Graves' disease presentation after covid-19 infection

Graves' disease is an autoimmune condition characterized by hyperthyroidism due to higher levels of circulating autoantibodies that bind to and activate the thyrotropin receptors (TSH receptors) on the surface of thyroid follicular cells. We report a unique case of Graves' disease after the cytokine surge due to an infection with COVID-19. We present a case of a 45-year-old male with a past medical history of hypertension who developed graves' disease after being diagnosed with COVID-19, a highly infectious viral disease caused by SARS- COV 2. Physical examinations showed, patient to be tachycardiac, with an irregular pulse of 155 beats per minute. The patient had a mild resting bilateral hand tremor but did not have any sign of Graves' ophthalmopathy or dermopathy. Electrocardiogram tracing showed the heart rhythm in atrial fibrillation, and the Burch-Wartofsky Point Scale indicated a score of 25 reflecting an impending thyroid storm. Laboratory work-up conducted on the same day showed an undetectable TSH level with elevated free thyroxine (FT4) and free triiodothyronine (FT3). The patient was then started on medical therapy with Propranolol and Methimazole. This is a case of COVID-19 followed by graves hyperthyroidism. This case raises the possibility of triggering of autoimmunity due to cytokine surge seen in genetically susceptible COVID-19 patients. Hence one needs to recognize and treat the autoimmune conditions that might be seen in COVID-19 patients.