DOI: 10.12890/2025_006006

Paediatric autoimmune thyroiditis triggered by prior SARS-CoV-2 exposure: a case with transient hashitoxicosis

Authors

  • Ligia Rodina Doctoral School of Medicine, Faculty of Medicine, Lucian Blaga University of Sibiu, Sibiu, Romania; Clinical Hospital of Pneumology and Infectious Diseases of Brasov, Brasov, Romania
  • Lavinia Georgeta Caplan Clinical Hospital of Pneumology and Infectious Diseases of Brasov, Brasov, Romania
  • Elena-Vanda Ciudin Clinical Hospital of Pneumology and Infectious Diseases of Brasov, Brasov, Romania
  • Maria Elena Cocuz Clinical Hospital of Pneumology and Infectious Diseases of Brasov, Brasov, Romania; Department of Infectious Disease, Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania
  • Victoria Birlutiu Doctoral School of Medicine, Faculty of Medicine, Lucian Blaga University of Sibiu, Sibiu, Romania; Department of Clinical Medicine II, County Emergency Clinical Hospital, Lucian Blaga University of Sibiu, Sibiu, Romania

ligiarodinadr@gmail.com

Keywords

utoimmune thyroiditis, hashitoxicosis, SARS-CoV-2

Abstract

Introduction: Thyroid dysfunctions in the paediatric population can present with atypical and nonspecific systemic manifestations, making diagnosis particularly challenging. Viral infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have increasingly been implicated in the onset or exacerbation of autoimmune thyroid diseases both in children and adults. This report describes a case of autoimmune thyroiditis with a transient hyperthyroid phase (hashitoxicosis) following prior exposure to SARS-CoV-2, highlighting the possible immune-mediated mechanisms of viral-induced endocrine autoimmunity that may extend to paediatric populations.
Case report: A previously healthy 13-year-old boy presented with fever, asthenia, bicytopenia, and hepatic cytolysis. Extensive infectious workup, including tests for hepatitis viruses, Epstein–Barr virus, cytomegalovirus, Leptospira spp., and Coxiella burnetii, was negative, except for rhinovirus detection by reverse transcription-polymerase chain reaction. Thyroid function testing revealed elevated thyroid-stimulating hormone (11.9 µIU/ml) and positive anti-thyroid antibodies (anti-thyroid peroxidase >1000 IU/ml, anti- thyroglobulin, 2108 IU/ml). Anti–SARS-CoV-2 neutralizing antibodies were markedly increased, consistent with previous infection. Thyroid ultrasound showed diffuse inhomogeneous echotexture with a pseudonodular pattern and increased vascularity, consistent with autoimmune thyroiditis. Corticosteroid therapy led to fever resolution and normalization of laboratory parameters, followed by a transient hyperthyroid phase (hashitoxicosis) and subsequent progression to subclinical hypothyroidism.
Conclusion: This case underscores the importance of thyroid function evaluation in paediatric or adult patients presenting with unexplained systemic inflammation or cytolysis following viral infections. The overlapping effects of SARS-CoV-2 and other respiratory viruses may unmask or accelerate autoimmune thyroid disorders.

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Published

2025-12-05

Issue

Vol. 13 No. 1 (2026)

Categories

How to Cite

1.
Rodina L, Caplan LG, Ciudin E-V, Cocuz ME, Birlutiu V. Paediatric autoimmune thyroiditis triggered by prior SARS-CoV-2 exposure: a case with transient hashitoxicosis. EJCRIM [Internet]. 2025 Dec. 5 [cited 2026 Nov. 3];13(1). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6006