1. Wednesday,
April 12, 2023
1
Coronavirus thyroiditis
DR. HIWA OMER AHMED
PROFESSOR IN GENERAL AND BARIATRIC SURGERY
UNIVERSITY OF SULAIMANI
COLLEGE OF MEDICINE – SULAIMANI CITY- KURDISTAN
2. Wednesday,
April 12, 2023
2
Introduction
Coronavirus Disease 2019 (COVID-19) is a respiratory
disease caused by severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) first identified in Wuhan,
China in late 2019.
It can present with mild symptoms like fever, cough,
loss of taste and smell, or more severe symptoms
including dyspnea and acute respiratory distress
syndrome.
Although presenting symptoms are well documented,
clinicians continue to uncover sequelae.
3. Wednesday,
April 12, 2023
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Surgical complications
In addition to respiratory disease, some
complications include
hypercoagulability with venous
thromboembolism, neurologic disease
including stroke, and liver disease,
which can include hepatic failure,
cirrhosis, also pancreatitis and
encephalopathy.
4. Wednesday,
April 12, 2023
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Newly recorded complication
Thyroiditis is an inflammatory condition leading to
hyperthyroidism, with acute inflammation of the gland,
causing neck pain, tremors, palpitations, dyspnea,
insomnia, and anxiety. Unfortunately, these symptoms
have a wide differential diagnosis among emergency
department (ED) patients, which includes
1. pulmonary embolism
2. dysrhythmia
3. myocardial ischemia
4. electrolyte derangements
5. Wednesday,
April 12, 2023
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WHY THROID ATTACKED?
The ACE2 and transmembrane serine protease 2 (TMPRSS2),
which serve as entry points for the SARS-CoV-2, have been
identified in the thyroid follicular cells
Their expression levels have been found to be even higher than that
in the lungs
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April 12, 2023
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As acute disease
Diagnosing thyroiditis is particularly challenging in the ED, as it
presents with
vague symptoms
1. low-grade fever
2. Palpitations
3. Fatigue
4. Myalgias
5. Pharyngitis
6. a swollen and painful neck
7. with up to 50% of patients presenting with thyrotoxicosis
7. Wednesday,
April 12, 2023
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Findings
Weight loss with increasing appetite,
New-onset tremor, hyperdefecation or fever.
ECG documentation of atrial fibrillation or
sinus tachycardia
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April 12, 2023
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Biochemical abnormalities
1. Raised ESR
2. Raised C reactive protien (CRP)
3. Low TSH along
4. Raised total T4 and/or free T4
5. Raised/normal total T3 and/or free T3 levels, T3 to
T4 ratio less than 20
6. Raised anti-thyroid peroxidase antibodies (anti-
TPO-Abs) .
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April 12, 2023
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Imaging abnormalities
USG with colour Doppler of the thyroid :
heterogeneous echotexture and reduced
vascularity in a diffusely enlarged or
normal-sized thyroid gland.
A 99mTc thyroid uptake study showing
patchy uptake with the overall uptake
value of less than 5%.
Computed tomography of the soft tissue
of the neck, mild perithyroidal edema
10. Wednesday,
April 12, 2023
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DDX
A. Acute infection.
B. Known causes of thyroiditis include
1. Autoimmune dysfunction
2. Medications such as amiodarone or lithium
3. Viral infection.
4. As cases of SARS-CoV-2 continue to rise, recognizing COVID-19 as a
cause of thyroiditis can help guide ED work-up and management of
these patients.
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April 12, 2023
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Subacute thyroiditis
Subacute thyroiditis can occur either during an active viral infection or
during a postviral inflammatory process, 2–8 weeks after an infection.
Many viruses have been associated with thyroiditis, including
1. Coxsackievirus
2. Mumps
3. Measles
4. Rubella
5. Adenovirus
6. Influenza
7. Parvovirus B19
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April 12, 2023
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High index of suspicion
we should consider viral thyroiditis in the differential
diagnosis of patients presenting to the ED with
Palpitations
Shortness of breath
Recent COVID-19 infections.
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April 12, 2023
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Impact of contrast
Using iodinated contrast as part of the imaging
modality of choice. The normal acute response to
excess iodine by the thyroid gland, known as the
Wolff-Chaikov effect, high iodine levels transiently
decreased thyroid hormone synthesis.
If this effect is impaired, iodine-induced
hyperthyroidism, known as the Jöd-Basedow
phenomenon, can result.
A single dose of iodinated contrast has been shown
to increase the risk of hyperthyroidism by about 2–2.5
times
