Subacute Thyroiditis and Heart Failure in a Patient Presenting With COVID-19

Sherin Elsa Mathews; Jessica Castellanos-Diaz; Ashok Srihari; Sushma Kadiyala; Julio Leey-Casella; Hans K Ghayee; Amie Ogunsakin

doi:10.1177/23247096211009412

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Subacute Thyroiditis and Heart Failure in a Patient Presenting With COVID-19

Journal article

Open access

Peer reviewed

Subacute Thyroiditis and Heart Failure in a Patient Presenting With COVID-19

Sherin Elsa Mathews, Jessica Castellanos-Diaz, Ashok Srihari, Sushma Kadiyala, Julio Leey-Casella, Hans K Ghayee and Amie Ogunsakin

JIM - high impact case reports, Vol.9, pp.23247096211009412-23247096211009412

01/2021

DOI: 10.1177/23247096211009412

PMID: 33853424

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Abstract

A 67-year-old male was admitted with shortness of breath and diarrhea. His COVID-19 polymerase chain reaction test was positive, and he was found to be in acute heart failure. Troponin levels were elevated, echocardiogram showed ejection fraction of 24%, and his electrocardiogram was normal. Inflammatory markers were elevated. Further testing revealed suppressed thyroid-stimulating hormone and elevated free thyroxine (T4). Differential diagnosis at this point included possible myocarditis from the viral illness, exacerbation of heart failure from the viral infection or from thyrotoxicosis was considered. Patient's heart failure improved with initiation of heart failure therapies; however, biochemically, his thyroid function tests (TFTs) did not improve, despite empiric methimazole. Thyroid antibody tests were unremarkable. Thyroid ultrasound showed mildly enlarged thyroid gland with no increased vascularity and 5-mm bilateral cysts. Thyroid dysfunction was attributed to subacute thyroiditis from COVID-19, methimazole was tapered, and prednisone was initiated. The patient's TFTs improved. With the ongoing COVID-19 pandemic, it is imperative that clinicians keep a broad differential in individuals presenting with heart failure, and obtaining baseline TFTs may be reasonable. Rapid treatment of the underlying thyroiditis is important in these patients to improve the cardiovascular outcomes. In our experience, steroid therapy showed a rapid improvement in the TFTs.

Aged

COVID-19 - complications

COVID-19 - therapy

Diagnosis, Differential

Heart Failure - complications

Heart Failure - diagnosis

Heart Failure - therapy

Humans

Male

SARS-CoV-2

Thyroiditis, Subacute - complications

Thyroiditis, Subacute - diagnosis

Thyroiditis, Subacute - drug therapy

Details

Title: Subtitle: Subacute Thyroiditis and Heart Failure in a Patient Presenting With COVID-19
Creators: Sherin Elsa Mathews - University of Florida, Gainesville, FL, USA
Jessica Castellanos-Diaz - University of Florida, Gainesville, FL, USA
Ashok Srihari - University of Florida, Gainesville, FL, USA
Sushma Kadiyala - University of Florida, Gainesville, FL, USA
Julio Leey-Casella - University of Florida, Gainesville, FL, USA
Hans K Ghayee - University of Florida, Gainesville, FL, USA
Amie Ogunsakin - University of Iowa, Internal Medicine
Resource Type: Journal article
Publication Details: JIM - high impact case reports, Vol.9, pp.23247096211009412-23247096211009412
DOI: 10.1177/23247096211009412
PMID: 33853424
NLM abbreviation: J Investig Med High Impact Case Rep
eISSN: 2324-7096
Language: English
Date published: 01/2021
Academic Unit: Endocrinology and Metabolism; Internal Medicine
Record Identifier: 9984124763302771

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