Nodular goiter and anamnesis of COVID-19: clinical and pathogenetic relationships, sonographic and cytological features

There is literature data on the development of destructive thyroiditis in patients with COVID-19, which may increase the risk of thyroid pathology in the post-COVID period. Special attention is paid to autoimmune thyroid diseases, while the impact of COVID-19 on nodular goiter (NG) has been studied little.

The aim of this study was to investigate the sonographic and cytological features of nodular goiter in patients with a recent history of COVID-19. Materials and Methods: A total of 132 patients who sequentially presented to a healthcare facility between October and May 2021-2022, where they were fi rst diagnosed with nodular goiter, were examined. Of these, 36 denied a history of COVID-19 (control group), while 96 had experienced it 2-9 months prior (main group).

Results: According to sonographic data, there were more patients in the main group with microcalcifications (17 (17.8%) vs. 2 (5.6%), p = 0.047), cystic components of nodules (22 (22.9%) vs. 2 (5.6%), p = 0.015), and hypoechoic nodules (23 (23.9%) vs. 4 (11.1%), p = 0.078). In the main group, cytological signs of degenerative changes in thyrocytes combined with macrophage clusters were more frequently observed, which is a nonspecifi c but common manifestation of the consequences of destructive thyroiditis (16 (39.0%) vs. 2 (10.0%), p = 0.017).

Conclusion: Nodular goiter identified in the post-COVID period is characterized by an increased prevalence of microcalcifi cations, a tendency towards reduced echogenicity of nodules, as well as cyst formation against a background of degenerative changes in thyroid tissue. The features of nodular goiter identified in the post-COVID period do not exclude a propensity for oncogenic disorders. 

1. Chen W., Lei J. & Li, Z. Thyroid function changes and COVID-19 severity: egg or chicken? Endocrine. 2022;78:436–440. DOI:10.1007/s12020-022-03129-1

2. Poma AM., Basolo A., Bonuccelli D., Proietti A., Macerola E., Ugolini C. et al. Activation of type I and type II interferon signaling in SARS-CoV-2-Positive thyroid tissue of patients dying from COVID-19. Thyroid. 2021;31:1766–75. DOI: 10.1089/thy.2021.0345

3. Rossetti CL., Cazarin J., Hecht F., Beltrгo FEL., Ferreira ACF., Fortunato RS., Ramos HE and de Carvalho DP (2022) COVID-19 and thyroid function: What do we know so far? Front. Endocrinol. 2022;13:1041676. DOI: 10.3389/fendo.2022.1041676

4. Naguib R. Potential relationships between COVID-19 and the thyroid gland: an update. J. Intern. Med. Res. 2022;50(2). DOI:10.1177/03000605221082898

5. Kolpakova E.A., Elfi mova A.R., Nikankina L.V., Troshina E.A. The role of systemic immune activation in the development of thyroid dysfunction in COVID-19. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(10):1136–1142. (In Russian)]. DOI: 10.26442/00403660.2022.10.201879

6. Kolpakova E.A., Elfi mova A.R., Nikankina L.V., Dyakov I.N., Bushkova K.K., Troshina E.A. COVID-19 and the possible development of autoimmune thyroid diseases. Clinical and experimental thyroidology. 2022;18(3):4–12. (In Russian)]. DOI: 10.14341/ket12740

7. Lania A., Sandri MT., Cellini M., Mirani M., Lavezzi E., Mazziotti G. Thyrotoxicosis in patients with COVID-19: the THYRCOV study. Eur. J. Endocrinol. 2020;183(4):381–387. DOI: 10.1530/EJE-20-0335

8. Urhan., E.., Karaca., Z.., Kara., C.S. et al. The potential impact of COVID-19 on thyroid gland volumes among COVID-19 survivors. Endocrine. 2022;76:635–641 (). DOI:10.1007/s12020-022-03019-6

