جستجوی مقالات مرتبط با کلیدواژه "subacute thyroiditis" در نشریات گروه "پزشکی"

COVID-19 can affect thyroid gland and causes subacute thyroiditis.

We introduced a 60-year-old woman with an initial symptom of anterior cervical pain without any other constitutional symptoms. Nasopharyngeal and oropharyngeal swabs were detected positive for COVID-19 using RT-PCR assay. According to ultrasonographic,  laboratory (lowered TSH, elevated CRP and ESR), and physical findings, subacute thyroiditis was found following the SARS-CoV-2 infection.

As subacute thyroiditis associated with SARS-Cov-2 may be represented without any fever, ruling out this infection in these patients is considerable.

Subacute thyroiditis is an uncommon thyroid disease which usually occurs after a viral infection. During COVID-19 pandemics, several subacute thyroiditis cases were identified during or after COVID-19. Due to their similar manifestations and high prevalence of COVID-19, subacute thyroiditis might be neglected if the clinicians do not keep it in mind. In this care report, we present a missing patient with SARS-COV-2 infection and subacute thyroiditis which was not suspected until the latent phase of the disease.The patient report can be a re-emphasis on the importance of clinical examination and especially paying attention to palpation of the thyroid gland.

 Extrapulmonary manifestations of COVID-19 must not be neglected during the pandemic. Subacute thyroiditis is one of the possible complications people encounter during post-COVID-19 days. Thyroid scintigraphy and radioiodine uptake test help discriminate hyperthyroidism from destructive thyrotoxicosis. Finding a more precise way to diagnose subacute thyroiditis can help in the early detection and treatment of thyroid-related disorders.

 In this cross-sectional study, we evaluated 69 cases of COVID-19. Patients were divided into moderate and severe groups based on their clinical conditions. A thyroid scintigraphy scan was performed on the discharge day. Imaging was done 15-20 minutes after intravenous administration of 3-5 mCi of [99mTc]TcO4-. Scan findings were compared between moderate and severe groups and other participants' demographic and clinical features.

 In 69 patients, according to thyroid scintigraphy, 25 (36%) cases were reported as thyroiditis, and the rest were normal. There was no significant difference between the normal and subacute thyroiditis groups based on age, gender, past medical history, the severity of COVID-19, laboratory values and clinical signs and symptoms. Patients with subacute thyroiditis experienced palpitation and sore throat significantly higher than the normal group (P=0.002 and P=0.009, respectively).

 We conclude that patients admitted due to acute COVID-19 infection experiencing palpitation and sore throat can develop subacute thyroiditis more than others. Whereas the severity of the disease and laboratory testing were not diagnostic in subacute thyroiditis, thyroid scintigraphy may help in early detection.

Subacute thyroiditis has been classified as an auto inflammatory condition and occurs mainly due to a viral infection. According to the pathogenesis of SARS-CoV2 infection, which is mainly based on the uncontrolled inflammatory immune response, several studies have investigated the possible association between SARS-CoV2 and subacute thyroiditis. In this regard, we aimed to review and organize these studies.

First, we observed and provided evidence on the possible roles and mechanisms of SARS-CoV2 in inflammatory and autoimmune diseases, and then we discussed the findings on the association between subacute thyroiditis and SARS-CoV2 infection.

Regarding other autoimmune and inflammatory disorders, together with previous experience on the role of viruses in the pathogenesis of subacute thyroiditis, as well as studies on the inflammatory mechanism of SARS-CoV2 infection, support this hypothesis that SARS-CoV2 may initiate subacute thyroiditis.

Evidence so far suggests that subacute thyroiditis should be considered as a later symptom of covid-19.

Asymptomatic subacute thyroiditis (aSAT) without inflammatory features is often difficult to distinguish from papillary thyroid carcinoma (PTC), even with ultrasonography. Under certain circumstances, a fine-needle aspiration biopsy (FNAB) is performed, which is known to increase the patient’s physical pain.

To investigate the value of quantitative contrast-enhanced ultrasonography (CEUS) in discriminating aSAT from PTC nodules.

A total of 30 aSAT and 23 PTC patients were systematically reviewed. Quantitative CEUS parameters, including the rise time (RT), time to peak (TTP), maximum intensity (IMAX), as well as their extension indicators (ΔRT and ΔTTP), were determined in various nodule areas (total, central, peripheral, and control regions of nodules). Chi-square test and independent-samples t-test were performed to compare significant differences between PTC and aSAT. A receiver operating characteristics (ROC) curve analysis was also performed to assess the diagnostic efficacy of each parameter, as well as diagnostic efficacy indices, including sensitivity and specificity, in discriminating aSAT from PTC nodules.

Compared to the PTC group, patients with aSAT had a longer ∆RT1 (RT of the control area − RT of the whole area; 0.12 ± 0.69 vs. -0.2 ± 0.57, P = 0.03) and ∆RT3 (RT of the control area − RT of the central area; 0.43 ± 0.72 vs. 0.04 ± 0.94, P = 0.049). Besides, compared to the PTC group, the aSAT group had a shorter RT in the total area (RT1: 4.05 ± 1.56 vs. 4.91 ± 2.09, P = 0.045); a shorter TTP in the total (TTP1: 4.91 ± 1.76 vs. 7.30 ± 3.92, P = 0.005), peripheral (TTP2: 5.06 ± 1.97 vs. 7.00 ± 3.48, P = 0.01), and central (TTP3: 4.90 ± 1.68 vs. 7.57 ± 4.41, P = 0.004) areas; and a lower IMAX in the peripheral area (IMAX2: 0.74 ± 0.36 vs. 1.09 ± 0.57, P = 0.009). Based on the ROC curve analysis, the area under the curve was significantly larger for TTP1 as compared to RT1 (P = 0.027).

