Thyrotoxicosis misdiagnosed as long COVID by telemedicine – a cautionary tale
  • Toshitaka Sawamura
    Department of Internal Medicine, Asanogawa General Hospital, Kanazawa, Japan; Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medicine, Kanazawa, Japan; Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Japan
  • Shigehiro Karashima
    Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Japan
  • Mitsuhiro Kometani
    Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medicine, Kanazawa, Japan; Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Japan
  • Ai Ohmori
    Department of Internal Medicine, Asanogawa General Hospital, Kanazawa, Japan; Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
  • Takashi Yoneda
    Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medicine, Kanazawa, Japan; Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Japan

Keywords

Long COVID, Graves’ disease, telemedicine, delayed diagnosis

Abstract

Introduction: Individuals who have had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may develop post-coronavirus disease conditions, also known as long COVID. The symptoms of long COVID are nonspecific, and there are similarities between the symptoms of long COVID and those of Graves’ disease (GD). Therefore, it is important to rule out GD in patients suspected of having long COVID. Telemedicine is widely used to avoid the risk of SARS-CoV-2 infection. However, owing to the lack of in-person examinations, diagnostic errors can occur.
Case description: A 27-year-old Japanese woman presented complaining of persistent fatigue, dyspnea, and low-grade fever, and after in-person examination was finally diagnosed with GD. She had been diagnosed with SARS-CoV-2 infection four months earlier and her symptoms had resolved within 5 days but then recurred. Subsequently, she had 3 telemedicine visits and had been diagnosed with long COVID.
Discussion: With telemedicine there may be delayed diagnosis of GD in patients with a recent history of SARS-CoV-2 infection. Some symptoms and abnormalities cannot be confirmed in telemedicine visits performed using a simple mobile phone. Therefore it is important to know which findings obtained in telemedicine visits with a simple mobile phone are suggestive of GD. Low-grade fever and tachycardia are often observed in patients with GD, but rarely occur in patients with long COVID.
Conclusion: Tachycardia and persistent low-grade fever after SARS-CoV-2 infection, which can be confirmed by telemedicine, can be clues for the diagnosis of GD. Therefore, in-person examination should be added if these symptoms are confirmed by telemedicine.

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    Published: 2024-01-09
    Issue: 2024: Vol 11 No 2 (view)

    How to cite:
    1.
    Sawamura T, Karashima S, Kometani M, Ohmori A, Yoneda T. Thyrotoxicosis misdiagnosed as long COVID by telemedicine – a cautionary tale. EJCRIM 2024;11 doi:10.12890/2024_004206.