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1.
Front Endocrinol (Lausanne) ; 13: 835880, 2022.
Article in English | MEDLINE | ID: covidwho-1952295

ABSTRACT

Background: The ongoing coronavirus disease 2019 (COVID-19) pandemic has forced the development of vaccines. Reports have suggested that vaccines play a role in inducing autoimmune diseases (AIDs). Scattered cases have reported that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines may promote thyroid disease, including Graves' disease (GD). However, the effect of inactivated SARS-CoV-2 vaccine on GD remains unclear. The aim of the present study was to investigate the response of thyrotropin receptor antibody (TRAB) to inactivated SARS-COV-2 vaccines. Methods: We conducted a retrospective study to observe the differences in thyroid function and TRAB trends between pre-vaccination (n=412) and post-vaccination (n=231) groups at an interval of 2 months. We then retrospectively observed the differences in serum thyroid function and TRAB levels at 3 months before (n=280), 1 month before (n=294), 1 month after (n=306), and 3 months after (n=250) vaccination. Subsequently, 173 GD patients who were not vaccinated with inactivated SARS-COV-2 vaccines were selected for a prospective study. Thyroid function and TRAB assessment were performed before 3 and 1 months and 1 and 3 months after the first dose of vaccination and were then compared by repeated measures ANOVA to explore their dynamic changes. Results: A retrospective study preliminarily observed that the trend of TRAB post-vaccination was opposite of that pre-vaccination (p=0.000), serum TRAB levels decreased before vaccination and increased after vaccination. In this prospective study, repeated measures ANOVA indicated significant differences in serum FT3 (p=0.000), FT4 (p=0.000), TSH (p=0.000), and TRAB (p=0.000) levels at different time points before and after vaccination. Serum TRAB levels showed dynamic changes that decreased significantly at 1 month before vaccination (p=0.000), no significant differences at 1 month after vaccination (p=0.583), and reflected an upward trend at 3 months after vaccination (p=0.034). Serum FT3 and FT4 levels showed similar trends to serum TRAB levels before and after vaccination. Instead, the serum TSH levels showed a continuous upward trend over time. Conclusion: Based on the results obtained in both retrospective and prospective studies, we concluded that serum TRAB levels decreased less after inactivated SARS-CoV-2 vaccination and showed an upward trend, which may be related to humoral immunity induced by vaccination.


Subject(s)
COVID-19 , Graves Disease , Viral Vaccines , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Humans , Immunoglobulins, Thyroid-Stimulating , Prospective Studies , Retrospective Studies , SARS-CoV-2 , Thyrotropin
2.
Front Endocrinol (Lausanne) ; 13: 900964, 2022.
Article in English | MEDLINE | ID: covidwho-1933632

ABSTRACT

After the beginning of COVID-19 vaccination campaigns, several reports of thyroid disease possibly related to the COVID-19 vaccination progressively appeared in the literature, raising the question of whether the thyroid disorder might be a SARS-CoV-2 vaccine complication. The aim of this study was to analyze the data about COVID-19 vaccination and thyroid disease, evaluate the size and quality of related literature, assess the type of these events, and investigate their timing of onset with respect the vaccination. Pubmed/MEDLINE and Cochrane were systematically reviewed until February 2022 to retrieve the largest number of original papers, case reports, and case series articles reporting thyroid disease after SARS-CoV-2 vaccination. Forty-six articles were included with a total of 99 patients aged from 26 to 73 years were described, of whom 74.75% female. Regarding the vaccination received, 49.49% of patients received Comirnaty (Pfizer/BioNTech), 14.14% CoronaVac (Sinovac), 12.12% Vaxzevria (Oxford/Astrazeneca), 11.11% Spikevax (Moderna), 3.03% Ad26.COV2.S (Janssen, Johnson & Johnson), one patient Covaxin (Bharat Biotech) and one patient Convidecia (Cansino). In 7 cases the thyroid disorder developed after the third dose with a combination of different vaccines. Regarding the type of thyroid disorder, 59 were subacute thyroiditis (SAT), 29 Graves' disease (GD), 2 co-occurrence of SAT and GD, 6 painless thyroiditis (PT), and single cases of thyroid eye disease and hypothyroidism associated with mixedema. The timeline between vaccination and thyroid disorder ranged between 0.5 to 60 days, with an average of 10.96 days. Considering the limited follow-up time, a complete remission was reported in most of SAT and PT cases while a persistence was observed in GD. In conclusion, both size and quality of published data about thyroid inconveniences after COVID-19 vaccination are limited; thyroid disorders may occur within 2 months after COVID-19 vaccination; among all thyroid diseases after COVID-19 vaccination, GD and SAT seem to be more frequent.


