Graves’ orbitopathy post-SARS-CoV-2 vaccines: report on six patients

Abstract

Context Autoimmune and inflammatory thyroid diseases (Graves’ disease, subacute thyroiditis, chronic autoimmune thyroiditis) have been reported following SARS-CoV-2 vaccines but Graves’ orbitopathy (GO) post-COVID-19 vaccination is uncommon. Methods We describe six new patients seen in Endocrinology Departments with Outpatient Clinics for GO following SARS-CoV-2 vaccines in France. Results After COVID-19 vaccination, GO was observed in six patients (three men, three women, mean age 53 ± 6 years) with a personal past history of Graves’ disease (5/6) or orbitopathy (4/6). New-onset ( n = 2) or recurrence ( n = 4) of GO was observed following mRNA vaccines after the first (3/6) or second (3/6) dose, with the mean time from vaccination to GO at 23.8 ± 10.4 days. In one patient, thyrotoxicosis was confirmed by increased free T4 and low TSH concentrations while others had normal TSH levels, during chronic levothyroxine treatment in three patients. Four patients had significant anti-TSH receptor antibodies levels. According to the severity and activity of GO, the patients were treated using selenium ( n = 2), intravenous glucocorticoids ( n = 2), teprotumumab ( n = 1), tocilizumab ( n = 2) and orbital decompression ( n = 1) with a significant improvement in GO signs and symptoms observed by most patients. Conclusion In this study, we report the main data from six new patients with GO following SARS-CoV-2 vaccines. Clinicians need to be aware of the risk of new-onset or recurrent GO in predisposed patients with autoimmune thyroid diseases after COVID-19 vaccination. This study should not raise any concerns regarding SARS-CoV-2 vaccination since the risk of COVID-19 undoubtedly outweighs the incidence of uncommon GO after SARS-CoV-2 vaccination.

New-onset Thyroid Eye Disease after COVID-19 Vaccination in a Radioactive Iodine-Treated Graves’ Disease Patient: A Case Report and Literature Review

“…where the T lymphocytes are excessively sensitized to the TSH receptor thereby causing GD or TED. 20 It is also possible that epigenetic changes or alterations in the patient's microbiome, such as those demonstrated following mRNA SARS-CoV-2 vaccination, may play a role in TED pathogenesis. 19 Lastly, Sriwijitalai and Wiwanitkit suggested that vaccination-induced increase in blood viscosity is another possible pathophysiological process.…”

“…To date, there have been 16 cases of reactivation or newonset TED after SARS-CoV-2 vaccination reported. 10,[15][16][17][18][19][20] A summary table (Table 1) is presented comparing the patient characteristics, clinical presentation and treatments of other similar post-vaccination TED patients together with the index patient of this report.…”

“…teprotumumab, including patients with the sightthreatening disease. 19,20 Three cases were given oral prednisolone, MTP and a combination of MTP and tocilizumab with a limited response, but symptoms improved favorably after teprotumumab treatment. 18,19 While teprotumumab has been proven effective in TED treatment, its use is restricted by cost and availability, and long-term efficacy and safety data are still lacking.…”

Thyroid Inflammation and Immunity During the COVID-19 Pandemic: A Comprehensive Review and Case Study

“…patients (mean age of 53 years) with GO following vaccination [16]. All of these had a previous history of immune thyroid disease.…”

“…Four patients had elevated TSH-R-Ab levels. Treatment varied based on the severity and activity of GO, including selenium, intravenous glucocorticoids, teprotumumab, tocilizumab, and orbital decompression, resulting in significant improvement in GO signs and symptoms [16].…”