New Onset of Graves’ Disease After COVID-19 Infection

October 2, 2021

By Erika Powers

VIRTUAL -- October 1, 2021 -- At the Virtual 2021 Annual Meeting of the American Thyroid Association (ATA), physicians presented a case series of patients who developed new onset Graves’ disease after infection with coronavirus disease 2019 (COVID-19).

“All 3 of our patients developed Graves’ thyrotoxicosis after diagnosis of COVID-19 and were controlled with methimazole,” said Shaveta Gupta, MD, Tulane University Health Sciences Center, New Orleans, Louisiana. “Clinicians should be aware of the association of Graves’ disease with COVID-19 and consider proactively screening their COVID-19 patients for Graves’ disease when symptoms persist.”

The first case was a female aged 58 years who presented to the emergency department (ED) with persistent palpitations and dyspnoea. She had laboratory-confirmed COVID-19 3 months prior. She had no previous history of thyroid illness and had normal thyroid labs before contracting the virus. Exam revealed a symmetric goiter, and she was found to have atrial fibrillation with rapid ventricular response. Labs were diagnostic of Graves’ thyrotoxicosis.

The second case was a female aged 32 years who presented to the ED with fever and cough and was diagnosed with COVID-19 by polymerase chain reaction (PCR). She had no previous history of thyroid illness and had normal thyroid labs 8 months earlier. CT chest revealed a symmetric goiter and labs confirmed Graves’ thyrotoxicosis.

The third case was a female aged 54 years who was referred to the endocrinology clinic with complaints of palpitations and dyspnoea. Her symptoms began 9 months prior when she was diagnosed with COVID-19 by PCR. She had no prior history of thyroid disease and had normal thyroid labs in 2019. Labs were diagnostic of Graves’ thyrotoxicosis.

The researchers don’t know exactly what caused Graves’ thyrotoxicosis in these patients, but it may have to do with the cytokine storm the infection causes.

“COVID-19 is associated with cytokine storm and immune system dysregulation,” said Dr. Gupta. “The key cytokines, such as interleukin-6, interleukin-1beta, tumour necrosis factor-alpha, and interferon-y, stimulate the pathogenic CD4+ T lymphocytes, and these cells activate thyrotropin receptor-specific B cells to produce autoantibodies to the thyrotropin receptor, inciting Graves’ thyrotoxicosis.”

[Presentation title: New Onset of Graves’ Disease After COVID-19: Case Series. Late-Breaking Highlighted Poster 4]