi ◽  
Owain Leng ◽  
Avais Jabbar ◽  
Arjola Bano ◽  
Lorna Ingoe ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Reference Interval ◽  
Reference Ranges ◽  
Diagnosis And Prognosis ◽  
Time Period ◽  
All Cause Mortality ◽  
The Impact

Abstract Objective The objective of this study was to determine the impact of blood sample timing on the diagnosis of subclinical thyroid dysfunction (SCTD) and mortality in patients with acute myocardial infarction (AMI). Patients, Design, and Main Outcome Measures Patients with AMI had thyroid function evaluated on admission between December 2014 and December 2016 and those with abnormal serum thyrotropin (TSH) had repeat thyroid function assessed at least a week later. The association between sample timing and SCTD was evaluated by logistic regression analysis. Secondary outcomes were confirmation of SCTD on repeat testing and all-cause mortality up to June 2018. Results Of the 1806 patients [29.2% women, mean (± standard deviation) age of 64.2 (±12.1) years] analyzed, the prevalence of subclinical hypothyroidism (SCH) was 17.2% (n = 311) and subclinical hyperthyroidism (SHyper) was 1.2% (n = 22) using a uniform TSH reference interval. The risk of being diagnosed with SCTD varied by sample timing in fully-adjusted models. The risk of SCH was highest between 00.01 and 06.00 hours and lowest between 12.01 and 18.00 hours, P for trend &lt;.001, and risk of SHyper was highest between 12.01 hours and 18.00 hours and lowest between 00.01 hours and 06.00 hours. Furthermore, time of the initial sample was associated with the risk of remaining in a SCH state subsequently. Mortality in SCH patients was not elevated when a uniform TSH reference interval was utilized. However, when time period–specific TSH reference ranges were utilized, the mortality risk was significantly higher in SCH patients with HR (95% CI) of 2.26 (1.01–5.19), P = .04. Conclusions Sample timing impacts on the diagnosis and prognosis of SCH in AMI patients. If sample timing is not accounted for, SCH is systemically misclassified, and its measurable influence on mortality is lost.

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