SARS-CoV-2 vaccine may trigger thyroid autoimmunity: real-life experience and review of the literature

Abstract

Purpose SARS-CoV-2 infection can be associated with destructive thyroiditis and triggers thyroid autoimmunity. More recent evidence suggests that SARS-CoV-2 vaccines may also be associated with permanent or transient thyroid dysfunction in susceptible individuals. Methods We observed three patients who developed/exacerbated autoimmune thyroid diseases (AITDs) shortly after receiving mRNA-based vaccines against SARS-CoV2. Clinical histories are reported, and relevant literature in the field is summarized. Results Our case series gives a description of the full spectrum of autoimmune disorders that may occur after SARS-CoV-2 vaccines administration, ranging from a case of new-onset Graves’ disease to autoimmune hypothyroidism in two patients with pre-existing AITDs. Our three patients had a personal and/or family history of autoimmune disorders, suggesting that genetic predisposition is an important risk factor for the development of AITDs following vaccination. Moreover, our real-life experience demonstrates that persistent hypothyroidism may occur in the long run and should be overlooked; subjects with a previous AITDs are at risk of developing it. Reviewing the pertinent literature up to date Graves’ disease is the most common vaccine-related AITDs with up to 51 cases reported in the literature, occurring mainly in female patients with no personal history of AIDTs, while only a case of autoimmune hypothyroidism has been reported so far. Conclusions SARS-CoV-2 vaccines can trigger autoimmune reactions and the present case series contributes to make clinicians aware of full spectrum of AITDs that may occur following vaccination. Thyroid function monitoring is recommended, mainly in subjects with a personal/family history of AITDs.

Increased incidence of Graves' disease during the SARS‐CoV2 pandemic

“…The possible interrelationship of vaccines developed for SARS‐COV‐2 and the activation of the autoimmune system has been highlighted in recent months. 24 The most widely accepted theory is the “adjuvant‐induced autoimmune/inflammatory syndrome” (AISIS); for example, aluminum salts are the adjuvant in the Ad26‐CoV‐2 from Johnson and Johnson vaccine, Pfizer‐BioNTech's BNT162b2 vaccine contains lipid nanoparticles to facilitate the transport of mRNA into the host cell and two of them contain polyethylene glycol (PEG) extracts that can trigger an exaggerated immune response. In addition to AISIS (also known as ASIA syndrome), other possible explanations for GD being triggered by SARS‐CoV‐2 vaccinations include molecular mimicry of the spike protein with endogenous thyroid antigens, or a toxic activity of the spike protein due to the interaction with ACE‐II, which is highly expressed in the thyroid gland, triggering inflammation and then autoimmunity.…”

COVID-19 and thyroid function: What do we know so far?

“…Currently, more than 30 articles reporting data of SAT onset after COVID-19 vaccine. This relation seems more prevalent in women and the main symptoms are neck pain, palpitations, fatigue, fever and weight loss ( 148 , 149 ). The patients almost always presented with thyrotoxicosis and elevated serum inflammatory markers ( 148 , 150 ).…”

Potential Conscientious Objection to mRNA Technology as Preventive Treatment for COVID-19

“…The cellular autoimmune mechanisms described above have translated into the occurrence of clinical postvaccination syndromes, including thrombotic thrombocytopenia, thrombocytopenic purpura, hepatitis, cholangitis, IgA nephropathy, polyarthritis, rheumatoid arthritis, and thyroid disease. (Klomjit et al, 2021;Chen et al, 2022, Ruggeri et al, 2022. Last, but not least, myocarditis has been recognized by the manufacturers as an adverse event, with an incidence that varies depending on the cohort analyzed, but that may reach 4 to 28 excess events per 100 000 vaccine doses in young males (Østein et al, 2022).…”

“…Unwarranted hope had been placed on pandemic control through distribution of the so-called "vaccines" to a majority of the world population, without individual risk-benefit assessment. While some traditional vaccines were produced on the basis of traditional technology using inactivated virus (Sinovac Biotech CoronaVac or Bharat Biotech BBV152), other injectable formulations were based on viral vectors (Vaxzevria ChAdOx1, AstraZeneca, Janssen or Cansino Biotech; see Ruggeri et al, 2022) or experimental genetic products based on messenger RNA (mRNA) as developed in 2020 by Pfizer-BioNTech (Comirnaty) and ModernaTherapeutics (Spikevax; see Dolgin, 2021).…”