Subacute thyroiditis with liver dysfunction following coronavirus disease 2019 (COVID-19) vaccination: report of two cases and a literature review

Abstract

Subacute thyroiditis is a transient inflammatory thyroid disease characterized by neck pain, fever, and typical symptoms associated with thyrotoxicosis. The incidence of subacute thyroiditis is higher in female than in male, and susceptibility is prominent in the 30-50-year age range. The variety of case reports on subacute thyroiditis associated with coronavirus disease 2019 (COVID-19) appears to be increasing, and subacute thyroiditis following COVID-19 vaccination has recently been reported. Herein, we report two cases of subacute thyroiditis that developed after receiving the COVID-19 mRNA vaccine, one of which exhibited remarkable liver dysfunction. The mechanism underlying the development of postvaccination subacute thyroiditis remains unknown; however, one theory suggests that adjuvants contained in vaccines may play a role in triggering diverse autoimmune and inflammatory responses. Another possibility is the potential cross-reactivity between the coronavirus spike protein target produced by the mRNA vaccine and thyroid cell antigens. Common side effects of the COVID-19 vaccine include pain at the injection site, fever, fatigue, headache, muscle pain, chills, and nausea. These symptoms are usually resolved within a few days. Subacute thyroiditis may present symptoms similar to those of short-term vaccination side effects or exhibit non-specific symptoms, potentially leading to misdiagnosis or underdiagnosis. Therefore, clinicians should be aware of the possible development of subacute thyroiditis after COVID-19 vaccination.

New-onset and relapsed liver diseases following COVID-19 vaccination: a systematic review

“…Raised liver enzymes (RLEs) was the third most-common disease (twenty-six cases) reported following COVID-19 vaccination from our review (twenty-four new onset cases [9-11, 23, 25-28, 32, 33, 36, 38-40, 46, 70, 77, 79, 83, 94, 114, 121] and two relapsed cases [89,93]) (see Table 1). Most common clinical presentations in those cases who presented with RLEs post-COVID-19 vaccination were fever (n = 11) [9,10,25,28,38,70,77,79,83,114,121], rash (n = 8) [25,32,38,39,79,83,89,94], oedema (n = 8) [25,32,40,79,83,89], weakness (n = 6) [26,28,46,77,79,83,89], fatigue (n = 5) [9,[25][26][27]83], shortness of breath (n = 5) [26,77,78,83,89]…”

“…Most common clinical presentations in those cases who presented with RLEs post-COVID-19 vaccination were fever (n = 11) [9,10,25,28,38,70,77,79,83,114,121], rash (n = 8) [25,32,38,39,79,83,89,94], oedema (n = 8) [25,32,40,79,83,89], weakness (n = 6) [26,28,46,77,79,83,89], fatigue (n = 5) [9,[25][26][27]83], shortness of breath (n = 5) [26,77,78,83,89], vomiting (n = 5) [9,11,39,77,89], abdominal pain (n = 5) [39,46,…”

“…The median (IQR) time between the COVID-19 vaccination and time of presentation was 7 (4.5-11.5) days. Eleven, nine, and four of these twenty-five cases were reported following Pfizer-BioNTech (five after the first dose and six after the second dose) [9, 10, 25, 27, 28, 38-40, 79, 83, 93], Oxford Uni-AstraZeneca (eight after the first dose and one after the second dose) [23,32,33,36,46,77,114], and Moderna (four after the first dose) [26,70,89,94] vaccination; respectively. Only two cases presented with RLEs were reported after Johnson & Johnson COVID-19 vaccination [11,121].…”

“…Six of the patients who presented with RLEs had hypertension [11,27,33,38,83,89] and nine patients had no medical history (n = 9, 34.1%) [9,10,26,28,32,39,40,46,121], however, few of those cases presented with a previous known history of hepatic diseases [chronic hepatitis B (n = 1) [83], alcohol-associated liver disease (n = 1) [70], chronic liver disease (n = 1) [36], portal hypertension (n = 1) [36], hepatitis C infection (n = 1) [89], and compensated alcoholic liver cirrhosis (n = 1) [25]]. Radiological imaging was unremarkable for a high number of the cases who presented with RLEs (n = 10, 40%) [11,23,25,28,38,77,79,83,93,94] or not performed (n = 3, 12%) [10,27,36], nevertheless, few cases shown fatty liver and gallbladder polyps (n = 1) [70], liver cirrhosis (n = 1) [89], and abruptly collapsed hepatic veins (n = 1) [40]. Liver biopsy revealed histopathological findings consistent with leukocytoclastic vasculitis (n = 1) [36], drug reaction with eosinophilia (n = 1) [32], giant cell arteritis (n = 1) [23], plasmacytoid dendritic cells (n = 1)…”

“…Patients who suffered RLEs post-COVID-19 vaccination were more likely to have high C-reactive protein (n = 14) [10,11,23,25,32,33,36,38,70,89,114,121], thrombocytopenia (n = 13) [10,11,27,33,39,83,89,93,94,114,121], high lactate dehydrogenase (n = 11) [10,11,26,27,33,36,39,46,83,89,93], raised bilirubin (n = 10) [10,11,26,27,38,39,79,83,89,114], low haemoglobin (n = 7) [11,27,33,38,39,…”