Graves' Disease Caused by SARS-CoV-2 Infection. 2022

Bruno Sousa, and Catarina Pestana Santos, and Ana Gonçalves Ferreira, and Tiago Judas
Internal Medicine Department, Hospital Garcia de Orta, Almada, Lisbon, Portugal.

Graves' disease is an autoimmune disorder that results in hyperthyroidism, caused by autoantibodies to the thyrotropin receptor (TRAbs) stimulating thyroid hormone synthesis, giving rise to a variety of systemic manifestations such as goitre, dermatopathy and orbitopathy. The authors present the case of a 28-year-old man admitted to hospital for a 3-week history of fatigue, shortness of breath, palpitations and diffuse goitre, after recent mild SARS-CoV-2 infection. Laboratory investigation revealed hyperthyroidism with TRAbs elevation. Thyroid ultrasound confirmed a diffusely heterogeneous and irregular thyroid gland and a nodular image below the sternal notch. Thyroid scintigraphy excluded the nodule and confirmed a Graves' disease pattern. Following the initiation of methimazole, the patient had complete resolution of symptoms and normalization of thyroid values. The results suggest a possible association between Graves' disease and SARS-CoV-2 infection acting as a trigger. Graves' disease is an important differential diagnosis to keep in mind when patients present with hyperthyroidism after COVID-19 disease. CONCLUSIONS Graves' disease may be induced after SARS-CoV-2 infection by a possible autoimmune pathway.Graves' disease induced by SARS-CoV-2 infection responds well to antithyroid medication.

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