Kosar Chitzan-Zadeh

Subclinical hypothyroidism (SCH) is biochemically characterized by elevated thyrotropin (thyroid-stimulating hormone [TSH]) levels, while free thyroxine (FT4) levels remain normal. Given the high prevalence of vitamin D deficiency in Iran, investigating the association between vitamin D levels and SCH may improve treatment. A case-control study was conducted at the endocrinology clinic of Imam Khomeini Hospital, affiliated with Ahvaz Jundishapur University of Medical Sciences. A total of 106 subjects who met the inclusion criteria were selected and divided into 2 groups: 53 subjects with SCH and 53 healthy controls (HC). Serum levels of vitamin D, TSH, and FT4 were obtained from medical records. Other variables including age, weight, and height were also recorded. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 26. The mean age of the SCH and HC groups was 35.98 ± 12.9 years and 34.34 ± 13.49 years, respectively. In the SCH group, the mean serum vitamin D level was 23.99 ± 9.26 ng/mL, compared to 26.73 ± 9.42 in the HC group, with no statistically significant difference ( P  = .10). In both groups, no significant correlation was found between vitamin D levels and variables, such as sex, age, and body mass index. However, the TSH and FT4 levels in the SCH group were significantly higher than those in the control group. No significant difference in vitamin D deficiency was observed between SCH patients and HC.

Background: Subacute thyroiditis (SAT) is a self-limiting thyroid inflammatory disease occurring specifically after upper respiratory tract infections. Since COVID-19 is a respiratory disease leading to multi-organ involvements, we aimed to systematically review the literature regarding SAT secondary to COVID-19. Methods: We searched Scopus, PubMed/MEDLINE, Cochrane, Web of Science, ProQuest, and LitCovid databases using the terms "subacute thyroiditis" and "COVID-19" and their synonyms from inception to November 3, 2022. We included the original articles of the patients with SAT secondary to COVID-19. Studies reporting SAT secondary to COVID-19 vaccination or SAT symptoms' manifestation before the COVID-19 infection were not included. Results: Totally, 820 articles were retained. Having removed the duplicates, 250 articles remained, out of which 43 articles (40 case reports and three case series) with a total of 100 patients, were eventually selected. The patients aged 18-85 years (Mean: 42.70, SD: 11.85) and 68 (68%) were women. The time from the onset of COVID-19 to the onset of SAT symptoms varied from zero to 168 days (Mean: 28.31, SD: 36.92). The most common symptoms of SAT were neck pain in 69 patients (69%), fever in 54 (54%), fatigue and weakness in 34 (34%), and persistent palpitations in 31 (31%). The most common ultrasonographic findings were hypoechoic regions in 73 (79%), enlarged thyroid in 46 (50%), and changes in thyroid vascularity in 14 (15%). Thirty-one patients (31%) were hospitalized, and 68 (68%) were treated as outpatients. Corticosteroids were the preferred treatment in both the inpatient and outpatient settings (25 inpatients (81%) and 44 outpatients (65%)). Other preferred treatments were nonsteroidal anti-inflammatory drugs (nine inpatients (29%) and 17 outpatients (25%)) and beta-blockers (four inpatients (13%) and seven outpatients (10%)). After a mean duration of 61.59 days (SD: 67.07), 21 patients (23%) developed hypothyroidism and thus, levothyroxine-based treatment was used in six of these patients and the rest of these patients did not receive levothyroxine. Conclusion: SAT secondary to COVID-19 seems to manifest almost similarly to the conventional SAT. However, except for the case reports and case series, lack of studies has limited the quality of the data at hand.