Subject(s)
COVID-19 Vaccines , COVID-19 , Thyroid Diseases , Adult , Aged , Autoimmune Diseases , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Graves Disease , Humans , Male , Middle Aged , SARS-CoV-2 , Thyroid Diseases/chemically induced , Thyroid Diseases/epidemiology , Thyroiditis, Subacute , Vaccination/adverse effects
3.
Intern Med ; 61(10): 1561-1565, 2022.
Article in English | MEDLINE | ID: covidwho-1847021

ABSTRACT

Although there is a great demand for increased coronavirus disease 2019 (COVID-19) vaccination worldwide, rare side effects of the vaccine in susceptible individuals are attracting attention. We recently treated a patient with type 1 diabetes who had HLA-A*240201/A*020101, B*5401/B*5601, DRB1*0405/DRB1*0405, DPB1*0501/DPB1*0501 and DQB1*0401/DQB1*040 and developed Graves' disease soon after the administration of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. While causal relationships between vaccinations and adverse events are difficult to discern due to both confounding and masking factors, our findings suggest that attention to possible adjuvant-related endocrinological diseases in certain individuals receiving SARS-CoV-2 vaccines is appropriate.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Graves Disease , COVID-19 Vaccines/adverse effects , Diabetes Mellitus, Type 1/complications , Humans , SARS-CoV-2 , Vaccination/adverse effects
5.
Eur Rev Med Pharmacol Sci ; 26(7): 2627-2630, 2022 04.
Article in English | MEDLINE | ID: covidwho-1811984

ABSTRACT

The COVID-19 virus has been responsible for the development of several systemic diseases. Recently, the COVID-19 vaccine has also been incriminated in the development of autoimmune diseases. Currently, researchers have focused on the relationship between the COVID-19 vaccine and the activation of autoimmune phenomenon. We report a case of Graves' disease (GD) whose symptoms appeared 3 days after vaccination against COVID-19. A forty-three-year-old female, without pathological history, presented with diarrhea and palpitation. She received her first SARS-CoV-2 Vaccine dose (Pfizer-BioNTech), in August 2021. Three days after the vaccine, she felt palpitations, sleep disorders, muscle weakness, and heat intolerance. On examination, her pulse was 119 beats per minute, she weighed 63 kg, and she had lost 4 kg in only two months. GD was suspected. Thyroid hormone testing showed low thyroid-stimulating hormone, and an elevated serum free thyroxine hormone T4 level. Serology tests were positive for TSH receptor autoantibodies (TRAB). A GD induced by adjuvants of SARS-CoV-2 vaccine has been retained as a final diagnosis. Several autoimmune diseases have been attributed to adjuvant-induced autoimmune/inflammatory syndrome, including systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis, and recently few cases of GD have been explained by this phenomenon.


Subject(s)
COVID-19 , Graves Disease , Adjuvants, Immunologic , Adult , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Graves Disease/diagnosis , Humans , Receptors, Thyrotropin , SARS-CoV-2
6.
Horm Metab Res ; 54(8): 556-561, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1758430

ABSTRACT

Subacute thyroiditis (SAT) is an inflammatory disease of the thyroid that develops following viral upper respiratory tract infections. SARS-CoV-2 virus, the cause of COVID-19, binds to the Angiotensin-Converting Enzyme-2 (ACE2) molecule expressed on the target cell surface. Thyroid gland shows high levels of ACE2 expression. The cases of SARS-CoV-2-related subacute thyroiditis and Graves' disease have been reported. It has recently been noted that vaccines for SARS-CoV-2 also induce autoimmune and inflammatory reactions. We present six (4 male, 2 female) cases of SAT that developed after mRNA and inactivated SARS-CoV-2 vaccines. And we have reviewed the literature. SAT was seen in 5 patients after mRNA vaccine, in one after inactivated vaccine. Their clinic and laboratory findings suggested to SAT. They were treated with nonsteroid anti-inflamatory drugs and/or methylprednisolone.They recovered within few weeks. Out patients did not have permanent hypothyroidism after SAT. The history of SARS-CoV-2 vaccination should be questioned in patients with subacute thyroiditis in pandemic days.


