Subacute Thyroiditis and Heart Failure in a Patient Presenting With COVID-19
| Autor: | Jessica Castellanos-Diaz, Julio Leey-Casella, Sushma Kadiyala, Hans K. Ghayee, Amie Ogunsakin, Sherin Elsa Mathews, Ashok Srihari |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Medicine (General) Myocarditis Exacerbation Epidemiology Case Report 030209 endocrinology & metabolism 030204 cardiovascular system & hematology Thyroid function tests Thyroiditis Diagnosis Differential 03 medical and health sciences 0302 clinical medicine R5-920 Internal medicine medicine Pathology Humans RB1-214 Thyroiditis Subacute Safety Risk Reliability and Quality subacute thyroiditis Aged Subacute thyroiditis Heart Failure Ejection fraction medicine.diagnostic_test SARS-CoV-2 business.industry COVID-19 medicine.disease Anti-thyroid autoantibodies Heart failure prednisone Cardiology business Safety Research |
| Zdroj: | Journal of Investigative Medicine High Impact Case Reports, Vol 9 (2021) Journal of Investigative Medicine High Impact Case Reports |
| ISSN: | 2324-7096 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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