A case report and literature review found at least 5 medically confirmed cases of Graves disease following vaccination for COVID-19, according to a report published in Frontiers in Public Health.

Researchers from The University of Hong Kong reported a case of Graves disease which occurred in a patient following vaccination for COVID-19. The case prompted them to perform a medical literature search through August 2021 for other instances potentially linking COVID-19 vaccination with the development of Graves disease.

The case they reported was of a 40-year-old Chinese woman who had no personal or family history of thyroid disorders until the patient presented in September 2013 (then aged 32 years) with cold intolerance and lethargy. A thyroid function test indicated subclinical hypothyroidism with thyroid stimulating hormone concentration of 5.30 mIU/L and free thyroxine of 13.9 pmol/L. The patient was negative for antithyroid peroxidase and antithyroglobulin.


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The patient was given an intermediate dose of 50 mcg thyroxine daily 5 days per week and 100 mcg 2 days a week. The patient remained clinically euthyroid through July 2020.

The now 40-year-old patient received her first and second doses of the BNT162b2 mRNA vaccine in April 2021 and May of 2021, respectively.

On June 8, 2021, the patient presented with palpitations and sinus tachycardia. Thyroid stimulating hormone (TSH) concentration was <0.02 mIU/L, free thyroxine was 66.6 pmol/L, and free triiodothyronine was 30.50 pmol/L. A physical examination identified moderate diffuse goiter and thyroid bruit.  The patient also became positive for antithyroid peroxidase and antithyroglobulin.

A thyroid ultrasound was suggestive of diffuse thyroid disease, and technetium thyroid scan showed typical Graves disease. Thyroid function was improved after thyroxine replacement was stopped and the patient was given carbimazole and propranolol.

The study authors found 4 previous reports of Graves disease following COVID-19 vaccination during a subsequent literature review.  All patients received an mRNA COVID-19 vaccine. The 4 patients (1 man, 3 women) were aged 28 through 71 years, Two reports came from Mexico and 2 from Austria. Researchers also discovered 9 cases of subacute thyroiditis following vaccination of different types of COVID-19 vaccinations.

The BNT162b2 mRNA COVID-19 vaccine, the study authors noted, contains 4 lipids; 2 are polyethylene glycol (PEG), “which may act as an adjuvant and induce an immune response in predisposed individuals, as there are rare reports of reactions to PEGs.”

“Graves disease can occur after [COVID-19] vaccination,” the study authors concluded. “Our case represents the fifth in the literature of Graves disease after [COVID-19] vaccination, with an unusual presentation on a longstanding history of hypothyroidism.” They suggest clinicians should ‘remain vigilant’ about the potential manifestation of Graves disease in the current COVID-19 pandemic.”

Reference

Lui DTW, Lee KK, Lee CH, Lee ACH, Hung IFN, Tan KCB. Development of Graves disease after SARS-CoV-2 mRNA vaccination: a case report and literature review. Front Public Health. 2021;9:778964. doi:10.3389/fpubh.2021.778964