Thyroid

Fifth documented case of Graves’ disease linked to COVID-19 vaccine

Fifth documented case of Graves' disease linked to COVID-19 vaccine

According to a report published in Frontiers in public health.

Researchers from the University of Hong Kong have reported a case of Graves’ disease that occurred in a patient after vaccination against COVID-19. The case prompted them to search the medical literature through August 2021 for other cases potentially linking COVID-19 vaccination to the development of Graves’ disease.

The case they reported involved a 40-year-old Chinese woman who had no personal or family history of thyroid disorders until the patient presented in September 2013 (then 32 years old) with cold intolerance and lethargy. A thyroid function test indicated subclinical hypothyroidism with a thyroid-stimulating hormone concentration of 5.30 mIU/L and free thyroxine of 13.9 pmol/L. The patient was negative for antithyroid peroxidase and antithyroglobulin.


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The patient received an intermediate dose of 50 mcg of thyroxine per day 5 days per week and 100 mcg 2 days per week. The patient remained clinically euthyroid until July 2020.

The now 40-year-old patient received her first and second doses of the BNT162b2 mRNA vaccine in April 2021 and May 2021, respectively.

On June 8, 2021, the patient presented with palpitations and sinus tachycardia. Thyroid stimulating hormone (TSH) concentration was <0.02 mIU/L, free thyroxine was 66.6 pmol/L, and free triiodothyronine was 30.50 pmol/L. A physical examination identified moderate diffuse goiter and thyroid noise. The patient also tested positive for antithyroid peroxidase and antithyroglobulin.

A thyroid ultrasound suggested diffuse thyroid disease and a thyroid technetium scan showed typical Graves’ disease. Thyroid function improved after thyroxine replacement was discontinued and the patient received carbimazole and propranolol.

The study authors found 4 previous reports of Graves’ disease following COVID-19 vaccination during a subsequent literature review. All patients received a COVID-19 mRNA vaccine. The 4 patients (1 man, 3 women) were between 28 and 71 years old. Two reports came from Mexico and 2 from Austria. The researchers also discovered 9 cases of subacute thyroiditis following vaccination with different types of COVID-19 vaccines.

The BNT162b2 mRNA COVID-19 vaccine, the study authors noted, contains 4 lipids; 2 are polyethylene glycol (PEG), “which may act as an adjuvant and induce an immune response in susceptible individuals, as there are rare reports of reactions to PEGs.”

Graves’ disease can occur after [COVID-19] vaccination,” the study authors concluded. “Our case represents the fifth in the Graves’ disease literature after [COVID-19] vaccination, with an unusual presentation on a long history of hypothyroidism. They suggest that clinicians should “remain vigilant” about the potential manifestation of Graves’ disease in the current COVID-19 pandemic. »

Reference

Lui DTW, Lee KK, Lee CH, Lee ACH, Hung IFN, Tan KCB. Development of Graves’ disease after vaccination with SARS-CoV-2 mRNA: about a case and review of the literature. Public Health Front. 2021;9:778964. doi:10.3389/fpubh.2021.778964