Subacute thyroiditis during the COVID-19 pandemic: a prospective study.

Subacute thyroiditis(SAT) is a destructive thyroiditis associated with viral infections. Several SAT cases associated with SARS-CoV-2 infection/vaccination were recently reported. We aimed to evaluate prospectively all cases applied to our tertiary center and their relationship with SARS-CoV-2 during 16 months of the pandemic. Cases during similar pre-pandemic period were recorded for numeric comparison. Prospective study took place between March 2020 and July 2021. SAT was diagnosed by classical criteria. Swabs for SARS-CoV-2 and a wide respiratory viral panel (RV-PCR) were taken. Previous COVID-19 was assessed by SARS-CoV-2 IgM&IgG levels. Study group was divided into three as: CoV-SAT, patients who had or still have COVID-19, Vac-SAT, patients diagnosed within three months after SARS-CoV-2 vaccination and NonCoV-SAT, those not associated with COVID-19 or vaccination. Out of 64 patients, 18.8% (n = 12) was classified as CoV-SAT, 9.3% (n = 6) as Vac-SAT and 71.9% as (n = 46) NonCoV-SAT. SARS-CoV-2 RT-PCR tests on the diagnosis of SAT were negative in all, but two patients tested positive five days later, in second testing, performed upon clinical necessity. CoV-SAT and NonCoV-SAT groups were similar in terms of clinical, laboratory, and treatment characteristics. However, symptoms were milder and treatment was easier in Vac-SAT group (p = 0.006). Total number of SAT cases during the pandemic period was comparable to pre-pandemic period. However, a considerable rate of SARS-CoV-2 exposure in SAT patients was established. COVID-19 presented with SAT, as the first manifestation in three cases. Vaccine-related cases developed in a shorter time period, clinical presentation was milder, and only a few required corticosteroids.

Bahçecioğlu AB ，Karahan ZC ，Aydoğan BI ，Kalkan IA ，Azap A ，Erdoğan MF ... -  《-》

Differences in Clinical Aspects Between Subacute Thyroiditis Associated with COVID-19 Vaccines and Classical Subacute Thyroiditis.

Subacute thyroiditis (SAT) developed after SARS-CoV-2 vaccines has been less studied. We aimed to compare classical SAT and SAT developed after SARS-CoV-2 vaccines in the context of clinical aspects. Adults with SAT detected in 90 days of COVID-19 vaccination (CoronaVac or Pfizer/BioNTech) were grouped as Vac-SAT. Those with a history of SARS-CoV-2 or upper respiratory tract infection in 6 months before the vaccination, or vaccination with another antiviral vaccine after COVID-19 vaccination were excluded. Those with SAT detected before COVID-19 pandemic were grouped as Classical-SAT. Of total (n=85), female/male (54/31) ratio and age [43 (23-65)] were similar in Vac-SAT (n=23) and Classical-SAT (n=62). Duration between vaccine and SAT was 45 (7-90) days, and similar in CoronaVac-SAT (n=5) and BioNTech-SAT (n=18). SAT-duration was 28 (10-150) days, and higher in Vac-SAT than in Classical-SAT (p=0.023). SAT was developed after the 1st dose vaccine in minority in CoronaVac-SAT (n=2) and BioNTech-SAT (n=3) (p=0.263). Previous LT4 use, and TSH elevation after resolution were more frequent in Vac-SAT than in Classical-SAT (p=0.027 and p=0.041). We included a considerable number of patients with SAT occurred after COVID-19 vaccines. We cannot provide clear evidence regarding the association of COVID-19 vaccines with SAT. SAT associated with CoronaVac or BioNTech seems unlikely to be occurred after the 1st dose, and to have a longer duration, more likely to be associated with previous LT4 use and lead TSH elevation after resolution than Classical-SAT. TSH should be followed-up after the resolution of SAT detected after COVID-19 vaccination.

Topaloğlu Ö ，Tekin S ，Topaloğlu SN ，Bayraktaroglu T ... -  《-》

Subacute THYROiditis Related to SARS-CoV-2 VAccine and Covid-19 (THYROVAC Study): A Multicenter Nationwide Study.

The aims of the study are to compare characteristics of subacute thyroiditis (SAT) related to different etiologies, and to identify predictors of recurrence of SAT and incident hypothyroidism. This nationwide, multicenter, retrospective cohort study included 53 endocrinology centers in Turkey. The study participants were divided into either COVID-19-related SAT (Cov-SAT), SARS-CoV-2 vaccine-related SAT (Vac-SAT), or control SAT (Cont-SAT) groups. Of the 811 patients, 258 (31.8%) were included in the Vac-SAT group, 98 (12.1%) in the Cov-SAT group, and 455 (56.1%) in the Cont-SAT group. No difference was found between the groups with regard to laboratory and imaging findings. SAT etiology was not an independent predictor of recurrence or hypothyroidism. In the entire cohort, steroid therapy requirement and younger age were statistically significant predictors for SAT recurrence. C-reactive protein measured during SAT onset, female sex, absence of antithyroid peroxidase (TPO) positivity, and absence of steroid therapy were statistically significant predictors of incident (early) hypothyroidism, irrespective of SAT etiology. On the other hand, probable predictors of established hypothyroidism differed from that of incident hypothyroidism. Since there is no difference in terms of follow-up parameters and outcomes, COVID-19- and SARS-CoV-2 vaccine-related SAT can be treated and followed up like classic SATs. Recurrence was determined by younger age and steroid therapy requirement. Steroid therapy independently predicts incident hypothyroidism that may sometimes be transient in overall SAT and is also associated with a lower risk of established hypothyroidism.

