Thyroid dysfunction following vaccination with COVID-19 vaccines: a basic review of the preliminary evidence

Abstract

Purpose The safety and efficacy of the several types of COVID-19 vaccines, including mRNA-based, viral vector-based, and inactivated vaccines, have been approved by WHO. The vaccines can confer protection against severe SARS-CoV-2 infection through induction of the anti-spike protein neutralizing antibodies. However, SARS-CoV-2 vaccines have been associated with very rare complications, such as thyroid disorders. This review was conducted to highlight main features of thyroid abnormalities following COVID-19 vaccination. Methods A comprehensive search within electronic databases was performed to collect reports of thyroid disorders after vaccination with COVID-19 vaccines. Results Among 83 reported cases including in this review, the most cases of thyroid abnormalities were observed after vaccination with mRNA-based vaccines (68.7%), followed by viral vector vaccines (15.7%) and 14.5% cases following inactivated vaccines. Subacute thyroiditis (SAT) was the most common COVID-19 vaccination-related thyroid disease, accounting for 60.2% of all cases, followed by Graves' disease (GD) with 25.3%. Moreover, some cases with focal painful thyroiditis (3.6%), silent thyroiditis (3.6%), concurrent GD and SAT (2.4%), thyroid eye disease (1.2%), overt hypothyroidism (1.2%), atypical subacute thyroiditis (1.2%), and painless thyroiditis with TPP (1.2%) were also reported. Overall, in 58.0% of SAT cases and in 61.9% of GD cases, the onset of the symptoms occurred following the first vaccine dose with a median of 10.0 days (ranged: 3–21 days) and 10.0 days (ranged: 1–60 days) after vaccination, respectively. Moreover, 40.0% of SAT patients and 38.1% of GD patients developed the symptoms after the second dose with a median of 10.5 days (ranged: 0.5–37 days) and 14.0 days (ranged: 2–35 days) after vaccination, respectively. Conclusion Fortunately, almost all cases with COVID-19 vaccination-associated thyroid dysfunctions had a favorable outcome following therapy. The benefits of COVID-19 vaccinations in terms of terminating the pandemic and/or reducing mortality rates can exceed any risk of infrequent complications such as a transient thyroid malfunction.

What Should We Do after the COVID-19 Vaccination? Vaccine-Associated Diseases and Precautionary Measures against Adverse Reactions

“…Graves' Disease [88,89], hypophysitis [90], hypothyroidism [88], thyroiditis (painful, silent, and subacute) [88,91], syndrome of inappropriate antidiuresis [92], and Type 1 diabetes mellitus [15] have been reported following COVID-19 vaccination (Table 1). Jafarzadeh et al reported thyroid dysfunction following COVID-19 vaccination [88], and Yamamoto et al reported a case of thyroid storm [14]. Therefore, the evaluation of the thyroid hormones after vaccination is important.…”

“…As COVID-19 mRNA vaccines encode the SARS-CoV-2 spike protein, autoantibodies may be produced due to the cross-reactivity between the SARS-CoV-2 spike protein and thyroid protein. A link between vaccine-induced autoimmunity and the human leukocyte antigen gene has also been suggested [88].…”

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

“…In the effort to face the pandemic, a number of vaccines have been developed with various technologies, including mRNA-based vaccine (Pfizer/BioNTech BNT162b2 or Moderna mRNA-1273), viral vector vaccine (Vaxzevria ChAdOx1, AstraZeneca or Janssen or Cansino Biotech), and inactivated virus (Sinovac Biotech CoronaVac or Bharat Biotech BBV152) [ 9 ]. In the last year, following massive diffusion of SARS-CoV-2 vaccines administration, an increasing number of case reports have suggested a possible association between SARS-CoV-2 vaccines and thyroid disorders, replicating the spectrum of thyroid dysfunction that have already been described to occur during SARS-CoV-2 infection [ 10 – 13 ].…”

Study of Thyroid function among COVID-19 affected and non-affected people during pre and post vaccination

“…However, as the vaccination program progressed, some cases were reported suggesting a possible association between thyroid disease (e.g., subacute thyroiditis, Graves' disease, focal painful thyroiditis, silent thyroiditis, thyroid-ocular disease, etc.) and vaccination [13]. Although these studies provide useful information, the effects of COVID-19 infection and vaccination on the thyroid axis are contradictory.…”