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Sakai M, Takao K, Kato T, Ito K, Kubota S, Hirose T, Liu Y, Mizuno M, Hirota T, Suwa T, Horikawa Y, Yabe D. Graves' Disease after Administration of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccine in a Type 1 Diabetes Patient. Intern Med 2022; 61:1561-1565. [PMID: 35569928 PMCID: PMC9177353 DOI: 10.2169/internalmedicine.9231-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/30/2022] [Indexed: 11/07/2022] Open
Abstract
Although there is a great demand for increased coronavirus disease 2019 (COVID-19) vaccination worldwide, rare side effects of the vaccine in susceptible individuals are attracting attention. We recently treated a patient with type 1 diabetes who had HLA-A*240201/A*020101, B*5401/B*5601, DRB1*0405/DRB1*0405, DPB1*0501/DPB1*0501 and DQB1*0401/DQB1*040 and developed Graves' disease soon after the administration of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. While causal relationships between vaccinations and adverse events are difficult to discern due to both confounding and masking factors, our findings suggest that attention to possible adjuvant-related endocrinological diseases in certain individuals receiving SARS-CoV-2 vaccines is appropriate.
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Affiliation(s)
- Mayu Sakai
- Department of Diabetes, Endocrinology and Metabolism, Gifu University Graduate School of Medicine, Japan
- Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Japan
| | - Ken Takao
- Department of Diabetes, Endocrinology and Metabolism, Gifu University Graduate School of Medicine, Japan
- Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Japan
| | - Takehiro Kato
- Department of Diabetes, Endocrinology and Metabolism, Gifu University Graduate School of Medicine, Japan
- Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Japan
| | - Kodai Ito
- Department of Diabetes, Endocrinology and Metabolism, Gifu University Graduate School of Medicine, Japan
- Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Japan
| | - Sodai Kubota
- Department of Diabetes, Endocrinology and Metabolism, Gifu University Graduate School of Medicine, Japan
- Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Japan
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Japan
| | - Tokuyuki Hirose
- Department of Diabetes, Endocrinology and Metabolism, Gifu University Graduate School of Medicine, Japan
- Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Japan
| | - Yanyan Liu
- Department of Diabetes, Endocrinology and Metabolism, Gifu University Graduate School of Medicine, Japan
- Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Japan
| | - Masami Mizuno
- Department of Diabetes, Endocrinology and Metabolism, Gifu University Graduate School of Medicine, Japan
- Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Japan
| | - Takuo Hirota
- Department of Diabetes, Endocrinology and Metabolism, Gifu University Graduate School of Medicine, Japan
- Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Japan
| | - Tetsuya Suwa
- Department of Diabetes, Endocrinology and Metabolism, Gifu University Graduate School of Medicine, Japan
- Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Japan
| | - Yukio Horikawa
- Department of Diabetes, Endocrinology and Metabolism, Gifu University Graduate School of Medicine, Japan
- Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Japan
| | - Daisuke Yabe
- Department of Diabetes, Endocrinology and Metabolism, Gifu University Graduate School of Medicine, Japan
- Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Japan
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Japan
- Center for Healthcare Information Technology, Tokai National Higher Education and Research System, Japan
- Division of Molecular and Metabolic Medicine, Kobe University Graduate School of Medicine, Japan
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Pla Peris B, Merchante Alfaro AÁ, Maravall Royo FJ, Abellán Galiana P, Pérez Naranjo S, González Boillos M. Thyrotoxicosis following SARS-COV-2 vaccination: a case series and discussion. J Endocrinol Invest 2022; 45:1071-1077. [PMID: 35015288 PMCID: PMC8749352 DOI: 10.1007/s40618-022-01739-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/30/2021] [Indexed: 12/18/2022]
Abstract
AIM To describe a case series of thyrotoxicosis likely triggered by SARS-CoV-2 vaccination and to warn physicians about this potential correlation. To report clinical, laboratory and imaging findings and provide further information that goes in line with the underlying mechanisms. METHODS Single-center case series based on all the information collected in the hospital medical records, as well as the temporal sequence between the onset of symptoms and COVID-19 vaccination. RESULTS We report 8 cases with thyrotoxicosis after SARS-CoV-2 vaccination. 4 cases of Graves' disease (GD), 2 cases of subacute painful thyroiditis (SAT), 1 case of concurrent GD and SAT and 1 case of atypical subacute thyroiditis. Five patients received BNT162b2 mRNA vaccine, 3 patients 1273 mRNA vaccine. The onset of symptoms following vaccination ranged from 10 to 14 days in six of eight patients and from 7 to 8 weeks in two patients. CONCLUSIONS Several hypotheses have been proposed to explain the potential correlation between SARS-CoV-2 vaccination and thyrotoxicosis, including immune system hyper-stimulation, molecular mimicry and Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA). We should pay greater attention to thyroid disorders in patients receiving vaccine against SARS-CoV-2.
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Affiliation(s)
- B Pla Peris
- Department of Endocrinology and Nutrition, Hospital General Universitario de Castellón, Avinguda de Benicàssim, 128, 12004, Castelló de la Plana, Castelló, Spain.
| | - A Á Merchante Alfaro
- Department of Endocrinology and Nutrition, Hospital General Universitario de Castellón, Avinguda de Benicàssim, 128, 12004, Castelló de la Plana, Castelló, Spain
- Departament of Medicine, Jaume I University, Castelló de la Plana, Castelló, Spain
| | - F J Maravall Royo
- Department of Endocrinology and Nutrition, Hospital General Universitario de Castellón, Avinguda de Benicàssim, 128, 12004, Castelló de la Plana, Castelló, Spain
- Departament of Medicine, Jaume I University, Castelló de la Plana, Castelló, Spain
| | - P Abellán Galiana
- Department of Endocrinology and Nutrition, Hospital General Universitario de Castellón, Avinguda de Benicàssim, 128, 12004, Castelló de la Plana, Castelló, Spain
- Departament of Medicine, Cardenal Herrera-CEU University, Castelló de la Plana, Castelló, Spain
| | - S Pérez Naranjo
- Department of Endocrinology and Nutrition, Hospital General Universitario de Castellón, Avinguda de Benicàssim, 128, 12004, Castelló de la Plana, Castelló, Spain
| | - M González Boillos
- Department of Endocrinology and Nutrition, Hospital General Universitario de Castellón, Avinguda de Benicàssim, 128, 12004, Castelló de la Plana, Castelló, Spain
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Yano M, Morioka T, Natsuki Y, Sasaki K, Kakutani Y, Ochi A, Yamazaki Y, Shoji T, Emoto M. New-onset Type 1 Diabetes after COVID-19 mRNA Vaccination. Intern Med 2022; 61:1197-1200. [PMID: 35135929 PMCID: PMC9107966 DOI: 10.2169/internalmedicine.9004-21] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
During the ongoing coronavirus disease 2019 (COVID-19) pandemic, it is critical to ensure the safety of COVID-19 vaccines. We herein report a 51-year-old Japanese woman who developed acute-onset type 1 diabetes with diabetic ketoacidosis six weeks after receiving the first dose of a COVID-19 messenger ribonucleic acid (mRNA) vaccine. Laboratory tests indicated exhaustion of endogenous insulin secretion, a positive result for insulin autoantibody, and latent thyroid autoimmunity. Human leukocyte antigen typing was homozygous for DRB1*09:01-DQB1*03:03 haplotypes. This case suggests that COVID-19 vaccination can induce type 1 diabetes in some individuals with a genetic predisposition.
