Distinct Clinical Features of Post-COVID-19 Vaccination Early-onset Graves’ Disease

Abstract

Context Several case reports of Graves’ disease (GD) occurrence after COVID-19 vaccination were recently published and possibly related to the autoimmune syndrome induced by adjuvants (ASIA). The aim of our study was to evaluate possible distinctive features in the presentation and clinical course of patients with GD occurring early (within 4 weeks) after COVID-19 vaccination who attended our Endocrine Unit in 2021. Design Patients with first episode of GD attending a tertiary endocrine center between January 1st and December 31st 2021 were included. Results Sixty-four patients with first episode of GD were seen in 2021: 20 (31.2%) of them had onset within 4 weeks following vaccine administration. Compared to the other 44 patients, the 20 patients with post-vaccine early-onset (PoVEO) GD were older (median age: 51 years vs 35 years, p = 0.003) and more likely male (40.0% vs 13.6%, p = 0.018). At diagnosis, the biochemical and immune profiles were similar between the two groups. However, at 3 months after starting methimazole, PoVEO GD patients had significantly lower TRAb titer and were taking lower doses of methimazole than the other GD patients. None in the PoVEO group had sustained fT3 elevation. Conclusions This relatively large series suggests that in 2021, PoVEO GD may be a new nosological entity representing one third of patients evaluated for new-onset GD in our center. Distinctive features included older age at onset, higher male prevalence and a better initial biochemical and immunological response to treatment. Further studies are warranted to clinically and biochemically differentiate these cases from sporadically occurred GD.

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

“…Another study, focusing on early-onset GD within 4 weeks of COVID-19 vaccination, revealed distinctive features in this patient group, such as an older age at onset, a higher prevalence of males, and an initially favorable response to treatment [13].…”

Graves’ Disease after mRNA COVID-19 Vaccination, with the Presence of Autoimmune Antibodies Even One Year Later

“…In this case, we report a case of suspected Graves’ disease due to COVID-19 vaccination with a good response to thiamazole, but TRAb was still positive one year later. Although Graves’ disease following COVID-19 vaccination has been reported [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ], few reports have presented data on the chronic phase of Graves’ disease after vaccination.…”

“…Under such circumstances, although the COVID-19 mRNA vaccine was developed and administered worldwide, various adverse effects have been reported, including cardiovascular diseases such as acute coronary syndrome (ACS) and myocarditis [ 2 , 3 , 4 ], and hyperthyroidism including Graves’ disease, Graves’ orbitopathy, subacute thyroiditis, and silent thyroiditis [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

“…The main cause of Graves’ disease following COVID-19 vaccination is related to autoimmunity, which is explained by autoimmune/inflammatory syndrome induced by adjuvants (ASIA) and cross-reactivity between thyroid tissue including thyroid peroxidase (TPO) and the SARS-COV2 spike protein [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The mRNA vaccine contains adjuvants such as lipid nanoparticles (LNPs) that can trigger ASIA [ 16 , 17 ].…”

Increased prevalence of autoimmune thyroid disease after COVID-19: A single-center, prospective study

“…Other exclusion criteria were: age less than 18 years, pregnancy, history of thyroid disease or previous thyroid surgery, concomitant medications known to interfere with thyroid function (lithium, amiodarone, interferon-α and antiretroviral drugs), severe kidney insufficiency (eGFR < 30 ml/min), and severe liver failure. Patients’ enrollment took place between 2 May and 31 July 2020, before availability of SARS-CoV-2 vaccines, to avoid potential biases due to occurrence of post-vaccination thyroid disorders ( 21 , 22 ).…”