Development of Graves' Disease After SARS-CoV-2 mRNA Vaccination: A Case Report and Literature Review

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.

Relapsed and newly diagnosed Graves’ disease due to immunization against COVID-19: A case series and review of the literature

“…The COVID-19 vaccine-associated GD cases published until the end of December 2021 and the current cases were summarized in Table 1 . It was identified that 13 GD cases associated with the COVID-19 vaccine have been reported [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ]. Eight (61.5%) of these cases were women, and the median age at diagnosis was 40 (range, 28–71) years.…”

“…From this point of view, the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-associated autoimmune thyroid diseases (AITD) can be expected. Indeed, some cases of GD and other AITD have been reported following SARS-CoV-2 infection and its immunization [ [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ]. When considering the pre-COVID-19 period, in a case report published after the H1N1 pandemic, two newly-diagnosed autoimmune diseases (GD and narcolepsy type 1) had been detected following H1N1 vaccination in a 40-year-old female patient [ 14 ].…”

COVID-19 vaccine and autoimmunity. A new case of autoimmune hepatitis and review of the literature

“…It has been suggested that portal infiltration with eosinophils correlates with drug-induced liver injury, including vaccines (i.e., Moderna mRNA-1273 and AstraZeneca ChAdOx1 nCoV-19 vaccines) [ 8 , 27 , 28 ]. This could partially explain the existence of hepatitis following vaccination without positivity for liver-associated autoantibodies ( Table 1 ) [ 8 , 10 , 12 , 13 , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] ].…”

Thyrotoxicosis following SARS-COV-2 vaccination: a case series and discussion

“…Second, the exposure to vaccine adjuvants used as immunogenicity enhancing agents of the vaccine formulation [ 19 , 20 ] has been proposed to be capable of inducing diverse immune reactions [ 16 , 21 , 22 ]. This leads to the so-called Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA).…”

“…These two patients’ diagnoses were Graves’s disease. Literature review concerning cases reports in different countries regarding thyroid dysfunction after SARS-CoV-2 vaccination has shown a maximum time of onset after vaccination of 56 days [ 21 ]. In contrast and as it has recently been described [ 10 ], subacute thyroiditis triggered not by COVID-19 vaccination but by COVID-19 infection, seemed to take place 2–3 weeks after viral infection, and classic subacute thyroiditis (postviral) usually occurs within 2–8 weeks following viral infection [ 16 ].…”