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Affiliation(s)
- Masahiro Yano
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Tomoaki Morioka
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Yuka Natsuki
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Keyaki Sasaki
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Yoshinori Kakutani
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Akinobu Ochi
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Yuko Yamazaki
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
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Two Case Reports of Subacute Thyroiditis after Receiving Vaccine for COVID-19. Case Rep Endocrinol 2022; 2022:3180004. [PMID: 35433060 PMCID: PMC9008488 DOI: 10.1155/2022/3180004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/06/2022] [Accepted: 03/25/2022] [Indexed: 12/23/2022] Open
Abstract
The ongoing COVID-19 pandemic, caused by a coronavirus named SARS-CoV-2, has struck the planet with great force. As of December 2019, the virus has made its devasting route across all continents . In January 2022, the World Health Organization (WHO) registered over 5.5 million COVID-19 related deaths. Most of these people had suffered from pneumonia and acute respiratory distress syndrome , and in some cases, extensive damage to all organ systems. To get hold of this pandemic, it was vital to find effective vaccines against it. The two vaccine candidates BNT162b2 (BioNTech/Pfizer) and ChAdOx1 (University of Oxford and AstraZeneca) offer a high level of protection against COVID-19 by providing immunity due to antibody production against the spike protein of SARS-CoV-2. In addition to general side effects, immunological side effects such as subacute thyroiditis can follow the vaccination. This transient inflammatory condition of the thyroid gland is characterized with hyperthyroxinemia, inflammation, pain, and tenderness in the thyroid region, as well as an elevation of serum thyroglobulin concentration. There are only a few reports on the occurrence of this disease after receiving a COVID-19 vaccine. We present two cases of subacute thyroiditis after vaccination with the vaccines BNT162b2 and ChAdOx1 and try to enlighten the problem of immunological phenomena after vaccination. It must be discussed whether cross-reactivity of the spike protein and tissue proteins such as thyroid peroxidase (TPO), an “autoimmune/inflammatory syndrome by adjuvants” (ASIA), or the circulating spike protein itself after vaccination are responsible for the SAT.
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Pujol A, Gómez LA, Gallegos C, Nicolau J, Sanchís P, González-Freire M, López-González ÁA, Dotres K, Masmiquel L. Thyroid as a target of adjuvant autoimmunity/inflammatory syndrome due to mRNA-based SARS-CoV2 vaccination: from Graves' disease to silent thyroiditis. J Endocrinol Invest 2022; 45:875-882. [PMID: 34792795 PMCID: PMC8598936 DOI: 10.1007/s40618-021-01707-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/07/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND As COVID-19 became a pandemic, the urgent need to find an effective treatment vaccine has been a major objective. Vaccines contain adjuvants which are not exempt from adverse effects and can trigger the autoimmune/inflammatory syndrome induced by adjuvants (ASIA). There is very little information about autoimmune endocrine disease and the ASIA after the use of mRNA-based SARS-CoV2 vaccination. CASE SERIES We report three cases and also review the literature showing that the thyroid gland can be involved in the ASIA induced by the mRNA-based SARS-CoV2 vaccination. We present the first case to date of silent thyroiditis described in the context of SARS-CoV2 vaccination with Pfizer/BioNTech. Also, we discuss the first subacute thyroiditis in the context of SARS-CoV2 vaccination with the Moderna's vaccine. Finally, we provide another case to be added to existing evidence on Graves' disease occurring post-vaccination with the Pfizer/BioNTech vaccine. DISCUSSION Adjuvants play an important role in vaccines. Their ability to increase the immunogenicity of the active ingredient is necessary to achieve the desired immune response. Both the Moderna and the Pfizer/BioNTech vaccines use mRNA coding for the SARS-CoV2 S protein enhanced by adjuvants. In addition, the cross-reactivity between SARS-CoV2 and thyroid antigens has been reported. This would explain, at least, some of the autoimmune/inflammatory reactions produced during and after SARS-CoV2 infection and vaccination. CONCLUSION The autoimmune/inflammatory syndrome induced by adjuvants involving the thyroid could be an adverse effect of SARS-CoV2 vaccination and could be underdiagnosed.
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Affiliation(s)
- A. Pujol
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - L.-A. Gómez
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - C. Gallegos
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
- Microbiology Department, Son Llàtzer University Hospital, Palma, Baleares Spain
| | - J. Nicolau
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - P. Sanchís
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
- Chemistry Department, University of Balearic Islands, Palma, Baleares Spain
| | - M. González-Freire
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - Á. A. López-González
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
- ADEMA University School, Palma, Baleares Spain
| | - K. Dotres
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - L. Masmiquel
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
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Bahçecioğlu AB, Karahan ZC, Aydoğan Bİ, Kalkan İA, Azap A, Erdoğan MF. Subacute thyroiditis during the COVID-19 pandemic: a prospective study. J Endocrinol Invest 2022; 45:865-874. [PMID: 35023078 PMCID: PMC8754549 DOI: 10.1007/s40618-021-01718-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/29/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Subacute thyroiditis(SAT) is a destructive thyroiditis associated with viral infections. Several SAT cases associated with SARS-CoV-2 infection/vaccination were recently reported. We aimed to evaluate prospectively all cases applied to our tertiary center and their relationship with SARS-CoV-2 during 16 months of the pandemic. Cases during similar pre-pandemic period were recorded for numeric comparison. METHODS Prospective study took place between March 2020 and July 2021. SAT was diagnosed by classical criteria. Swabs for SARS-CoV-2 and a wide respiratory viral panel (RV-PCR) were taken. Previous COVID-19 was assessed by SARS-CoV-2 IgM&IgG levels. Study group was divided into three as: CoV-SAT, patients who had or still have COVID-19, Vac-SAT, patients diagnosed within three months after SARS-CoV-2 vaccination and NonCoV-SAT, those not associated with COVID-19 or vaccination. RESULTS Out of 64 patients, 18.8% (n = 12) was classified as CoV-SAT, 9.3% (n = 6) as Vac-SAT and 71.9% as (n = 46) NonCoV-SAT. SARS-CoV-2 RT-PCR tests on the diagnosis of SAT were negative in all, but two patients tested positive five days later, in second testing, performed upon clinical necessity. CoV-SAT and NonCoV-SAT groups were similar in terms of clinical, laboratory, and treatment characteristics. However, symptoms were milder and treatment was easier in Vac-SAT group (p = 0.006). CONCLUSIONS Total number of SAT cases during the pandemic period was comparable to pre-pandemic period. However, a considerable rate of SARS-CoV-2 exposure in SAT patients was established. COVID-19 presented with SAT, as the first manifestation in three cases. Vaccine-related cases developed in a shorter time period, clinical presentation was milder, and only a few required corticosteroids.
