Unusual Clinical Presentation of a Post-Severe Acute Respiratory Syndrome Coronavirus-2 Graves'Disease

Severe acute respiratory syndrome coronavirus-2 could act as a trigger of latent or new-onset auto-immunity. There have been reports of subacute thyroiditis, hypothyroidism or thyrotoxicosis, and Graves' disease. We describe an unusual case of a 48-year-old woman with a history of coronavirus disease 2019 infection 4 months before presenting abdominal distension and edema of the lower limbs, atrial fibrillation, and exophthalmos. The thyroid analysis revealed hyperthyroidism (thyrox-ine = 12.8 uIU/mL; thyroid-stimulating hormone = 0.008 uIU/mL). The transthoracic cardiac echogra-phy revealed dilated cardiomyopathy with a left ventricular ejection fraction of 54% and dilatated inferior vena cava and hepatic veins. Cardiac magnetic resonance imaging showed biventricular dila-tation with left ventricular ejection fraction 29% and no ischemic necrosis or myocarditis sequelae. A neck ultrasound showed a homogeneous hypervascularized goiter; the radionuclide thyroid scan-ning showed a thyroid in place, with increased uniform tracer uptake. Graves' disease was diagnosed with positive anti-thyro id-st imula ting hormone receptors antibodies at 35 IU/mL and anti-thyroid peroxidase antibodies at 312 IU/mL. The patient received treatment intravenous then oral furosemide besides 30 g of thiamazole, daily with Propranolol 40 mg/day. Six months later, the patient had radio-iodine therapy. The ophthalmopathy, the goiter, and ascites regressed. Based on the pathophysiology of severe acute respiratory syndrome coronavirus-2 infection and invasion of the thyroid gland and many similar case reports of post-severe acute respiratory syndrome coronavirus-2 infection auto -immune diseases and endocrinopathies, we suggest that clinicians should keep an eye on thyroid function in the acute phase for coronavirus disease 2019 patients and during convalescence to diag-nose hyperthyroidism before the onset of complications and control reversibility.