9. Brancatella A., Ricci D., Cappellani D., Viola N., Sgrò D., Santini F., Latrofa F. Is Subacute Thyroiditis an Underestimated Manifestation of SARS-CoV-2 Infection? Insights From a Case Series. J. Clin. Endocrinol. Metab. 2020;105(10):dgaa537. DOI: 10.1210/clinem/dgaa537

10. Medas F., Dobrinja C., Abdullah Al-Suhaimi E., Altmeier J., Anajar S., Enes Arikan A., Azaryan I., Bainset L. et al. Eff ect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, crosssectional study. Lancet Diabetes Endocrinol. 2023;11:402–13. DOI: 10.1016/S2213-8587(23)00094-3

11. Popa O., Barna R.A., Borlea A., Cornianu M., Dema A. and Stoian D. The impact of the COVID-19 pandemic on thyroid nodular disease: a retrospective study in a single center in the western part of Romania. Front. Endocrinol. 2023;14:1221795. DOI: 10.3389/fendo.2023.1221795

12. Giannoula E., Iakovou I., Giovanella L., Vrachimis A. Updated clinical management guidance during the COVID-19 pandemic: thyroid nodules and cancer. Eur. J. Endocrinol. 2022;186(4):G1–G7. DOI: 10.1530/EJE-21-0716

13. Vrachimis A., Iakovou I., Giannoula E., Giovanella L. Endocrinology in the time of COVID-19: Management of thyroid nodules and cancer. Eur. J. Endocrinol. 2020;183(1):G41–G48. DOI: 10.1530/EJE-20-0269

14. Wu Z., McGoogan J.M. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323:1239–1242. DOI: 10.1001/jama.2020.2648

15. ETA Public Health Board Statement: COVID-19: information and recommendations for patients with thyroid diseases. [Electronic resource]. URL: https://www.eurothyroid.com/files/download/ETAPHB.pdf Assessed on 4 May 2020.

16. Jantarapootirat M., Traiwanatham S., Hirunpat P., Boonsomsuk W., Sungkanuparph S., Sriphrapradang C. Thyroid incidentalomas in hospitalized patients with COVID-19: a single-center retrospective analysis. J. Endocrinol. Soc. 2023;7(6):bvad060. DOI: 10.1210/jendso/bvad060

17. Zubov A.D., Zubov A.A., Zyatieva A.P. Changes in thyroid nodules caused by COVID-19, according to ultrasound. First observations. Ultrasound. Med. Biol. 2022;48:S56. DOI: 10.1016/j.ultrasmedbio.2022.04.162

18. Bel’tsevich D.G., Vanushko V.E., Mel’nichenko G.A., Rumyantsev P.O., Fadeyev V.V. Russian Association of Endocrinologists Clinic Guidelines for Thyroid Nodules Diagnostic and Treatment. Endocrine Surgery. 2016;10(1):5–12. (In Russian)]. DOI:10.14341/serg201615-12

19. Lei Z., He Z., Mei Y., Qi X., Yu P., Xu G., Cheng H., Bai R., Deng J. Associations of psychological status and ultrasonic characteristics of thyroid nodules in adults during the COVID-19 pandemic. Front. Psychol. 2023;14:1202122. DOI: 10.3389/fpsyg.2023.1202122

20. Fisenko E.P., Sencha A.N., Katrich A.N., Sych Yu.P., Tsvetkova N.V., Borsukov A.V., Kostromina E.V. Оn the need to introduce the TI-RADS classifi cation in Russia. Clinical and experimental thyroidology. 2019;15(2):55–63. (In Russian).] DOI: 10.14341/ket10115

21. Shustov S.B., Khalimov Yu.Sh. Functional and topical diagnostics in endocrinology. Scientifi c and methodological publication. SPb., ELBI SPb. 2001:239. (In Russian)].

22. Merad M., Martin J.C. Pathological infl ammation in patients with COVID-19: a key role for monocytes and macrophages. Nat. Rev. Immunol. 2020;20(6):355–362. DOI: 10.1038/s41577-020-0331-4