Covid-19 and the Thyroid 2

No sooner than I posted an update on Covid-19 and the thyroid gland more research is coming through! At the recent ENDO 2021 (The Endocrine Society Annual Meeting) research was presented describing 'atypical' subacute thyroiditis that can persist for months after COVID-19 infection.

If you read my blog you will have discovered that patients with the acute COVID infection were developing subacute thyroiditis ( overactive thyroid/ hyperthyroidism) which can lead to the symptoms as below:

Many of us with Long Covid are suffering with these symptoms - especially the fast heart rate, insomnia, heat intolerance, weight loss etc.

The research found that:

  • Patients experiencing thyroid inflammation during acute COVID-19 illness may have persistent subacute thyroiditis months later, despite thyroid function returning to normal.

  • This thyroiditis appears to be distinct from the classic viral subacute thyroiditis and is characterized by absence of neck pain, presence of mild thyroid dysfunction, and higher frequency in men.

Why this matters:

  • The findings suggest that COVID-19 could provoke thyroid dysfunction in some patients which has complex and multifactorial mechanisms.

Study design:

  • 51 patients underwent assessment at 3 months after they were hospitalized for moderate-to-severe COVID-19.

  • The patients had no history of thyroid disease and were not on thyroid medications, amiodarone, or steroids prior to baseline thyroid stimulating hormone (TSH) measurement.

Key results:

  • TSH increased from 1.2 mIU/L at baseline to 1.6 mIU/L at 3 months, whereas serum tetraiodothyronine, triiodothyronine, C-reactive protein, and complete blood counts had all normalized (P<.01 for all vs baseline).

  • 16 patients (33%) showed signs of focal thyroiditis on thyroid ultrasound at 3 months.

  • Among 14 patients who underwent thyroid 99mTc or I123 uptake scans, thyroid uptake was normal, focally reduced, and diffusely reduced in 29%, 57%, and 14%, respectively.

  • Of the 16 patients with focal thyroiditis, 3 tested positive for autoantibodies to thyroglobulin (TgAb) or thyroid peroxidase (TPOAb).

  • Of the 2 patients with diffusely reduced uptake, only 1 was positive for TgAb or TPOAb.

Limitations of study:

  • Small sample size

  • Only follow up for 3 months currently

Expert commentary:

Lead author Ilaria Muller, MD, PhD, said:

"We are continuing to monitor these patients to see what happens during the following months. It is important to know whether SARS-CoV-2 virus has late-onset negative effects on the thyroid gland, in order to promptly diagnose, and eventually treat, the condition."


Muller I et al. Early Follow-up of Atypical Thyroiditis Induced by SARS-CoV-2. Presented at The Endocrine Society Annual Meeting (ENDO) 2021 on 21 March 2021.

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