Subject(s)
COVID-19 , Graves Disease , Thyroiditis, Subacute , Angiotensin-Converting Enzyme 2 , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Humans , Male , SARS-CoV-2 , Thyroiditis, Subacute/drug therapy , Thyroiditis, Subacute/etiology , Vaccines, Synthetic , mRNA Vaccines
7.
J Autoimmun ; 128: 102809, 2022 04.
Article in English | MEDLINE | ID: covidwho-1757474

ABSTRACT

In addition to genetic factors, environmental factors such as viruses are thought to be triggers in the development of autoimmune thyroid diseases (AITD) such as Graves' disease (GD). In this context, AITD cases that may be associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or immunization have begun to be reported in increasing numbers. Although it is not clear by which pathogenetic mechanisms immunization against coronavirus disease 2019 (COVID-19) triggers the development of AITD, both the potential effect of the adjuvants in the vaccines and the cross-reactivity that can be generated by the molecular similarity of viral particles with mammalian proteins seem to be possible mechanisms. In this article, 7 GD patients consisting of relapsed and newly diagnosed cases following the COVID-19 vaccination were presented. Of these 7 cases, 5 (71.4%) were female, and the median age of the patients was 47 years (range, 31-53). One of the patients was associated with the inactivated COVID-19 vaccine, while the others were associated with the mRNA COVID-19 vaccine. The median post-vaccination symptom onset was 7 days (range, 4-30). Three of the patients had a history of GD and one had a history of Hashimoto's thyroiditis. Rapidly developing Graves' ophthalmopathy was detected in one patient. These cases are cautionary that GD and its extrathyroidal manifestations may develop in a short period after COVID-19 vaccination. When considered together with the literature review, the history of AITD in approximately half of the patients suggests that more attention should be paid to these patients in the post-vaccination period. Nevertheless, multicenter, prospective studies are needed to better understand this possible causal relationship.


Subject(s)
COVID-19 , Graves Disease , Adult , Animals , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Graves Disease/diagnosis , Graves Disease/etiology , Humans , Mammals , Middle Aged , Multicenter Studies as Topic , SARS-CoV-2 , Vaccination/adverse effects
8.
Travel Med Infect Dis ; 47: 102314, 2022.
Article in English | MEDLINE | ID: covidwho-1747537

ABSTRACT

COVID-19 is a severe acute respiratory syndrome. Recent reports showed that autoimmune thyroiditis might occur following COVID-19 infection. We aimed to review the literature to assess the prevalence, clinical features and outcome of autoimmune thyroid disorders triggered by COVID-19. We reviewed case reports, case series, and observational studies of autoimmune thyroiditis including Graves' disease, Hashimoto thyroiditis, and silent thyroiditis developed in COVID-19 patients by searching PubMed, SCOPUS and Web of Science and included in the systematic review. Our search yielded no prevalence study. We noted 20 reported cases: Fourteen cases of Graves' disease, 5 cases of hypothyroidism due to Hashimoto's thyroiditis and one case of postpartum thyroiditis. The majority (16/20, 80%) were middle-aged (mean age: 40 years) female patients. Autoimmune thyroiditis was diagnosed either concomitantly or 7-90 days after the COVID-19 infection. Eight out of 14 cases with Graves' disease had a known thyroid disorder and they were stable in remission. One out of 5 cases with Hashimoto's thyroiditis had known prior hypothyroidism. The majority of the patients achieved remission within 3 months. One patient with thyroid storm due to Graves' disease and one patient with myxedema coma have died. Current data suggest that COVID-19 may cause autoimmune thyroid disease or exacerbate the underlying thyroid disease in remission. It is reasonable to routinely assess the thyroid functions both in the acute phase and during the convalescence so as not to overlook a thyroid disorder and not to delay treatment especially in patients with preexisting autoimmune thyroid diseases.


