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Sofia Macedo Institute for Research & Innovation in Health, University of Porto, Porto, Portugal
Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
Faculty of Medicine, University of Porto, Porto, Portugal

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Ana Pestana Institute for Research & Innovation in Health, University of Porto, Porto, Portugal
Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
Faculty of Medicine, University of Porto, Porto, Portugal

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Liliana Santos Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
Faculty of Medicine, University of Porto, Porto, Portugal
North Lisbon University Hospital Center, Lisbon, Portugal

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Celestino Neves Faculty of Medicine, University of Porto, Porto, Portugal
University Hospital Center of São João, Porto, Portugal

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Susana Guimarães Faculty of Medicine, University of Porto, Porto, Portugal
University Hospital Center of São João, Porto, Portugal

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Amaro Duarte-Neto Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

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Marisa Dolhnikoff Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

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Paulo Saldiva Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

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Georgina Alves Institute for Research & Innovation in Health, University of Porto, Porto, Portugal

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Rute Oliveira Institute for Research & Innovation in Health, University of Porto, Porto, Portugal

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Didier Cabanes Institute for Research & Innovation in Health, University of Porto, Porto, Portugal

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Fátima Carneiro Institute for Research & Innovation in Health, University of Porto, Porto, Portugal
Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
Faculty of Medicine, University of Porto, Porto, Portugal
University Hospital Center of São João, Porto, Portugal

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Manuel Sobrinho-Simões Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
Faculty of Medicine, University of Porto, Porto, Portugal
University Hospital Center of São João, Porto, Portugal

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Paula Soares Institute for Research & Innovation in Health, University of Porto, Porto, Portugal
Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
Faculty of Medicine, University of Porto, Porto, Portugal

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also affect endocrine organs, such as the thyroid gland ( 1 , 2 ). Angiotensin-converting enzyme 2 (ACE-2) receptor was reported as the functional receptor of the SARS-CoV virus ( 3 ). Recent studies reported that SARS-CoV-2 also employs the same

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Liliana Ribeiro Santos Internal Medicine Department, Hospital of Santa Maria, Lisbon, Portugal
Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal

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Inês Vasconcelos Bessa Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
Health Investigation and Innovation Institute (i3S), University of Porto, Porto, Portugal

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Adriana Gaspar da Rocha Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
Health Investigation and Innovation Institute (i3S), University of Porto, Porto, Portugal
Public Health Unit, ACES Baixo Mondego, Coimbra, Portugal

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Celestino Neves Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
Department of Endocrinology, Hospital University Centre of São João, Porto, Portugal

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Cláudia Freitas Department of Endocrinology, Hospital University Centre of Porto, Porto, Portugal

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Paula Soares Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
Health Investigation and Innovation Institute (i3S), University of Porto, Porto, Portugal
Department of Pathology, Faculty of Medicine of the University of Porto, Porto, Portugal

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Introduction Autoimmune thyroid disease (AITD) is one of the most prevalent groups of autoimmune diseases ( 1 ). Hashimoto’s thyroiditis (HT) and Graves' disease (GD) are the most significant AITDs ( 2 ), GD being around ten times less common

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Carla Colombo Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Milan, Italy
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

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Daniele Ceruti Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

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Simone De Leo Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Milan, Italy

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Grzegorz Bilo Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

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Matteo Trevisan Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

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Noemi Giancola Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

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Claudia Moneta Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

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Gianfranco Parati Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

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Luca Persani Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Milan, Italy
Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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Laura Fugazzola Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Milan, Italy
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

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) #2/female 79/79 PTC T3bNXMX/II LN 10 1 PR 17 6 2 2 (CCB, ACE-i) #3/female 33/75 PTC T2N1aMX/I LN 10 1 PR 68 1 2 2 (ACE-i, CCB) #4/female 42/58 FTC T2NXM0 /I Lung, vertebrae 20 0 PR

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Akshay Khatri Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA

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Esti Charlap Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Great Neck, New York, USA

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Angela Kim Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA

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the thyroid tissue [ 9 ]. Although SARS-CoV-2 has not yet been isolated in the thyroid, the possibility of direct viral damage has not been ruled out. Interactions with ACE2 receptor – Angiotensin-converting enzyme 2 (ACE2) receptors are