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Affiliation(s)
- A. B. Bahçecioğlu
- Department of Endocrinology and Metabolism, School of Medicine, Ankara University, Ankara, Turkey
| | - Z. C. Karahan
- Department of Medical Microbiology, School of Medicine, Ankara University, Ankara, Turkey
| | - B. İ. Aydoğan
- Department of Endocrinology and Metabolism, Güven Hospital, Ankara, Turkey
| | - İ. A. Kalkan
- Department of Clinical Microbiology and Infectious Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - A. Azap
- Department of Clinical Microbiology and Infectious Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - M. F. Erdoğan
- Department of Endocrinology and Metabolism, School of Medicine, Ankara University, Ankara, Turkey
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Bostan H, Ucan B, Kizilgul M, Calapkulu M, Hepsen S, Gul U, Ozturk Unsal I, Cakal E. Relapsed and newly diagnosed Graves’ disease due to immunization against COVID-19: A case series and review of the literature. J Autoimmun 2022; 128:102809. [PMID: 35220164 PMCID: PMC8867370 DOI: 10.1016/j.jaut.2022.102809] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 01/06/2023]
Abstract
In addition to genetic factors, environmental factors such as viruses are thought to be triggers in the development of autoimmune thyroid diseases (AITD) such as Graves' disease (GD). In this context, AITD cases that may be associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or immunization have begun to be reported in increasing numbers. Although it is not clear by which pathogenetic mechanisms immunization against coronavirus disease 2019 (COVID-19) triggers the development of AITD, both the potential effect of the adjuvants in the vaccines and the cross-reactivity that can be generated by the molecular similarity of viral particles with mammalian proteins seem to be possible mechanisms. In this article, 7 GD patients consisting of relapsed and newly diagnosed cases following the COVID-19 vaccination were presented. Of these 7 cases, 5 (71.4%) were female, and the median age of the patients was 47 years (range, 31–53). One of the patients was associated with the inactivated COVID-19 vaccine, while the others were associated with the mRNA COVID-19 vaccine. The median post-vaccination symptom onset was 7 days (range, 4–30). Three of the patients had a history of GD and one had a history of Hashimoto's thyroiditis. Rapidly developing Graves' ophthalmopathy was detected in one patient. These cases are cautionary that GD and its extrathyroidal manifestations may develop in a short period after COVID-19 vaccination. When considered together with the literature review, the history of AITD in approximately half of the patients suggests that more attention should be paid to these patients in the post-vaccination period. Nevertheless, multicenter, prospective studies are needed to better understand this possible causal relationship.
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Affiliation(s)
- Hayri Bostan
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
| | - Bekir Ucan
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Muhammed Kizilgul
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Murat Calapkulu
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Sema Hepsen
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Umran Gul
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ilknur Ozturk Unsal
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Abstract
Autoimmune endocrine diseases have been reported after influenza and the human papillomavirus vaccine, but there is limited data on autoimmune diseases after coronavirus disease 2019 (COVID-19) vaccination. Our report is about a 42-year-old Caucasian male and a 68-year-old Caucasian female who developed Graves' disease after receiving Moderna (Moderna, Inc., Cambridge, Massachusetts, United States) and Johnson & Johnson (Johnson & Johnson, New Brunswick, New Jersey, United States) vaccines, respectively. Both patients had no previous autoimmune thyroiditis and had normal thyroid function but developed hyperthyroidism characterized by suppressed thyroid-stimulating hormone (TSH), elevated free T4 level, and TSH receptor antibodies after vaccination. COVID-19 vaccines, either mRNA-based (Moderna) or non-mRNA-based (Johnson & Johnson), can cause Graves' disease. The clinical manifestations are similar to Graves' disease but without ocular manifestations.
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Affiliation(s)
- Gurdeep Singh
- Endocrinology, Diabetes and Metabolism, Our Lady of Lourdes Memorial Hospital, Binghamton, USA
| | - Timothy Howland
- Internal Medicine/Endocrinology, Our Lady of Lourdes Memorial Hospital, Binghamton, USA
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Bulatova NR, Zayed AA, Hijjawi UQ, Sharkas SG, Bakri FG. Painful subacute thyroiditis occurring after the administration of influenza vaccine and hyaluronic acid dermal filler: A case report. Medicine (Baltimore) 2022; 101:e29120. [PMID: 35356951 PMCID: PMC10684237 DOI: 10.1097/md.0000000000029120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/04/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE The occurrence of subacute thyroiditis (SAT) after vaccines or after hyaluronic acid skin fillers is very rare and might be related to genetic susceptibility. We suggest that the co-administration of both products could potentially increase the possibility of development of SAT. PATIENT CONCERNS A 58-year-old Caucasian healthy female initially presented with chills, myalgia, dysphagia, sore throat, dry cough, fatigue, and intermittent fever of 38.5°C orally after simultaneous injection of an influenza vaccine and a dermal filler containing hyaluronic acid. Ten days later the patient developed palpitations and neck pain radiating to the left jaw. DIAGNOSIS AND INTERVENTIONS She was diagnosed with SAT on day 16 after her first visit and responded promptly to etoricoxib treatment. OUTCOMES The patient progressed clinically from hyperthyroidism to euthyroid state and eventually to hypothyroidism and further testing showed she had HLA B-35 haplotype. LESSONS Physicians should be aware that SAT might be associated with the administration an influenza vaccine and this possible association might increase if the vaccine was co-administered with a dermal filler.