Conventional ultrasound and CEUS examinations were inadequate in distinguishing PTC from aSAT. Overall, a quantitative analysis may indicate more biological characteristics of nodules, which can be helpful in the differential diagnosis.

 Asymptomatic subacute thyroiditis (aSAT) lacking inflammatory features is often difficult to distinguish from papillary thyroid carcinoma (PTC), even with the help of ultrasound. Under the circumstances, a fine-needle aspiration biopsy(FNAB) may be performed, which increasing patients’ suffering.

 To investigate the value of quantitative contrast-enhanced ultrasonography(CEUS) analysis in discriminating aSAT from PTC nodules.

 A total of 30 aSAT and 23 PTC patients were systematically reviewed. Quantitative CEUS indicators, including rise time(RT), time to peak(TTP), maximum intensity (IMAX) and their extension indicators, were gathered from various nodule areas(the whole, central, peripheral and control regions of the nodules). We used a chi-square test and independent-sample t test to compare significant differences between the two diseases. Receiver operating characteristic (ROC) curve analysis was used to assess diagnostic efficacy (and its indices including sensitivity and specificity) for each variable in discriminating aSAT from PTC nodules.

 Compared with PTC patients, aSAT patients showed longer RT of the control region−RT of the whole region(∆RT1; 0.12 ± 0.69 vs. -0.2 ± 0.57, P = 0.03) and RT of the control region−RT of the central region(∆RT3; 0.43 ± 0.72 vs. 0.04 ± 0.94, P = 0.049). In addition, aSAT patients showed shorter RT of the whole region(RT1; 4.05 ± 1.56 vs. 4.91 ± 2.09, P = 0.045), TTP of the whole region(TTP1; 4.91 ± 1.76 vs. 7.30 ± 3.92, P = 0.005), TTP of the peripheral region(TTP2; 5.06 ± 1.97 vs. 7.00±3.48, P = 0.01) and TTP of the central region (TTP3; 4.90 ± 1.68 vs. 7.57 ± 4.41, P = 0.004), as well as lower IMAX of the peripheral region(IMAX2; 0.74 ± 0.36 vs. 1.09 ± 0.57, P = 0.009), than PTC patients. Also, when compared with the ROC curve, the area under the curve for TTP1 was significantly larger than that for RT1 (P = 0.027).

 Conventional-ultrasound and contrast-enhancing analysis were still inadequate for distinguishing PTC from aSAT. Quantitative analysis might provide more nodule biological characteristics, which would be more helpful in differential diagnosis.
 

The aim of this study was to determine whether technetium (99mTc) uptake is a relevant method for the differential diagnosis of Graves disease and subacute thyroiditis and calculate its cutoff value in case of its relevancy.

A total of 69 patients, who were followed up (>3 months) in our hospital for thyrotoxicosis within 2015-2019 were enrolled in the study. Out of these 69 subjects, 39 patients had been diagnosed with Graves disease, and 30 of them had subacute thyroiditis. Biochemical parameters, thyroid scintigraphy, and 99mTc uptake test results were evaluated.

99mTc uptake was significantly higher in the patients with Graves disease than in the patients with subacute thyroiditis (P<0.001). Based on the ROC analysis the 99mTc uptake cutoff value of 1.55% had an accuracy of 92.9%, with the sensitivity and specificity of 92% and 87%, respectively.

In conclusion, the results of our study suggested that 99mTc uptake test could be used in the differential diagnosis of Graves disease and subacute thyroiditis. The cutoff value of 1.55% for 99mTc uptake test may guide in establishing a differential diagnosis between the two diseases.

The main purpose of the present study was to determine the efficacy of real-time elastography (RTE) and strain elastography (STE) in the diagnosis of different thyroid diseases. We also aimed to calculate the cut-off points for the differential diagnosis of subacute thyroiditis (SAT), Graves’ disease (GD), and Hashimoto’s thyroiditis (HT), which have a similar B-mode sonographic appearance.
Patients and A total of 24 patients with GD (10.9%), 94 patients with HT (42.7%), 20 patients with SAT (9.1%), and 82 individuals with normal healthy thyroids (37.3%) were included. Grayscale ultrasound evaluation of thyroid glands was performed with standard transverse and longitudinal planes before sonoelastography.
The strain ratios (SRs) (mean ± standard deviation) of patients with GD, HT, and SAT, and the control group (CG) were 14.7 ± 14.8, 8.4 ± 9.6, 23.2 ± 10.8, and 1.37 ± 0.8, respectively. The cut-off points of strain elastography of the patients with GD, HT, and SAT to the CG were 2.69 (sensitivity 92%, specificity 90%, area under the curve (AUC) 0.983; 95% CI), 2.18 (sensitivity 100%, specificity 85%, AUC 0.898), and 5.54 (sensitivity 100%, specificity 100%, AUC 1.000; 95% CI), respectively. The cut-off point of the strain ratios (SR) of the total amount of patients with HT and GD to SAT was 14.79 (sensitivity 80%, specificity 85%, AUC 0.869; 95% CI).
Statistically significant differences were noted in the SR values and elasticity scores of the three experimental groups, and the CG. The elasticity scores of the SAT and HT groups were not significantly different from those of the GD group. The diagnostic performance of strain ratio elastography (P