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Lisbeth Harder Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
Center of Brain, Behavior and Metabolism (CBBM)/Medizinische Klinik I, University of Lübeck, Lübeck, Germany

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Nancy Schanze Institute for Experimental Endocrinology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Assel Sarsenbayeva Institute for Experimental Endocrinology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Franziska Kugel Institute for Experimental Endocrinology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Josef Köhrle Institute for Experimental Endocrinology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Lutz Schomburg Institute for Experimental Endocrinology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Jens Mittag Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
Center of Brain, Behavior and Metabolism (CBBM)/Medizinische Klinik I, University of Lübeck, Lübeck, Germany

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Carolin S. Hoefig Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
Institute for Experimental Endocrinology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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) and excluded. Statistical testing was performed using a multiple t test and controlled with the Sidak-Bonferroni correction for multiple comparisons for each tissue. For pulmonary angiotensin-1-converting enzyme ( Ace ) an unpaired, nonparametric, 2

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Ilaria Muller Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Department of Clinical Sciences and Community Health, University of Milan, Italy

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Anita Daturi Department of Clinical Sciences and Community Health, University of Milan, Italy

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Matteo Varallo Department of Clinical Sciences and Community Health, University of Milan, Italy

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Tiziana E Re Internal Medicine - High Intensity of Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

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Davide Dazzi Casa di Cura Val Parma SRL, Langhirano (Parmigiano: Langhiràn), Italy

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Sara Maioli Department of Clinical Sciences and Community Health, University of Milan, Italy

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Erica Crivicich Department of Clinical Sciences and Community Health, University of Milan, Italy

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Francesco Di Marco Department of Clinical Sciences and Community Health, University of Milan, Italy

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Virgilio Longari Nuclear Medicine Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

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Beatrice Dazzi Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

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Massimo Castellani Nuclear Medicine Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

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Giovanna Mantovani Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Department of Clinical Sciences and Community Health, University of Milan, Italy

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Maura Arosio Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Department of Clinical Sciences and Community Health, University of Milan, Italy

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Mario Salvi Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

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-converting enzyme 2 (ACE2) is the entry receptor used by SARS-CoV-2 to infect the host cell ( 3 , 4 ). Both ACE2 and the transmembrane protease serine 2 (TMPRSS2), necessary for SARS-CoV-2 internalisation and activation, are highly expressed in the thyroid tissue

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Fabyan Esberard de Lima Beltrão Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
University Center of João Pessoa – UNIPE, João Pessoa, PB, Brazil

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Daniele Carvalhal de Almeida Beltrão University Center of João Pessoa – UNIPE, João Pessoa, PB, Brazil
Post-Graduation Program in Cognitive Neuroscience and Behavior, Psychology Department of the Center of Human Sciences, Federal University of Paraíba, João Pessoa, Paraíba, Brazil

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Giulia Carvalhal Center for Biological and Health Sciences, Federal University of Campina Grande, Campina Grande, Paraíba, Brazil

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Fabyanna Lethicia de Lima Beltrão Post-Graduate Program in Medicine and Health, Medical School of Medicine, Federal University of Bahia, Salvador, Brazil

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Jocyel de Brito Oliveira Bioregulation Department, Health and Science Institut, Federal University of Bahia, Salvador, Bahia, Brazil

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Hatilla dos Santos Silva Bioregulation Department, Health and Science Institut, Federal University of Bahia, Salvador, Bahia, Brazil

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Helena Mariana Pitangueira Teixeira Bioregulation Department, Health and Science Institut, Federal University of Bahia, Salvador, Bahia, Brazil

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Juliana Lopes Rodrigues Laboratory of Immunopharmacology and Molecular Biology, Health Sciences Institute, Federal University of Bahia, Brazil

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Camila Alexandrina Viana de Figueiredo Laboratory of Immunopharmacology and Molecular Biology, Health Sciences Institute, Federal University of Bahia, Brazil