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Affiliation(s)
- Nailya R. Bulatova
- Correspondence: Nailya R. Bulatova, Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman 11942, Jordan (e-mail: ).
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Bostan H, Unsal IO, Kizilgul M, Gul U, Sencar ME, Ucan B, Cakal E. Two cases of subacute thyroiditis after different types of SARS-CoV-2 vaccination. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:97-103. [PMID: 35029854 PMCID: PMC9991036 DOI: 10.20945/2359-3997000000430] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022]
Abstract
Although the development of subacute thyroiditis (SAT) following viral infections is well-documented, the actual mechanism has not been clearly elucidated. The occurrence of SAT after vaccination has been reported in several case series and possible mechanisms such as molecular mimicry due to the exposure to viral proteins and/or abnormal reactogenicity by adjuvants have been implicated. We describe two cases who developed SAT three days after the messenger RNA vaccine against COVID-19 (Pfizer-BioNTech®) and six days after the inactivated COVID-19 vaccine (CoronaVac®). SAT diagnosis of these patients was delayed for more than two weeks. When the current cases were evaluated together with 1 Pfizer-BioNTech® and 3 CoronaVac® related cases reported previously, the patients were female aged between 30-42, except for the male patient we presented, and the complaints of the patients initiated within the first 2-7 days. While two Pfizer-BioNTech® vaccine-related cases were severely symptomatic and thyrotoxic at presentation, there were cases with mild to moderate clinical manifestations in CoronaVac® vaccine-related group. Physicians should be aware of SAT that may occur within a few days following the COVID-19 vaccination.
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Affiliation(s)
- Hayri Bostan
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey,
| | - Ilknur Ozturk Unsal
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Muhammed Kizilgul
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Umran Gul
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Muhammed Erkam Sencar
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Bekir Ucan
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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61
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Chua MWJ. Graves’ disease after COVID-19 vaccination. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022. [DOI: 10.47102/annals-acadmedsg.2021398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Smith E, Tran T, Gillies A, Yeung S, Ma PE. Multiple Evanescent White Dot Syndrome following COVID-19 mRNA Vaccination in Two Patients. Ocul Immunol Inflamm 2022; 30:1240-1243. [PMID: 35201960 DOI: 10.1080/09273948.2022.2032198] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To describe two cases of multiple evanescent white dot syndrome (MEWDS) occurring after administration of COVID-19 vaccine. STUDY DESIGN Case Report. RESULTS Two patients presented soon after receiving their second-dose of the BNT162b2 Pfizer-BioNTech COVID-19 vaccine with findings consistent with MEWDS. Due to the significant reduction in vision, patients were treated with a short dose of oral corticosteroids. Both had complete resolution of their symptoms, visual acuity and retinal findings. CONCLUSIONS The onset of inflammatory ocular adverse events following COVID-19 vaccinations suggest a maladaptive inflammatory response triggered by the vaccine. Onset of symptoms after COVID-19 vaccinations should prompt the ophthalmologist to assess for these rare adverse events. Despite the extremely rare occurrences of ocular adverse events, we unequivocally recommend that patients receive the full vaccine due to the vast benefit for both individuals and society that far outweighs the inconsiderable risk of harm.
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Affiliation(s)
- Ebony Smith
- Department of ophthalmology, Sydney Eye Hospital, Sydney, NSW, Australia
| | - Tuan Tran
- Department of ophthalmology, Sydney Eye Hospital, Sydney, NSW, Australia.,Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada.,Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Alex Gillies
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Shanna Yeung
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Patrick E Ma
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
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63
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Jhon M, Lee SH, Oh TH, Kang HC. Subacute Thyroiditis After Receiving the mRNA COVID-19 Vaccine (Moderna): The First Case Report and Literature Review in Korea. J Korean Med Sci 2022; 37:e39. [PMID: 35166076 PMCID: PMC8845100 DOI: 10.3346/jkms.2022.37.e39] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022] Open
Abstract
Subacute thyroiditis (SAT) is a painful thyroiditis that often requires steroid therapy. Here, we report the first case of severe SAT in a patient who received the first dose of mRNA coronavirus disease 2019 (COVID-19) vaccination. A 34-year-old man without a viral prodrome felt a lump when swallowing 5 days after his first dose of mRNA-1273 (Moderna) vaccination. Ten days after vaccination, the patient visited the hospital and was advised to rest and take nonsteroidal anti-inflammatory drugs. He revisited the hospital 10 days later as symptoms aggravated with anterior neck pain, headache, fatigue, muscle weakness, and weight loss. Thyroid hormone levels and inflammatory markers were consistent with thyrotoxicosis. A thyroid ultrasound scan revealed typical SAT findings. His symptoms rapidly improved after receiving prednisone. A week later, the patient successfully completed his second dose of the vaccine. The thyroid function test results were nearly normal 1 month after the completion of the vaccination. We report this case to raise awareness of the occurrence of SAT after COVID-19 vaccination. As the risk of COVID-19 outweighs the minor risks of the vaccine, managing the side effects of the first vaccine dose is crucial to complete COVID-19 vaccination.
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Affiliation(s)
- Min Jhon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Ho Lee
- Department of Orthopedic Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Tae-Hoon Oh
- Division of Infectious Diseases, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ho-Cheol Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
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64
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Das L, Bhadada SK, Sood A. Post-COVID-vaccine autoimmune/inflammatory syndrome in response to adjuvants (ASIA syndrome) manifesting as subacute thyroiditis. J Endocrinol Invest 2022; 45:465-467. [PMID: 34585363 PMCID: PMC8478264 DOI: 10.1007/s40618-021-01681-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/18/2021] [Indexed: 01/31/2023]
Affiliation(s)
- L Das
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, 1008, Nehru Extension Block, Chandigarh, 160012, India
| | - S K Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, 1008, Nehru Extension Block, Chandigarh, 160012, India.
