FRI469 Natural History Of de Quervain’s Thyroiditis In The Era Of COVID -19: The Greek Experience Of 226 Cases
Authors: Angelopoulos Nikolaos , Askitis Dimitrios P , Androulakis Ioannis , Valvis Nicolas , Paparodis Rodis , Petkova Valentina , Boniakos Anastasios , Zianni Dimitra , Perogamvros Ilias , Toulis Konstantinos A , Livadas Sarantis 
Published: October 2023

Abstract
Disclosure: N. Angelopoulos: None. D.P. Askitis: None. I. Androulakis: None. N. Valvis: None. R. Paparodis: None. V. Petkova: None. A. Boniakos: None. D. Zianni: None. I. Perogamvros: None. K.A. Toulis: None. S. Livadas: None.
Background: Subacute thyroiditis (SAT) is a usually self-limiting disease however,patients with pronounced tenderness normally receive nonsteroidal anti-inflammatorydrugs (NSAIDs) or systemic steroids. Disease recurrence is unfortunately common, while approximately 0.5-15% of patients require permanent thyroxine substitution. Among the thyroid SARS-CoV-2 complications, SAT was reported early and the question whether SAT might be underestimated was raised. Aims and Scope: The aims of this retrospective study were: (1) to determine predictive factors for SAT recurrence and the development of hypothyroidism and (2) to identify potential clinical and laboratory characteristics in patients with SAT due to SARS-CoV-2 infection. Methods: We retrospectively reviewed the records of 226 patients with confirmed subacute thyroiditis between January 2020 and November 2022 in eleven outpatient endocrine clinics with geographical representativeness of Greek territory. Results: Mean age was 48.01 years and F/M 158/68. Baseline hypothyroidism was present in 11 patients (4.86%), 36 had Hashimoto, 30 had nodular disease, 4 had both Hashimoto and nodules, 1 was hyperthyroid and the remaining 144 patients had no thyroid disease. At the end of follow up (16.77±0.8 months) 68 patients (34.5%) had hypothyroidism (P &lt;0.001, 15 of them with nodules), 17 Hashimoto, 4 Hashimoto and nodular disease, 1 developed hyperthyroidism and 1 was thyroidectomized due to multiple recurrences. Regarding treatment protocols, significant differences were detected for treatment duration (shorter with ibuprofen, p&lt;0.001), time-to-symptoms relief (shorter with methylprednisolone, p&lt;0.05) and the initial equivalent dose of cortisone (lower in combined treatment with cortisone and ibuprofen, p&lt;0.001). Demographical (age, gender, BMI), serological (ESR,CRP) and treatment parameters (type of therapy, duration of therapy, initial dose of treatment, time to treat, time to symptoms relief) were not related with the development of hypothyroidism. Recurrence was observed in 28 patients (14.1%) all treated with glucocotricoids. 34 patients had covid-19 related SAT with no specific clinical manifestation of the disease. Compared to the non-covid group, BMI was higher (27.58±4.05 vs 25.69±5.44, respectively, p=0.026) and a shorter time-to-symptoms relief was observed (3.56±1.94 vs 5.46±6.93 days, respectively, p=0.044). Conclusion: In a large cohort of patients, corticosteroid therapy was found to promptly alleviate the acute symptoms during the onset of SAT, duration of treatment was longer and the incidence of recurrence greater than that observed with nonsteroidal anti-inflammatory drugs. Both regimens could not prevent the development of delayed hypothyroidism. Clinical characteristics of SAT after COVID-19 were similar to those of typical SAT.
Presentation: Friday, June 16, 2023