SARS-CoV-2 Vaccine-Associated Subacute Thyroiditis: Insights from a Systematic Review

Abstract

Purpose To perform a systematic review on published cases of subacute thyroiditis (SAT) secondary to SARS-CoV-2 vaccination, to highlight main features and increase the awareness of this condition. Methods Original reports of SAT developed after SARS-CoV-2 vaccination (mRNA, viral vector, or inactivated virus vaccines) were retrieved from a search of electronic databases. Individual patient data on demographics, medical history, type of vaccine, workup and therapies were collected. Wilcoxon rank-sum, Kruskal-Wallis and chi-squared tests were employed for comparisons. Results 30 articles including 48 reports were retrieved, 3 additional cases evaluated by the Authors were described and included for analysis. Of the 51 patients, 38 (74.5%) were women, median age was 39.5 years . Patients developed SAT after a median of 10 days (IQR 4-14) after the vaccine shot. Baseline thyroid exams revealed thyrotoxicosis in 88.2% of patients, decreasing at 31.6% at follow-up. Corticosteroids were used in 56.4% of treated patients. Patients undergoing non-mRNA vaccines were most frequently Asian (p = 0.019) and reported more frequently weight loss (p = 0.021). All patients with a previous diagnosis of thyroid disease belonged to the mRNA vaccine group. Conclusion SARS-CoV-2 vaccine-associated SAT is a novel entity that should be acknowledged by physicians. Previous history of thyroid disease may predispose to develop SAT after mRNA vaccines, but further studies and larger cohorts are needed to verify this suggestion. SARS-CoV-2 vaccine-associated SAT is usually of mild/moderate severity and could be easily treated in most cases, thus it should not raise any concern regarding the need to be vaccinated.

Case report: subacute thyroiditis after receiving SARS-CoV-2 vaccine, maybe not only adjuvants

“…Early recognition and diagnosis necessitate clinicians' vigilance. Nevertheless, it should not raise any concern regarding the vaccination, because vaccine-associated SAT is usually of moderate severity and could be easily treated (36).…”

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).…”

“…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). Two cases of vaccineinduced Graves' disease have been reported in two female health-care workers of 28 and 40 years of age.…”

“…Cases of SAT had already been observed after the administration of the H1N1 vaccine (152, 153). The first mechanism suggested to explain the relation between COVID-19 vaccination and thyroid disease is the autoimmune/ inflammatory syndrome induced by adjuvants (ASIA) (148,151). But it is also already shown that antibodies against SARS-CoV-2 proteins could cross-react with tissue antigens, including thyroid peroxidase (TPO) (154).…”