| | - A Sood
- Department of Nuclear Medicine, PGIMER, Chandigarh, India
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65
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Shih SR, Wang CY. SARS-CoV-2 Vaccination Related Hyperthyroidism of Graves’ Disease. J Formos Med Assoc 2022; 121:1881-1882. [PMID: 35227587 PMCID: PMC8849858 DOI: 10.1016/j.jfma.2022.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/12/2022] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
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66
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Atiyeh B, Emsieh S. Breast Implant Illness (BII): Real Syndrome or a Social Media Phenomenon? A Narrative Review of the Literature. Aesthetic Plast Surg 2022; 46:43-57. [PMID: 34231017 DOI: 10.1007/s00266-021-02428-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/13/2021] [Indexed: 12/16/2022]
Abstract
Breast implant illness (BII) is a condition characterized by elusive diagnostic criteria and self-reported diverse disabling and distressing physical and psychological symptoms. With currently significant increase in public awareness, BII is perhaps becoming the most controversial subject in aesthetic and reconstructive breast surgery, generating heated debates between those who do not believe such a condition exists and those who demand its acceptance as a recognized diagnosis. Silicone incompatibility has been associated with "autoimmune/inflammatory syndrome induced by adjuvants" (ASIA syndrome) or Shoenfeld's syndrome. It is still unclear, however, whether BII symptoms would have occurred if no implants had been placed in the first place. The purpose of this literature review is to analyze critically the current state of scientific evidence related to this condition. Though the psychosomatic theory is most likely, the mechanism of BII symptoms is probably multifactorial. At present, BII being an underlying connective tissue disorder cannot be confirmed; moreover, whether improved aesthetic outcome and patient's overall satisfaction with the profile of their reconstructed or augmented breasts translate into decreased self-reported BII symptoms is still not well elucidated. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Bishara Atiyeh
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Saif Emsieh
- American University of Beirut Medical Center, Beirut, Lebanon.
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67
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Ng XL, Betzler BK, Ng S, Chee SP, Rajamani L, Singhal A, Rousselot A, Pavesio CE, Gupta V, de Smet MD, Agrawal R. The Eye of the Storm: COVID-19 Vaccination and the Eye. Ophthalmol Ther 2022; 11:81-100. [PMID: 34914035 PMCID: PMC8675299 DOI: 10.1007/s40123-021-00415-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/21/2021] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has galvanized the global response towards the development of new vaccines based on novel technologies at an unprecedented pace. Since the widespread implementation of vaccination campaigns, case reports on vaccines' systemic side effects, including ocular manifestations, have emerged. Since administered vaccines are generally not able to cause the disease in the recipient, or induce an immune response against the pathogen, we hypothesize that the development of ocular phenomena post-COVID-19 vaccination may occur via an immune response elicited by the vaccine. Of many, the most common ocular adverse events include facial nerve palsy, central venous sinus thrombosis and acute anterior uveitis. These COVID-19 vaccine-induced ocular (CVIO) adverse events could resemble the ocular findings in some of the COVID-19 patients. This review will provide a comprehensive overview of published ocular side effects potentially associated with COVID-19 vaccination and serve as a springboard for further research into CVIO adverse events.
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Affiliation(s)
- Xin Le Ng
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | - Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sean Ng
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Soon Phaik Chee
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Lakshminarayanan Rajamani
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Amit Singhal
- A*STAR ID Labs & Singapore Immunology Network (SIgN), Singapore, Singapore
| | - Andres Rousselot
- Department of Ophthalmology, Universidad del Salvador, Buenos Aires, Argentina
| | | | - Vishali Gupta
- Department of Ophthalmology, Advance Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Marc D de Smet
- MicroInvasive Ocular Surgery Clinic, Lausanne, Switzerland
- Department of Ophthalmology, University of Leiden, Leiden, The Netherlands
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Singapore, Singapore.
- Singapore Eye Research Institute, The Academia, Singapore, Singapore.
- Department of Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK.
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68
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Sasaki H, Itoh A, Watanabe Y, Nakajima Y, Saisho Y, Irie J, Meguro S, Itoh H. Newly developed type 1 diabetes after COVID-19 vaccination: A case report. J Diabetes Investig 2022; 13:1105-1108. [PMID: 35088548 PMCID: PMC9153841 DOI: 10.1111/jdi.13757] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 01/08/2023] Open
Abstract
The vaccine for the coronavirus disease 2019 (COVID-19) has been reported to potentially develop or worsen diabetes. A 73-year-old Japanese woman received 2 doses of Moderna COVID-19 vaccine. Four-weeks after the second vaccination, her glycemic control began to deteriorate and 8 weeks after the second vaccination, the patient was diagnosed with new-onset type 1 diabetes that was strongly positive for autoantibodies and showed a disease-susceptible HLA haplotype, DRB1*04:05:01-DQB1*04:01:01. The glucagon stimulation test suggested an insulin-dependent state and induction of intensive insulin therapy made her fair glycemic control. The duration from the COVID-19 vaccination to the development of type 1 diabetes is relatively longer than to the onset or exacerbation of type 2 diabetes as previously reported, suggesting the complicated immunological mechanisms for the destruction of β-cells associated with the vaccination. In recipients with the disease-susceptible haplotypes, it should be cautious about autoimmune responses during several months after the vaccination.
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Affiliation(s)
- Hironobu Sasaki
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Center for Preventive Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Arata Itoh
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yasuhiro Watanabe
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuya Nakajima
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoshifumi Saisho
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Junichiro Irie
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shu Meguro
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Itoh
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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69
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Triantafyllidis KK, Giannos P, Stathi D, Kechagias KS. Graves' disease following vaccination against SARS-CoV-2: A systematic review of the reported cases. Front Endocrinol (Lausanne) 2022; 13:938001. [PMID: 36237182 PMCID: PMC9552880 DOI: 10.3389/fendo.2022.938001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/23/2022] [Indexed: 01/08/2023] Open
Abstract
The newly developed COVID-19 vaccines have established a safe profile, yet some individuals experience a wide range of adverse events. Recently, thyroid dysfunction, including Graves' disease, has been observed after administration of different COVID-19 vaccines, although causality remains a matter of debate. The aim of this systematic review was to examine the available literature and provide an overview of reported cases of Graves' disease following COVID-19 vaccination. We identified 21 eligible articles which included 57 patients with Graves' disease following COVID-19 vaccination. Fourteen participants were males (25%, 14/57) and 43 (75%, 44/57) were females with a mean age of 44.3 years. The most common presenting symptom was palpitations (63%, 27/43) followed by weight loss (35%, 15/43). The majority of patients received thionamides (47%, 25/53). The clinical status after treatment was provided for 37 patients and it was improved in the majority of them (84%, 31/37). Graves' disease is possibly a condition clinicians may expect to encounter in patients receiving COVID-19 vaccines. While the above adverse event is rare, considering the scarcity of available data in scientific literature, and causality is not yet confirmed, the increased awareness of clinicians and the early recognition of the disorder are important for the optimal management of these patients.
