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Nikhil Prasad  Fact checked by:Thailand Medical News Team Jan 08, 2024  1 month, 1 week, 6 days, 7 hours, 5 minutes ago

COVID-19 News: Doctors From West Virginia Warn That SARS-CoV-2 Infections Can Lead To ‘Thyroid Storms’!

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COVID-19 News: Doctors From West Virginia Warn That SARS-CoV-2 Infections Can Lead To ‘Thyroid Storms’!
Nikhil Prasad  Fact checked by:Thailand Medical News Team Jan 08, 2024  1 month, 1 week, 6 days, 7 hours, 5 minutes ago
COVID-19 News: The global impact of the COVID-19 pandemic continues to unfold, revealing intricate connections between the SARS-CoV-2 virus and a myriad of health complications. Among the emerging concerns are cases linking COVID-19 to autoimmune disorders, particularly affecting the thyroid gland. In this COVID-19 news report, we delve into a case study presented by medical professionals from the West Virginia School of Osteopathic Medicine, Charleston Area Medical Center (CAMC), and West Virginia University, shedding light on the potential correlation between SARS-CoV-2 infections and the development of thyroid storms, with a focus on Graves' disease (GD).

SARS-CoV-2 Can Affect The Thyroid In Many Ways!
Thailand Medical News in our previous COVID-19 News coverages had already showed that SARS-CoV-2 can infect the thyroid glands and cause various issues.,-suppressed-male-sex-hormone-secretion-and-elevated-prolactin,-a-new-type-of-thyroid-cancer-in-a-post-covid-individual
The Case Study
The case revolves around a 42-year-old woman with a history of GD, who presented to the Emergency Department (ED) with an acute exacerbation of hyperthyroidism three weeks after testing positive for SARS-CoV-2. Her symptoms included daily headaches, increased bilateral eye pressure, fatigue, muscle weakness, confusion, agitation, persistent heart palpitations, and a noticeable goiter. Elevated thyroid hormone levels, with a Burch-Wartofsky scale indicating an impending thyroid storm, raised concerns among medical professionals.

Treatment involved a combination of propylthiouracil, potassium iodide oral solution, and propranolol, leading to symptom improvement. Due to the patient's prior intolerance to antithyroid medications and the recent exacerbation, a thyroidectomy was performed once she achieved a euthyroid state. This case underscores the critical importance of recognizing COVID-19 as a potential trigger for new onset or exacerbation of GD, emphasizing the need for early diagnosis and intervention.
Autoimmune Disorders and COVID-19
The broader context of the case points to a growing body of evidence linking COVID-19 to various autoimmune disorders, including those affecting the thyroid. Since the onset of the pandemic, reports have surfaced connecting SARS-CoV-2 to rheumatologic conditions, hematologic conditions, Guillain-Barré syndrome, and type 1 diabetes. The effects of the virus on the thyroid gland remain an area of active research, with documented cases involving Hashimoto disease, postpartum thyroiditis, and subclinical thyroid abnormalities.
Patients with pre-existing thyroid conditions or a genetic predisposition may experience more severe infections. The case study highlights GD as a rare complication following SARS-CoV-2 infection, emphasizing the need for heightened vigilance in recognizing the association between COVID-19 and thyroid abnormalities for timely diagnosis and treatment.
Understanding the Thyroid's Role in COVID-19
The mechanisms through which SARS-CoV-2 affects the thyroid gland are still under investigation. The virus binds to angiotensin-converting enzyme 2 (ACE2) receptors, primarily associated with lung tissue but also expressed in various other organs, including the thyroid. Studies suggest that the virus impacts follicular epithelial and parafollicular cells, limiting the production of thyroid hormones T3 and T4.
Research indicates an inverse correlation between measured T3 levels and the severity of SARS-CoV-2 infections, with subclinical and euthyroid alterations in thyroid function being common even in less severe cases. Thyroid-stimulating hormone (TSH) and free T3 levels could serve as markers for clinical outcomes in infected patients, with lower levels associated with higher rates of lymphopenia and increased mortality.
The Impact of Pro-inflammatory Cytokines
A key aspect of the association between COVID-19 and thyroid disorders involves the impact of pro-inflammatory cytokines. Interferon-g and tumor necrosis factor-a, elevated in SARS-CoV-2-infected patients, increase the thyroid's ACE2 receptor expression. This heightened expression modulates the immune response, potentially leading to thyroid-related disorders. Higher ACE2 expression is associated with comorbidities like cardiovascular disease, hypertension, chronic obstructive pulmonary disease, and obesity, which increase the risk and severity of COVID-19 infections.
Pathogenic Mechanisms and Molecular Mimicry
Beyond aberrant immune responses, various pathogenic mechanisms contribute to SARS-CoV-2-induced autoimmunity, with molecular mimicry being a notable avenue. Shared characteristics between the virus's spike protein and various endocrine cells, including those in the thyroid, suggest a potential link to autoimmune responses. Genetic predisposition could further explain the underlying pathophysiology leading to autoimmunity.
Observations and Future Implications
Reports and studies examining the incidence of autoimmune cases since the onset of the pandemic highlight an increased likelihood of acquiring autoimmune diseases following SARS-CoV-2 infection. While the correlation between COVID-19 and autoimmune thyroid disorders is becoming apparent, comprehensive long-term data sets are needed for a thorough understanding of this relationship.
The case presented by medical professionals from West Virginia serves as a crucial reminder of the intricate interplay between COVID-19 and thyroid disorders. Recognizing COVID-19 as a potential trigger for new onset or exacerbation of Graves' disease is essential for early diagnosis, treatment, and long-term care. As the scientific community continues to unravel the complexities of SARS-CoV-2's impact on various organs, including the thyroid, heightened awareness and ongoing research are paramount to advancing our understanding of this unprecedented global health crisis.
The case report was published in the peer reviewed American Journal of Case Reports.
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