Evaluation of the diagnostic features and clinical course of COVID-19 vaccine–associated subacute thyroiditis

Abstract

Objective This study aimed to identify cases of coronavirus disease 2019 (COVID-19) vaccine-associated subacute thyroiditis (SAT) during the active vaccination period of the pandemic, analyze the characteristics of these cases, and compare them with cases of non-vaccine associated SAT diagnosed in the same period. Methods A total of 55 patients diagnosed with SAT in our outpatient clinic between February and October, 2021, were included in this retrospective single-center study. Results Of the study population, 16 (29.1%) were diagnosed with COVID-19 vaccine-associated SAT (10 with CoronaVac® and six with Pfizer-BioNTech® vaccine), with a median time to onset of symptoms after vaccination of 6.5 (range, 2-20) days. There was no statistically significant difference between the vaccine-associated (VA) and non-vaccine associated (NVA) groups in terms of age, gender, time to diagnosis, thyroid volumes, thyroid function tests, and acute phase reactants. Seven (43.8%) and 25 (64.1%) patients were treated with methylprednisolone in the VA group and NVA group, respectively (p = 0.16). Follow-up data of 45 patients (16/16 for VA and 29/39 for NVA) were available. The mean follow-up of these patients was 47.4 ± 19.4 days, and the follow-up periods of the VA group and NVA group were comparable (p = 0.24). There was no difference between the two groups in terms of the frequency of euthyroidism at the follow-up visit (12/16 vs.14/29, p = 0.08). Conclusion With the increase in COVID-19 vaccination rates during the current pandemic, VA SAT cases are seen more frequently. The present study demonstrated that these cases have similar diagnostic features and clinical course to that of classic forms of SAT. In addition, most patients with VA SAT had a mild clinical course that improved with non-steroidal anti-inflammatory drugs.

Impact of the COVID-19 pandemic on the incidence, seasonal distribution, and characteristics of subacute thyroiditis

“…In the current study, 160 SAT cases during the 2-year pandemic period were examined and there was observed to be no increase in the number of newly-diagnosed SAT cases compared to previous years. In the previous study of our clinic, a temporal relationship with the vaccination was observed in 29.1% of SAT cases in the 10-month period following the COVID-19 vaccination in 2021 [16]. The present study showed that there was also no change in the incidence of SAT in the months corresponding to this period (February to October) compared to previous years (Fig.…”

“…The possible relationship between COVID-19 and SAT became one of the hot topics in the Endocrinology community during the pandemic. Some cases of SAT have been reported following COVID-19 infection and its vaccination, including in our clinic [12][13][14][15][16][17]. The high expression of the angiotensin-converting enzyme-2 (ACE2) receptor used by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to enter the cell in thyroid follicular cells suggests that COVID-19 may directly cause inflammation in thyroid cells [19][20][21].…”

“…Considering the possible relationship of SAT with viral pathogens, it can be expected that this pathology may also occur as a late complication of COVID-19. There are reports in the literature of SAT cases developing post-COVID-19 infection and even after COVID-19 vaccines [12][13][14][15][16][17]. These reported cases also raise the question of whether there has been an increase in the incidence of SAT and/or a variation in its character during the pandemic.…”

Endocrine system after 2 years of COVID-19 vaccines: A narrative review of the literature

“…Bostan et al. ( 16 ) retrospectively examined 55 patients diagnosed with SAT, of whom 16 had previously undergone COVID-19 vaccine, with a median of 6.5 days before SAT development. They found no differences concerning the characteristics of vaccine.…”

Note by Hormones’ new editor: metabolic syndrome plus obesity and COVID-19, the two concurrent pandemics and the field of endocrinology

“…Crucially, the disease caused by SARS-CoV-2, which was dubbed coronavirus disease 2019 (COVID-19), disproportionately affects persons with preexisting conditions, among them obesity, diabetes, and hypertension, which are endocrine-related disorders [1]. Since the outbreak of the pandemic, Hormones has continued to publish extensively on both COVID-19 and the vaccines developed to help fight the pandemic, as well as on their after-effects, as this issue illustrates [2][3][4]. Our intention is to attract more articles on long COVID while reporting further data concerning possible effects of the vaccines and information on their endocrinecorrelates.…”