COVID-19: a new etiological factor of Graves’ disease?




Graves’ disease, COVID-19, thyrotoxicosis, angiotensin-converting enzyme 2 receptors, reinfection, recurrence


SARS-CoV-2 rapidly became a pandemic and has affected millions of people worldwide. Even though the main target of the coronavirus is the respiratory system, researchers all over the world are increasingly concerned about the problem of the impact of COVID-19 on other organs and systems. There is a possibility that coronavirus can affect the thyroid gland because angiotensin-converting enzyme type 2 receptors, through which coronavirus enters cells, were detected in this organ. Recently, there has been an increasing number of reports about subacute thyroiditis and Graves’ disease developing after COVID-19. In our clinical practice, we had a first-onset of Graves’ disease with severe thyrotoxicosis after coronavirus. Severe thyrotoxicosis required the prescription of antithyroid drugs and glucocorticosteroids. Six months later, the patient was reinfected by COVID-19, after which Graves’ disease recurred and endocrine ophthalmopathy developed. We assume that coronavirus altering immunological tolerance can trigger autoimmune mechanisms that provoke autoaggression against various tissues in the human body. One such example is Graves’ disease, recurrence of which might occur due to reinfection of COVID-19. The authors suggest that because the coronavirus alters immunological tolerance in the human body, it can trigger autoimmune mechanisms, which provokes autoaggression against various organs and systems. One such manifestation is Graves’ disease, the onset and manifestation of which may occur after infection or reinfection with COVID-19. The clinical case describes a patient without previous thyroid pathology in whom coronavirus infection was a trigger for the development of Graves’ disease with overt severe thyrotoxicosis requiring glucocorticosteroids. Reinfection with COVID-19 six months after the first infection led to a recurrence of the autoimmune disease and the need for increased antithyroid therapy. Besides reinfection caused the development of endocrine ophthalmopathy, which did not exist at the beginning of Graves’ disease.


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Clinical Case