Description of a patient with Graves’ disease post COVID-19 with negative serology

We are presenting a 62-year-old African-American female who was admitted to our Emergency Department (ED) with septic shock due to pneumonia and diverticulitis. After improvement of the admitting conditions, we found out that the patient developed 1-month post-COVID-19 pneumonia Graves’ disease. The diagnosis was challenging because the patient was negative for thyroid-stimulating immunoglobulin (TSI) and thyroid receptor antibodies (TRAb). The clinical picture was highly suggestive of GD. The patient complained of increased sweating, palpitation, lower extremities weakness, and lack of sleep before the septic shock and after the COVID-19 infection. We palpated a trill and we heard a bruit on her thyroid gland which was a specific finding for the hypervascular gland as in GD. Our physical findings were confirmed by the laboratory findings of thyrotoxicosis with increased free thyroxin levels (Ft4) and very low thyroid stimulating hormone (TSH). The Doppler flow ultrasound of the thyroid confirmed bilateral hypervascular thyroid gland suggestive of hyperthyroidism without nodules. The patient did not have any thyroid disease or complaints before her COVID-19 infection. This is as far as we know the first described patient post-COVID-19 induced GD without TSI and TRAb.