Subject(s)
COVID-19 , Graves Disease , Hashimoto Disease , Hypothyroidism , Thyroiditis, Autoimmune , Thyroiditis , Adult , Female , Graves Disease/complications , Graves Disease/diagnosis , Hashimoto Disease/complications , Hashimoto Disease/epidemiology , Humans , Hypothyroidism/complications , Middle Aged , Thyroiditis/complications , Thyroiditis, Autoimmune/complications , Thyroiditis, Autoimmune/epidemiology
9.
J Clin Endocrinol Metab ; 107(6): e2324-e2330, 2022 05 17.
Article in English | MEDLINE | ID: covidwho-1724725

ABSTRACT

CONTEXT AND OBJECTIVE: Thyroid autoimmunity has been reported to be associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the SARS-CoV-2 vaccination recently. We report a series of patients who presented with new onset or relapse of Graves' disease-related hyperthyroidism shortly after receiving the SARS-CoV-2 messenger RNA (mRNA) vaccine at a single tertiary institution in Singapore. METHODS AND RESULTS: We describe 12 patients who developed hyperthyroidism within a relatively short interval (median onset, 17 [range, 5-63] days) after receiving the SARS-CoV-2 mRNA vaccine. The majority were females (11/12) with median age of 35.5 (range, 22-74) years. Six patients had new-onset hyperthyroidism, whereas the other 6 had relapse of previously well-controlled Graves' disease. TSH receptor antibody concentrations ranged from 2.4 to 32 IU/L. The majority of the patients were able to go for the second dose of the vaccine without any further exacerbations. Literature review revealed 21 other similar cases reported from across the world. CONCLUSION: Our case series provides insight into the characteristics of individuals in whom Graves' disease was triggered by the SARS-CoV-2 vaccination. Clinicians need to be vigilant of precipitation or exacerbation of autoimmune thyroid disorders in predisposed individuals after exposure to the SARS-CoV-2 vaccination. Further epidemiological and mechanistic studies are required to elucidate the possible associations between the SARS-CoV-2 vaccines and the development of thyroid autoimmunity.


Subject(s)
COVID-19 Vaccines , COVID-19 , Graves Disease , Adult , Aged , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Graves Disease/chemically induced , Humans , Male , Middle Aged , Recurrence , Vaccination/adverse effects , Vaccines, Synthetic/adverse effects , Young Adult
10.
J Clin Endocrinol Metab ; 107(5): e1823-e1834, 2022 04 19.
Article in English | MEDLINE | ID: covidwho-1724724

ABSTRACT

CONTEXT: The number of reported cases with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine-induced subacute thyroiditis (SAT) and Graves' disease (GD) is growing. However, active debate continues about managing such side effects and the safety of repeat or booster doses of the vaccines in such cases. OBJECTIVES: This study aims to present long-term clinical follow-up of SARS-CoV-2 vaccine-induced SAT or GD cases and provide data regarding the safety of revaccinations. METHODS: Patients diagnosed with SARS-CoV-2 vaccine-induced SAT or GD were included. Data regarding the long-term clinical follow-up of SARS-CoV-2 vaccine-induced SAT and GD cases and outcomes of repeat or booster SARS-CoV-2 vaccinations were documented. The literature, including cases of SARS-CoV-2 vaccine-induced SAT or GD, was reviewed. RESULTS: Fifteen patients with SARS-CoV-2 vaccine-induced SAT and 4 with GD were included. Pfizer/BioNTech COVID-19 vaccine (BNT162b2) was associated with symptoms in a majority of cases with SAT and all with GD. Median time from vaccination to symptom onset was 7 and 11.5 days, respectively, while 7 and 2 patients required medical treatment in SAT and GD groups, respectively. Remission was documented in 10 SAT patients, with a median time to remission of 11.5 weeks. No exacerbation/recurrence of SAT occurred in 7 of 9 patients who received a repeat vaccination dose, while symptoms of SAT worsened following the second vaccination in 2 cases. None of the patients experienced severe side effects that could be associated with revaccinations. CONCLUSIONS: Revaccinations appear to be safe in patients with SARS-CoV-2 vaccine-induced SAT cases, while more evidence is needed regarding SARS-CoV-2 vaccine-induced GD.