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Affiliation(s)
- Konstantinos Katsikas Triantafyllidis
- Society of Meta-research and Biomedical Innovation, London, United Kingdom
- Department of Nutrition and Dietetics, Homerton University Hospital Foundation Trust, London, United Kingdom
| | - Panagiotis Giannos
- Society of Meta-research and Biomedical Innovation, London, United Kingdom
- Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, London, United Kingdom
| | - Dimitra Stathi
- Society of Meta-research and Biomedical Innovation, London, United Kingdom
- Department of Endocrinology and Diabetes, Guy’s and St Thomas’ National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Konstantinos S. Kechagias
- Society of Meta-research and Biomedical Innovation, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
- *Correspondence: Konstantinos S. Kechagias,
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70
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Huang L, Jiang Z, Zhou J, Chen Y, Huang H. The Effect of Inactivated SARS-CoV-2 Vaccines on TRAB in Graves' Disease. Front Endocrinol (Lausanne) 2022; 13:835880. [PMID: 35651979 PMCID: PMC9150502 DOI: 10.3389/fendo.2022.835880] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The ongoing coronavirus disease 2019 (COVID-19) pandemic has forced the development of vaccines. Reports have suggested that vaccines play a role in inducing autoimmune diseases (AIDs). Scattered cases have reported that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines may promote thyroid disease, including Graves' disease (GD). However, the effect of inactivated SARS-CoV-2 vaccine on GD remains unclear. The aim of the present study was to investigate the response of thyrotropin receptor antibody (TRAB) to inactivated SARS-COV-2 vaccines. METHODS We conducted a retrospective study to observe the differences in thyroid function and TRAB trends between pre-vaccination (n=412) and post-vaccination (n=231) groups at an interval of 2 months. We then retrospectively observed the differences in serum thyroid function and TRAB levels at 3 months before (n=280), 1 month before (n=294), 1 month after (n=306), and 3 months after (n=250) vaccination. Subsequently, 173 GD patients who were not vaccinated with inactivated SARS-COV-2 vaccines were selected for a prospective study. Thyroid function and TRAB assessment were performed before 3 and 1 months and 1 and 3 months after the first dose of vaccination and were then compared by repeated measures ANOVA to explore their dynamic changes. RESULTS A retrospective study preliminarily observed that the trend of TRAB post-vaccination was opposite of that pre-vaccination (p=0.000), serum TRAB levels decreased before vaccination and increased after vaccination. In this prospective study, repeated measures ANOVA indicated significant differences in serum FT3 (p=0.000), FT4 (p=0.000), TSH (p=0.000), and TRAB (p=0.000) levels at different time points before and after vaccination. Serum TRAB levels showed dynamic changes that decreased significantly at 1 month before vaccination (p=0.000), no significant differences at 1 month after vaccination (p=0.583), and reflected an upward trend at 3 months after vaccination (p=0.034). Serum FT3 and FT4 levels showed similar trends to serum TRAB levels before and after vaccination. Instead, the serum TSH levels showed a continuous upward trend over time. CONCLUSION Based on the results obtained in both retrospective and prospective studies, we concluded that serum TRAB levels decreased less after inactivated SARS-CoV-2 vaccination and showed an upward trend, which may be related to humoral immunity induced by vaccination.
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Affiliation(s)
- LingHong Huang
- The Second Clinical Medical College of Fujian Medical University, Quanzhou, China
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - ZhengRong Jiang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - JingXiong Zhou
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - YuPing Chen
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - HuiBin Huang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- *Correspondence: HuiBin Huang,
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71
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di Filippo L, Castellino L, Giustina A. Occurrence and response to treatment of Graves' disease after COVID vaccination in two male patients. Endocrine 2022; 75:19-21. [PMID: 34727295 PMCID: PMC8561079 DOI: 10.1007/s12020-021-02919-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/16/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Milan, Italy
| | - Laura Castellino
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Milan, Italy.
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72
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A case report of new onset graves' disease induced by SARS-CoV-2 infection or vaccine? JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2021; 23:100104. [PMID: 34934633 PMCID: PMC8679515 DOI: 10.1016/j.jecr.2021.100104] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 12/22/2022] Open
Abstract
The virus responsible for the COVID-19 pandemic continues to pose unmatched challenges in the world. It can cause systemic inflammation, which can lead to multiorgan involvement and subsequent damage. The relationship that possibly exists between the COVID-19 infection, the newly developed vaccines, and thyroid disease are still under extensive investigation. We are reporting the first case of new-onset graves’ disease in a young, healthy man after COVID-19 infection and receiving a COVID-19 vaccine dose.
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73
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Giusti M, Maio A. Acute thyroid swelling with severe hypothyroid myxoedema after COVID-19 vaccination. Clin Case Rep 2021; 9:e05217. [PMID: 34938565 PMCID: PMC8667292 DOI: 10.1002/ccr3.5217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/09/2021] [Accepted: 12/03/2021] [Indexed: 12/13/2022] Open
Abstract
The SARS-CoV-2 virus can trigger thyroid dysfunction. Thyroid dysfunctions after COVID-19 vaccination have been rarely reported. We report the case of overt hypothyroidism in a 61-year-old woman seen after BNT162b2-mRNA vaccination. This case underlines the fact that thyroid function should also be monitored after COVID-19 vaccination, especially in at-risk subjects.
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74
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Lee KA, Kim YJ, Jin HY. Thyrotoxicosis after COVID-19 vaccination: seven case reports and a literature review. Endocrine 2021; 74:470-472. [PMID: 34637073 PMCID: PMC8507356 DOI: 10.1007/s12020-021-02898-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/30/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Yu Ji Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Heung Yong Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea.
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75
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Khan F, Brassill MJ. Subacute thyroiditis post-Pfizer-BioNTech mRNA vaccination for COVID-19. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM210142. [PMID: 34907904 PMCID: PMC8686178 DOI: 10.1530/edm-21-0142] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
SUMMARY There is emerging evidence of an association between COVID-19 vaccination and subacute thyroiditis. We present the case of a 42-year-old female healthcare worker who was diagnosed with subacute thyroiditis 4 days after receiving her second dose of Pfizer-BioNTech vaccine. Her clinical course followed the classical pattern for thyroiditis with spontaneous return to euthyroidism at 6 months post-presentation. The autoimmune/inflammatory syndrome induced by adjuvants has been implicated as a cause of autoimmune conditions post-vaccination and is a potential mechanism for subacute thyroiditis in our case. LEARNING POINTS Subacute thyroiditis should be considered in all patients who receive any kind of vaccine for COVID-19 and subsequently develop symptoms or signs of hyperthyroidism or neck pain. Subacute thyroiditis is a self-limiting condition, and recognising it is important as no specific thyroid treatment (antithyroid drugs or thyroid hormone replacement) is necessary for most patients. The autoimmune/inflammatory syndrome induced by adjuvants may be an under-recognised cause of endocrinopathies and should particularly be considered post-vaccination.