Batman A ，Yazıcı D ，Dikbaş O ，Ağbaht K ，Saygılı ES ，Demirci İ ，Bursa N ，Ayas G ，Anıl C ，Cesur M ，Korkmaz FN ，Bahçecioglu AB ，Çorapçıoğlu D ，Erdoğan MF ，Bostan H ，Calapkulu M ，Hepşen S ，Uçan B ，Çakal E ，Güler BY ，Haymana C ，İpekçi SH ，Aydın S ，Sezer H ，Özışık S ，Deyneli O ，Alagöl F ，Tanakol R ，Eroğlu M ，Mutlu Ü ，Hacışahinoğulları H ，Üzüm AK ，Demir C ，Koç G ，Fırat SN ，Omma T ，İnce N ，Polat ŞB ，Topaloğlu O ，Aydın C ，Çakır B ，Bahadır ÇT ，Güven M ，Sözen M ，Selek A ，Cantürk Z ，Çetinarslan B ，Aydemir M ，Taşkaldıran I ，Bozkuş Y ，İyidir ÖT ，Haydardedeoğlu FE ，Basmaz SE ，Ünal MÇ ，Demir T ，Oğuz A ，Çelik Ö ，Yilmaz M ，Cimsir A ，Kayıhan S ，Uc ZA ，Tekin S ，Topaloğlu Ö ，Saydam BÖ ，Ünsal YA ，Özer Ö ，Yorulmaz G ，Uğur K ，Çakır SD ，Aşık M ，Unubol M ，Genc S ，Andac B ，Okur M ，Dogan O ，Karakiliç E ，Kocabas GU ，Kirac CO ，Cansu GB ，Uygur MM ，Pekkolay Z ，Öztürk S ，Güngüneş A ，Gürkan E ，Keskin L ，Çağlayan K ，Günay YE ，İmre E ，Şener SY ，Kalkan AT ，Gök DE ，Şahin M ... -  《-》

Subacute Thyroiditis Following COVID-19 and COVID-19 Vaccination.

COVID-19 infection and immunizations have been implicated in developing a range of thyroid diseases, including subacute thyroiditis (SAT). This study aimed to evaluate the association between COVID-19 infection and/or COVID-19 vaccination with SAT. A population of 3 million adults insured by Clalit Health Services was evaluated from March 2020 to September 2022. Patients with a new diagnosis of SAT were identified and matched in a 1:10 ratio to a control group. Each control was assigned an index date that was identical to that of their matched case, defined as the date of SAT diagnosis. Multivariate conditional logistic regression models were used to evaluate the association between COVID-19 infection, vaccine, and thyroiditis. A total of 3221 patients with SAT were matched with 32 210 controls. Rates of COVID-19 vaccination (first, second, or third dose) and COVID-19 infection were evaluated prior to the date of SAT diagnosis (disease group) or index date (control group) to detect a possible association. No difference was detected between the groups in relation to vaccinations at the 30 days, 60 days, and 90 days of time points (P = .880/0.335/0.174, respectively). No difference was found between groups in relation to COVID-19 infection at these time points (P = .735/0.362/0.956, respectively). There was higher use of medications for the treatment of thyroiditis, including nonsteroidal anti-inflammatory drugs (28.6% vs 7.9%, P < .01), steroids (10.3% vs 1.8%, P < .01), and beta-blockers (18.3% vs 5.4%, P < .01). Based on this large population study, no association was found between COVID-19 infection and/or the COVID-19 vaccine and SAT.

Duskin-Bitan H ，Robenshtok E ，Peretz A ，Beckenstein T ，Tsur N ，Netzer D ，Cohen AD ，Saliba W ，Shimon I ，Gorshtein A ... -  《-》

Subacute Thyroiditis Following SARS-CoV-2 Vaccines: Six Cases Report and Review of the Literature.

Subacute thyroiditis (SAT) is an inflammatory disease of the thyroid that develops following viral upper respiratory tract infections. SARS-CoV-2 virus, the cause of COVID-19, binds to the Angiotensin-Converting Enzyme-2 (ACE2) molecule expressed on the target cell surface. Thyroid gland shows high levels of ACE2 expression. The cases of SARS-CoV-2-related subacute thyroiditis and Graves' disease have been reported. It has recently been noted that vaccines for SARS-CoV-2 also induce autoimmune and inflammatory reactions. We present six (4 male, 2 female) cases of SAT that developed after mRNA and inactivated SARS-CoV-2 vaccines. And we have reviewed the literature. SAT was seen in 5 patients after mRNA vaccine, in one after inactivated vaccine. Their clinic and laboratory findings suggested to SAT. They were treated with nonsteroid anti-inflamatory drugs and/or methylprednisolone.They recovered within few weeks. Out patients did not have permanent hypothyroidism after SAT. The history of SARS-CoV-2 vaccination should be questioned in patients with subacute thyroiditis in pandemic days.

Kurtulmus N ，Kayikci K 《-》