Subject(s)
COVID-19 , Drug-Related Side Effects and Adverse Reactions , Graves Disease , Thyroiditis, Subacute , Thyroiditis , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Follow-Up Studies , Graves Disease/diagnosis , Humans , Immunization, Secondary , SARS-CoV-2 , Thyroiditis, Subacute/chemically induced , Thyroiditis, Subacute/diagnosis
11.
J Int Med Res ; 50(2): 3000605221082898, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1714565

ABSTRACT

In this review, I aim to provide a complete overview of recent advances in knowledge regarding severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2)-induced thyroid dysfunction. I discuss the findings regarding the role of SARS-CoV-2 in the development of thyroid dysfunction, including subacute thyroiditis, Graves' disease, non-thyroidal illness, thyrotoxicosis and Hashimoto's thyroiditis during and subsequent to coronavirus disease 2019 (COVID-19). The thyroid gland and the entire hypothalamic-pituitary-thyroid (HPT) axis may represent key targets of SARS-CoV-2. Thyroid dysfunction during and subsequent to COVID-19 has been documented in clinical studies and is usually reversible. Most of the thyroid disorders, including Graves' disease, euthyroid sick syndrome, Hashimoto's thyroiditis and subacute thyroiditis, have been documented as sequelae to COVID-19, and the SARS-CoV-2 virus has been implicated in the aetiology of each. COVID-19 has been suggested to trigger the activation of pre-existing thyroid disease or autoimmunity. Furthermore, patients with uncontrolled thyrotoxicosis are at risk of SARS-CoV-2 infection-related consequences. Because of the neutropenia caused by antithyroid medications, which may obscure the signs of COVID-19, this group of patients should receive special attention. It is suggested that thyroid dysfunction during COVID-19 is caused by direct infection of the thyroid or "cytokine storm"-mediated autoimmune effects on the thyroid.


Subject(s)
COVID-19 , Graves Disease , Thyroid Diseases , COVID-19/complications , Graves Disease/complications , Humans , SARS-CoV-2 , Thyroid Diseases/complications
12.
Dtsch Med Wochenschr ; 146(20): 1337-1343, 2021 10.
Article in German | MEDLINE | ID: covidwho-1629686

ABSTRACT

DIAGNOSIS: The diagnosis of Graves' disease is mainly based on ultrasonography and laboratory diagnostics. This includes the determination of the TSH value and the peripheral thyroid hormones. TSH receptor antibody (TRAb) measurement is highly sensitive and specific for the detection of Graves' disease (GD) and helps to distinguish from autoimmune thyroiditis (AIT). However, as recent studies show, some may AIT patients may also reveal TRAb. THERAPY: Current guidelines recommend primarily the use of thiamazol/carbimazole in GD. Due to the comparatively higher hepatotoxicity, propylthiouracil is not recommended as first line therapy. In case of relapse during 12 up to 18 months of antithyroid drug therapy or after a frustrating attempt at cessation, definitive therapy should be considered. Alternatively, in accordance with the current recommendations of the European Thyroid Association, drug therapy may be continued for up to 12 months after initial diagnosis. PREGNANCY: The treatment of active GD during pregnancy is problematic due to diaplacental crossing of peripheral thyroid hormones, TSH receptor stimulating antibodies and antithyroid drugs. According to current guidelines, PTU is recommended during the first 16 weeks of pregnancy, whereas for the 2nd and 3 rd trimester no special recommendations are given. After that, you can choose which antithyroid drug might be used. The aim of antithyroid drug therapy during pregnancy is to achieve a suppressed TSH value together with normal or slightly increased fT4 while using lowest effective dose of antithyroid drug. IMMUNE CHECKPOINT INHIBITORS (ICI): The most common endocrine side effect with this therapy is thyroid dysfunction. Hyperthyroidism; occur most frequently in combination therapy (CTLA-4 / anti-PD-1 therapy) ICI mainly causes destructive thyroiditis with lymphocytic infiltration; GD is absolutely rare in this context and only few cases are described.