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Affiliation(s)
- Farooq Khan
- Department of Endocrinology, Tipperary University Hospital, Clonmel, Co. Tipperary, Ireland
| | - Mary Jane Brassill
- Department of Endocrinology, Tipperary University Hospital, Clonmel, Co. Tipperary, Ireland
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76
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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. [PMID: 34888290 PMCID: PMC8650637 DOI: 10.3389/fpubh.2021.778964] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Mounting evidence has revealed the interrelationship between thyroid and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to explain the thyroid dysfunction and autoimmune thyroid disorders observed after coronavirus disease 2019 (COVID-19). There are limited reports of thyroid dysfunction after SARS-CoV-2 vaccination. Methods: We report a case of a 40-year-old Chinese woman who developed Graves' disease after BNT162b2 mRNA vaccine. A search of PubMed and Embase databases from 1 September 2019 to 31 August 2021 was performed using the following keywords: "COVID," "vaccine," "thyroid," "thyroiditis," and "Graves." Results: A 40-year-old Chinese woman who had 8-year history of hypothyroidism requiring thyroxine replacement. Her anti-thyroid peroxidase and anti-thyroglobulin antibodies were negative at diagnosis. She received her first and second doses of BNT162b2 mRNA vaccine on 6 April and 1 May 2021, respectively. She developed thyrotoxicosis and was diagnosed to have Graves' disease 5 weeks after the second dose of vaccine, with positive thyroid stimulating immunoglobulin level, diffuse goiter with hypervascularity on thyroid ultrasonography and diffusely increased thyroid uptake on technetium thyroid scan. Both anti-thyroid peroxidase and anti-thyroglobulin antibodies became positive. She was treated with carbimazole. Literature search revealed four cases of Graves' disease after SARS-CoV-2 vaccination, all after mRNA vaccines; and nine cases of subacute thyroiditis, after different types of SARS-CoV-2 vaccines. Conclusion: Our case represents the fifth in the literature of Graves' disease after SARS-CoV-2 vaccination, with an unusual presentation on a longstanding history of hypothyroidism. Clinicians should remain vigilant about potential thyroid dysfunction after SARS-CoV-2 vaccination in the current pandemic.
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Affiliation(s)
| | | | | | | | | | - Kathryn Choon Beng Tan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
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77
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Siolos A, Gartzonika K, Tigas S. Thyroiditis following vaccination against COVID-19: Report of two cases and review of the literature. Metabol Open 2021; 12:100136. [PMID: 34693241 PMCID: PMC8520171 DOI: 10.1016/j.metop.2021.100136] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 01/07/2023] Open
Abstract
Introduction Immune response following viral infections has been suggested as a probable mechanism leading to subacute thyroiditis (SAT). A few cases of SAT following SARS-CoV-2 infection have been described since the outbreak of the pandemic in 2019. Cases of SAT after vaccination against influenza have also been reported. We describe two female patients with thyroiditis after vaccination against SARS-CoV-2. Presentation of cases The first patient presented with fever and pain in the thyroid area typical of SAT two weeks after vaccination with the BNT162B2 mRNA (Pfizer-BioNTech) COVID-19 vaccine. The second patient presented with biochemical and imaging features consistent with silent thyroiditis three weeks after vaccination with the ChAdOx1-S (AstraZeneca) vaccine. Both patients were asymptomatic prior to vaccination and PCR of nasopharyngeal swab for SARS-CoV-2 and other respiratory viruses associated with SAT was negative. Serology testing for measles, mumps, rubella, CMV and EBV viruses was suggestive of immunity. Antibody titre against spike S protein of SARS-CoV-2 was measured for both patients and was indicative of adequate post vaccination antibody response. Two months after initial assessment, both patients were euthyroid and asymptomatic. Conclusions Subacute as well as silent thyroiditis may rarely occur after vaccination against COVID-19. Further research is needed to investigate the prevalence and pathogenesis of thyroid dysfunction following vaccination against COVID-19. Thyroid function abnormalities are common in COVID-19 patients. Thyroiditis is a rare complication of influenza, HPV and HBV vaccination. We report two cases of thyroiditis after vaccination against COVID-19.
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Affiliation(s)
- Athanasios Siolos
- Department of Endocrinology, Ioannina University Hospital, Stavrou Niarchou Avenue, Ioannina, 45500, Greece
| | - Konstantina Gartzonika
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110, Ioannina, Greece
| | - Stelios Tigas
- Department of Endocrinology, Ioannina University Hospital, Stavrou Niarchou Avenue, Ioannina, 45500, Greece
- Corresponding author.
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78
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A case of Graves' disease and type 1 diabetes mellitus following SARS-CoV-2 vaccination. J Autoimmun 2021; 125:102738. [PMID: 34653776 PMCID: PMC8506108 DOI: 10.1016/j.jaut.2021.102738] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 01/06/2023]
Abstract
Autoimmune diseases, including autoimmune endocrine diseases (AIED), are thought to develop following environmental exposure in patients with genetic predisposition. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and vaccines against it could represent new environmental triggers for AIED. We report a patient, with history of vitiligo vulgaris and 8 years of type 2 diabetes, who came to our institution because of fever, weight loss, asthenia and thyrotoxicosis occurred 4 weeks later the administration of BNT162B2 (Pfizer-BioNTech) SARS-CoV-2 vaccine. Clinical, biochemical and instrumental work-up demonstrated Graves’ disease and autoimmune diabetes mellitus. The occurrence of these disorders could be explained through different mechanism such as autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome), mRNA “self-adjuvant” effect, molecular mimicry between human and viral proteins and immune disruption from external stimuli. However further studies are needed to better understand the underlying pathogenesis of AIED following SARS-CoV-2 vaccine.
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79
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Abstract
Viral infections have often been associated with subacute (De Quervain) thyroiditis. Rare cases of subacute thyroiditis have been reported after vaccines. Various vaccines have been developed with different techniques against SARS-CoV-2. This case report presents a rare case of subacute thyroiditis after the inactive SARS-CoV-2 virus vaccine, CoronaVac.
