ABSTRACT
Objective: Physicians should be aware that thyroiditis is a potential sequela of COVID-19 infection. Discussion: A 49-year-old female without any prior history of thyroid dysfunction presented with clinical and biochemical hyperthyroidism after a diagnosis of COVID-19 illness four months ago. At the time of thyroiditis diagnosis: free T4 was 1.52 ng/dL (normal, 0.76-1.46 ng/dL), TSH <0.005 uIU/mL (normal, 0.358-3.74 uIU/mL), Thyroglobulin antibodies 2 IU/mL (normal, <=1 IU/mL), TPO antibody 1 IU/mL (normal, <9 IU/mL), ESR 5 mm/hr (normal, 0-20 mm/hr). Thyroid US showed no nodules or evidence of autoimmune thyroid disease or abnormal vascular flow. A radioactive iodine uptake test was performed through the primary care office. The test demonstrated symmetric, uniform radiotracer uptake in the right and left lobe. 24-hour uptake was low at 0.1% (normal 15-25%) indicating thyroiditis. Patient features consistent with the diagnosis of subacute thyroiditis include suppressed TSH, diffuse tenderness on thyroid palpation, absent TPO/TG antibodies, and suppressed I-123 RAI uptake (<1%) on 24-hour scan. Conclusion: There is limited data surrounding thyroid disease and COVID-19. It has been suggested that a possible sequela of COVID-19 is thyroiditis. Physicians caring for recovering COVID-19 patients should be aware of possible painful subacute thyroiditis and to check thyroid studies in persons with symptoms of thyrotoxicosis post-COVID-19.
ABSTRACT
CONTEXT: Diabetes mellitus is associated with increased COVID-19 morbidity and mortality, but there are few data focusing on outcomes in people with type 1 diabetes. OBJECTIVE: The objective of this study was to analyze characteristics of adults with type 1 diabetes for associations with COVID-19 hospitalization. DESIGN: An observational multisite cross-sectional study was performed. Diabetes care providers answered a 33-item questionnaire regarding demographics, symptoms, and diabetes- and COVID-19-related care and outcomes. Descriptive statistics were used to describe the study population, and multivariate logistic regression models were used to analyze the relationship between glycated hemoglobin (HbA1c), age, and comorbidities and hospitalization. SETTING: Cases were submitted from 52 US sites between March and August 2020. PATIENTS OR OTHER PARTICIPANTS: Adults over the age of 19 with type 1 diabetes and confirmed COVID-19 infection were included. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Hospitalization for COVID-19 infection. RESULTS: A total of 113 cases were analyzed. Fifty-eight patients were hospitalized, and 5 patients died. Patients who were hospitalized were more likely to be older, to identify as non-Hispanic Black, to use public insurance, or to have hypertension, and less likely to use continuous glucose monitoring or insulin pumps. Median HbA1c was 8.6% (70 mmol/mol) and was positively associated with hospitalization (odds ratio 1.42, 95% confidence interval 1.18-1.76), which persisted after adjustment for age, sex, race, and obesity. CONCLUSIONS: Baseline glycemic control and access to care are important modifiable risk factors which need to be addressed to optimize care of people with type 1 diabetes during the worldwide COVID-19 pandemic.