Subject(s)
COVID-19/complications , Graves Disease/diagnosis , Graves Disease/therapy , Antithyroid Agents/adverse effects , Antithyroid Agents/therapeutic use , Carbimazole/therapeutic use , Causality , Diagnosis, Differential , Female , Graves Disease/complications , Graves Disease/diagnostic imaging , Humans , Methimazole/therapeutic use , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/drug therapy , Propylthiouracil/adverse effects , Propylthiouracil/therapeutic use , Thyroid Hormones/analysis , Thyrotropin/analysis , Ultrasonography
13.
J Endocrinol Invest ; 45(5): 1071-1077, 2022 May.
Article in English | MEDLINE | ID: covidwho-1616317

ABSTRACT

AIM: To describe a case series of thyrotoxicosis likely triggered by SARS-CoV-2 vaccination and to warn physicians about this potential correlation. To report clinical, laboratory and imaging findings and provide further information that goes in line with the underlying mechanisms. METHODS: Single-center case series based on all the information collected in the hospital medical records, as well as the temporal sequence between the onset of symptoms and COVID-19 vaccination. RESULTS: We report 8 cases with thyrotoxicosis after SARS-CoV-2 vaccination. 4 cases of Graves' disease (GD), 2 cases of subacute painful thyroiditis (SAT), 1 case of concurrent GD and SAT and 1 case of atypical subacute thyroiditis. Five patients received BNT162b2 mRNA vaccine, 3 patients 1273 mRNA vaccine. The onset of symptoms following vaccination ranged from 10 to 14 days in six of eight patients and from 7 to 8 weeks in two patients. CONCLUSIONS: Several hypotheses have been proposed to explain the potential correlation between SARS-CoV-2 vaccination and thyrotoxicosis, including immune system hyper-stimulation, molecular mimicry and Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA). We should pay greater attention to thyroid disorders in patients receiving vaccine against SARS-CoV-2.


Subject(s)
COVID-19 , Graves Disease , Thyroiditis, Subacute , Thyrotoxicosis , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Graves Disease/diagnosis , Humans , SARS-CoV-2 , Thyroiditis, Subacute/diagnosis , Thyroiditis, Subacute/etiology , Thyrotoxicosis/diagnosis , Thyrotoxicosis/etiology , Vaccination/adverse effects , Vaccines, Synthetic , mRNA Vaccines
16.
BMJ Case Rep ; 14(12)2021 Dec 30.
Article in English | MEDLINE | ID: covidwho-1593626

ABSTRACT

The SARS-CoV-2 vaccines have had an overwhelming success in curbing the COVID-19 global pandemic, accounting for countless lives saved. Adverse reactions are inevitable, given the vast scale of vaccination required to mitigate future surges of COVID-19. Hyperthyroid disorders have been reported as potential adverse reactions to SARS-CoV-2 vaccines in two patients with Graves' disease and a group of adults with subacute thyroiditis occurring in young women healthcare workers. We report a case of clinical Graves' disease in a woman with a previously stable multinodular goitre that occurred 14 days following her second dose of Pfizer-BioNTech SARS-CoV-2 vaccine.


Subject(s)
COVID-19 , Graves Disease , Adult , COVID-19 Vaccines , Female , Graves Disease/drug therapy , Humans , SARS-CoV-2
17.
J Investig Med High Impact Case Rep ; 9: 23247096211063356, 2021.
Article in English | MEDLINE | ID: covidwho-1582476

ABSTRACT

Widespread vaccination is a principal strategy to mitigate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and lessen the global burden of coronavirus disease 2019 (COVID-19). Information is rapidly evolving about the impact of SARS-CoV-2 vaccines on the immune and endocrine systems. This case series heightens clinical awareness of possible thyroid effects and conveys knowledge of what to monitor, which are fundamental components of public health and pharmacovigilance. We present a case series of Graves disease following mRNA SARS-CoV-2 vaccination, with symptoms and altered thyroid function tests developing within 7 days of the first dose in 2 women aged 38 and 63 years, and 28 days after the second dose in a 30-year-old man. New-onset Graves disease occurred following administration of mRNA vaccines against SARS-CoV-2. Based on the timing of signs and symptoms relative to administration of the vaccine and the absence of other probable causes, we consider the vaccine as a potential contributor to the diagnosis. The viral spike protein, delivered indirectly through an encoded mRNA vaccine, may be capable of triggering an inflammatory cascade and immune response triggering thyroid dysfunction.