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Ryan dos Santos Costa Laboratory of Immunopharmacology and Molecular Biology, Health Sciences Institute, Federal University of Bahia, Brazil

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Fabio Hecht The Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

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Giciane Carvalho Vieira Post-Graduation Program in Cognitive Neuroscience and Behavior, Psychology Department of the Center of Human Sciences, Federal University of Paraíba, João Pessoa, Paraíba, Brazil

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Maria da Conceição Rodrigues Gonçalves Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil

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Antonio C. Bianco Section of Endocrinology and Metabolism, Division of the Biological Sciences, University of Chicago, Chicago, Illinois, USA

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Helton Estrela Ramos Post-Graduate Program in Medicine and Health, Medical School of Medicine, Federal University of Bahia, Salvador, Brazil
Postgraduate Program in Interactive Processes of Organs and Systems, Health & Science Institute, Federal University of Bahia, Salvador, BA, Brazil

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-CoV-2). To infect the cells, the virus relies on a structural protein (Spike) that recognizes the angiotensin-converting enzyme 2 (ACE2) cell receptor ( 1 , 2 ), which is expressed in a wide range of tissues, including the thyroid gland ( 3 , 4

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X Y Hu Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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J Wu Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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P Seal EFW Radiology, Calgary, Alberta, Canada

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S A Ghaznavi Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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C Symonds Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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S Kinnear Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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R Paschke Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Departments of Medicine, Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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TUS malignancy risk assessment should be performed ( 2 , 3 ). Currently, there are multiple guidelines for the malignancy risk stratification of thyroid nodules based on TUS features, which include: the 2015 American Thyroid Association (ATA

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Sara De Vincentis Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy

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Simona Loiacono Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy

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Eleonora Zanni Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy

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Roberta Sueri Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy

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Maria Laura Monzani Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy

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Daniele Santi Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy

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Ilaria Muller Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Department of Endocrinology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

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Francesco Di Marco School of Specialisation in Endocrinology, University of Milan, Milan, Italy

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Erica Crivicich School of Specialisation in Endocrinology, University of Milan, Milan, Italy

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Mirco Armenti School of Specialisation in Endocrinology, University of Milan, Milan, Italy

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Uberto Pagotto Department of Medical and Surgical Sciences, Alma Mater Studiorum - Bologna University, Bologna, Italy
Department of Endocrinology and Diabetes Care and Prevention Unit, IRCCS Sant’Orsola-Malpighi Polyclinic, Bologna, Italy

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Lorenzo Tucci Department of Medical and Surgical Sciences, Alma Mater Studiorum - Bologna University, Bologna, Italy
Department of Endocrinology and Diabetes Care and Prevention Unit, IRCCS Sant’Orsola-Malpighi Polyclinic, Bologna, Italy

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Carolina Cecchetti Department of Medical and Surgical Sciences, Alma Mater Studiorum - Bologna University, Bologna, Italy
Department of Endocrinology and Diabetes Care and Prevention Unit, IRCCS Sant’Orsola-Malpighi Polyclinic, Bologna, Italy

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Tommaso Trenti Department of Laboratory Medicine and Anatomy Pathology, Azienda USL Modena, Modena, Italy

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Valentina Pecoraro Department of Laboratory Medicine and Anatomy Pathology, Azienda USL Modena, Modena, Italy

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Giulia Canu Department of Laboratory Medicine and Anatomy Pathology, Azienda USL Modena, Modena, Italy

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Manuela Simoni Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy

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Giulia Brigante Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy

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viral damage because of the expression of the angiotensin-converting enzyme 2 (ACE2) on thyroid follicular cells, and its receptor being used by SARS-CoV-2 to invade the cells ( 14 ). Another possible mechanism is molecular mimicry, where antibodies

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J L Reverter Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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L Ferrer-Estopiñan Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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F Vázquez Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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S Ballesta Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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S Batule Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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A Perez-Montes de Oca Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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C Puig-Jové Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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M Puig-Domingo Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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nodules has enhanced the need for endocrinologists to be able to define the risk of malignancy as accurately as possible ( 2 ). Ultrasound (US) is the first-line method to identify malignant thyroid nodules with the advantages of accessibility, cost

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