Vaccine-Induced Subacute Thyroiditis (De Quervain’s) after mRNA Vaccine against SARS-CoV-2: A Case Report and Systematic Review

Abstract

De Quervain’s thyroiditis, sometimes referred to as subacute thyroiditis (SAT), is the most common granulomatous disease of the thyroid, typically found after a viral infection in middle-aged women. The mRNA encoding for the angiotensin-converting enzyme-2 (ACE-2) receptor is expressed in follicular thyroid cells, making them a potential target for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Besides infection, SARS-CoV-2 vaccines have also been implicated in SAT pathogenesis. We present a case of a woman developing SAT following vaccination with Comirnaty by Pfizer Inc. (New-York, USA). We performed a systematic review of similar cases available in the literature to provide a better understanding of the topic. We searched the databases PubMed and Embase and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Patient records were then sorted according to the type of administered vaccine and a statistical analysis of the extracted data was performed. No statistically significant difference between mRNA vaccines and other vaccines in inducing SAT was found, nor was any found in terms of patient demographics, symptoms at presentation, initial, or follow-up blood tests. In our case report, we described the possible association between SARS-CoV-2 mRNA-based vaccine Comirnaty and SAT.

Tiroiditis subaguda dolorosa de De Quervain posterior a aplicación de vacuna contra SARS-CoV-2: reporte de un caso

“…De igual manera, İremli et al reportaron los casos de tres mujeres que desarrollaron TSA poco después de recibir la vacuna contra el coronavirus inactivado (vacuna CoV-2, Sinovac BioNTech) 7 y en informes más recientes se documentaron dos mujeres que desarrollaron enfermedad de Graves con tirotoxicosis poco después de recibir una vacuna de ARNm COVID-19 (Pfizer-BioN-Tech) 8 y dos casos asociados a la vacuna de Astra-Zeneca (ChAdOx1, Vaxzevria), una mujer de 57 años y un hombre de 75 años 9 . Según una revisión sistemática realizada por Pipitone et al, hasta septiembre de 2021 se habían reportado un total de 10 casos de TSA asociados a vacunas contra SARS-CoV-2 10 . En ninguno de los casos se contaba con antecedente de enfermedad tiroidea, ni de infección viral previa y las pruebas de reacción en cadena de la polimerasa con transcriptasa inversa para SARS-CoV-2 fueron negativas, descartando la presencia de esta enfermedad como posibilidad de sesgo confusor.…”

The course of subacute thyroiditis from COVID-19 infection

“…В начале 2022 г. был также опубликован систематический обзор, который был посвящен тиреоидиту де Кервена, индуцированному вакциной против SARS-CoV-2, авторы которого представили сводную таблицу по 10 пациентам [36]. 90% из них -женщины, медиана возраста составила 44 года.…”

A Literature Review on SARS-CoV-2 and Other Viruses in Thyroid Disorders: Environmental Triggers or No-Guilty Bystanders?

“…The first of these is based on the effects produced by adjuvants, immunological or pharmacological substances contained in vaccines, which, if they enhance the response to vaccination, may lead to the insurgence of serious side ef-fects, called "autoimmune/inflammatory syndrome by adjuvants" (ASIA) or Shoenfeld's syndrome in genetically susceptible and predisposed individuals [112]. ASIA originates from dysregulation of both the innate and adaptive immune systems and is responsible for several autoimmune diseases including systemic lupus erythematosus, rheumatoid arthritis, or autoimmune endocrinopathies like HT and SAT, as described after administration of other vaccines, such as the influenza, human papillomavirus and hepatitis B [112,113]. A second more convincing hypothesis is related to molecular mimicry, as demonstrated by an in vitro study revealing a strong cross-reactivity between antibodies against protein S (the protein that binds to ACE2 receptors and allows the virus to enter the cell) and a number of antigens, including TPO, which could account for autoimmunity and inflammatory reactions observed in both SARS-CoV-2 infection and vaccination in genetically predisposed individuals [111,114,115].…”