Subject(s)
COVID-19 , Graves Disease , Adult , COVID-19 Vaccines , Female , Humans , Male , SARS-CoV-2 , Vaccines, Synthetic
18.
Front Public Health ; 9: 778964, 2021.
Article in English | MEDLINE | ID: covidwho-1566669

ABSTRACT

Background: Mounting evidence has revealed the interrelationship between thyroid and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to explain the thyroid dysfunction and autoimmune thyroid disorders observed after coronavirus disease 2019 (COVID-19). There are limited reports of thyroid dysfunction after SARS-CoV-2 vaccination. Methods: We report a case of a 40-year-old Chinese woman who developed Graves' disease after BNT162b2 mRNA vaccine. A search of PubMed and Embase databases from 1 September 2019 to 31 August 2021 was performed using the following keywords: "COVID," "vaccine," "thyroid," "thyroiditis," and "Graves." Results: A 40-year-old Chinese woman who had 8-year history of hypothyroidism requiring thyroxine replacement. Her anti-thyroid peroxidase and anti-thyroglobulin antibodies were negative at diagnosis. She received her first and second doses of BNT162b2 mRNA vaccine on 6 April and 1 May 2021, respectively. She developed thyrotoxicosis and was diagnosed to have Graves' disease 5 weeks after the second dose of vaccine, with positive thyroid stimulating immunoglobulin level, diffuse goiter with hypervascularity on thyroid ultrasonography and diffusely increased thyroid uptake on technetium thyroid scan. Both anti-thyroid peroxidase and anti-thyroglobulin antibodies became positive. She was treated with carbimazole. Literature search revealed four cases of Graves' disease after SARS-CoV-2 vaccination, all after mRNA vaccines; and nine cases of subacute thyroiditis, after different types of SARS-CoV-2 vaccines. Conclusion: Our case represents the fifth in the literature of Graves' disease after SARS-CoV-2 vaccination, with an unusual presentation on a longstanding history of hypothyroidism. Clinicians should remain vigilant about potential thyroid dysfunction after SARS-CoV-2 vaccination in the current pandemic.


Subject(s)
COVID-19 , Graves Disease , Thyroiditis , Adult , COVID-19 Vaccines , Female , Humans , RNA, Messenger/genetics , SARS-CoV-2 , Tomography, X-Ray Computed , Vaccination/adverse effects , Vaccines, Synthetic
20.
J Investig Med High Impact Case Rep ; 9: 23247096211056497, 2021.
Article in English | MEDLINE | ID: covidwho-1542091

ABSTRACT

Since the start of the COVID-19 pandemic, there have been multiple reports of related thyroid dysfunction, most commonly, thyroiditis. The exact mechanism for this has not been elucidated, but it is known that thyroid gland cells have both angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) receptors, which the SARS-CoV-2 virus uses to enter cells. While SARS-CoV-2 has also been shown to precipitate other autoimmune diseases, there are only a few reported cases of new onset Graves' disease in the setting of SARS-CoV-2 infection. We report 2 patients who presented with severe thyrotoxicosis (thyroid storm and impending storm) that was likely precipitated by SARS-CoV-2 infection. Both patients had no previous history of hyperthyroidism, and potentially also developed Graves' disease after getting COVID-19. The addition of these cases to the medical literature will further highlight the fact that SARS-CoV-2 infection should be considered a causative agent for thyrotoxicosis when no other cause can be found, and that SARS-CoV-2 may be a potential trigger for autoimmune thyroid disease. It is important to know the SARS-CoV-2 status of such patients for infection control purposes, and to identify patients who may have their hospital course complicated by this disease. These cases may also help further our understanding of the etiology of autoimmune thyroid disease following a viral infection.


Subject(s)
COVID-19 , Graves Disease , Thyrotoxicosis , Humans , Pandemics , SARS-CoV-2 , Thyrotoxicosis/etiology
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