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Affiliation(s)
- Emre Sedar Saygılı
- Endocrinology and Metabolism, Canakkale Onsekiz Mart Universitesi Tip Fakultesi, Canakkale, Turkey
| | - Ersen Karakilic
- Endocrinology and Metabolism, Canakkale Onsekiz Mart Universitesi Tip Fakultesi, Canakkale, Turkey
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80
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Vera-Lastra O, Ordinola Navarro A, Cruz Domiguez MP, Medina G, Sánchez Valadez TI, Jara LJ. Two Cases of Graves' Disease Following SARS-CoV-2 Vaccination: An Autoimmune/Inflammatory Syndrome Induced by Adjuvants. Thyroid 2021; 31:1436-1439. [PMID: 33858208 DOI: 10.1089/thy.2021.0142] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: The autoimmune/inflammatory syndrome induced by adjuvants (ASIA) comprises four entities, including the postvaccination phenomenon, which appears after being exposed to adjuvants in vaccines that increase the immune response. There is limited information about autoimmune endocrine diseases and ASIA after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Patient's Findings: Two female health care workers received a SARS-CoV-2 vaccine, and three days later developed clinical manifestations of thyroid hyperactivity, with increased thyroid hormone levels on thyroid function tests, suppressed thyroid-stimulating hormone, and elevated antithyroid antibodies. Summary: Vaccines have been shown to trigger an immune response that leads to a broad spectrum of autoimmune diseases, including autoimmune thyroid disease. Our patients met the diagnostic criteria for ASIA; they were exposed to an adjuvant (vaccine), and they developed clinical manifestations of thyroid hyperfunction within a few days, with the appearance of antithyroid antibodies, despite being healthy before vaccination. Conclusion: Graves' disease can occur after SARS-CoV-2 vaccination.
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Affiliation(s)
- Olga Vera-Lastra
- Department of Internal Medicine, Hospital de Especialidades "Dr. Antonio Fraga Mouret," Centro Médico Nacional La Raza, México City, Mexico
- Division of Postgraduate Studies, Universidad Nacional Autónoma de México, México City, Mexico
| | - Alberto Ordinola Navarro
- Department of Internal Medicine, Hospital de Especialidades "Dr. Antonio Fraga Mouret," Centro Médico Nacional La Raza, México City, Mexico
| | - Maria Pilar Cruz Domiguez
- Division of Postgraduate Studies, Universidad Nacional Autónoma de México, México City, Mexico
- Research Division, Hospital de Especialidades "Dr Antonio Fraga Mouret," México City, Mexico
| | - Gabriela Medina
- Division of Postgraduate Studies, Universidad Nacional Autónoma de México, México City, Mexico
- Translational Research Unit, Hospital de Especialidades Centro Médico La Raza, Universidad Nacional Autónoma de México, México City, Mexico
| | - Tania Ivonne Sánchez Valadez
- Department of Pneumology Hospital General Dr. Gaudencio González Garza, Centro Médico La Raza, México City, Mexico
| | - Luis J Jara
- Division of Postgraduate Studies, Universidad Nacional Autónoma de México, México City, Mexico
- Direction of Education and Research, Hospital de Especialidades "Dr Antonio Fraga Mouret," México City, Mexico
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81
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Negre Busó M, Rodríguez Gasen A, Torrent Llongarriu È, Estorch Cabrera M. [SARS-Cov-2 vaccination and metabolic radionuclide therapy: document of the SEMNIM Endocrinology Working Group]. Rev Esp Med Nucl Imagen Mol 2021; 40:339-340. [PMID: 38620945 PMCID: PMC8272974 DOI: 10.1016/j.remn.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- M Negre Busó
- Medicina Nuclear-IDI, Hospital Universitari de Girona Dr. Josep Trueta, Girona, España
- Grupo de Trabajo de Endocrinología de la SEMNIM
| | - A Rodríguez Gasen
- Medicina Nuclear, Hospital Universitari de Bellvitge, Barcelona, España
- Grupo de Trabajo de Endocrinología de la SEMNIM
| | - È Torrent Llongarriu
- Medicina Nuclear-IDI, Hospital Universitari de Girona Dr. Josep Trueta, Girona, España
| | - M Estorch Cabrera
- Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
- Grupo de Trabajo de Endocrinología de la SEMNIM
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82
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İremli BG, Şendur SN, Ünlütürk U. Three Cases of Subacute Thyroiditis Following SARS-CoV-2 Vaccine: Postvaccination ASIA Syndrome. J Clin Endocrinol Metab 2021; 106:2600-2605. [PMID: 34043800 PMCID: PMC8194612 DOI: 10.1210/clinem/dgab373] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Indexed: 01/12/2023]
Abstract
CONTEXT Autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome) can be seen as a postvaccination phenomenon that occurs after exposure to adjuvants in vaccines that increase the immune responses. There are very limited data regarding ASIA syndrome following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. OBJECTIVES This work aims to report cases of subacute thyroiditis related to the SARS-CoV-2 vaccine. METHODS We describe the clinical, laboratory, and imaging features of 3 cases of subacute thyroiditis after inactivated SARS-CoV-2 vaccine (CoronaVac®). Three female healthcare workers have applied to our clinic with anterior neck pain and fatigue 4 to 7 days after SARS-CoV-2 vaccination. Two of them were in the breastfeeding period. They were negative for thyroid antibodies, and there was no previous history of thyroid disease, upper respiratory tract infection, or COVID-19. Laboratory test results and imaging findings were consistent with subacute thyroiditis. RESULTS SARS-CoV-2 vaccination can lead to subacute thyroiditis as a phenomenon of ASIA syndrome. Subacute thyroiditis may develop within a few days after the SARS-CoV-2 vaccination. Being in the postpartum period may be a facilitating factor for the development of ASIA syndrome after the SARS-CoV-2 vaccination. CONCLUSIONS This is the first report of subacute thyroiditis as a phenomenon of ASIA syndrome after inactivated COVID-19 vaccination. Clinicians should be aware that subacute thyroiditis may develop as a manifestation of ASIA syndrome after the inactive SARS-CoV-2 vaccine.
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Affiliation(s)
- Burçin Gönül İremli
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Hacettepe, Ankara, Turkey
| | - Süleyman Nahit Şendur
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Hacettepe, Ankara, Turkey
| | - Uğur Ünlütürk
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Hacettepe, Ankara, Turkey
- Correspondence and Reprint Requests: Uğur Ünlütürk, MD, Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Hacettepe, 06100, Ankara, Turkey, +903213051707,
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83
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Ng XL, Betzler BK, Testi I, Ho SL, Tien M, Ngo WK, Zierhut M, Chee SP, Gupta V, Pavesio CE, de Smet MD, Agrawal R. Ocular Adverse Events After COVID-19 Vaccination. Ocul Immunol Inflamm 2021; 29:1216-1224. [PMID: 34559576 PMCID: PMC8477588 DOI: 10.1080/09273948.2021.1976221] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The COVID-19 pandemic has galvanized the development of new vaccines at an unprecedented pace. Since the widespread implementation of vaccination campaigns, reports of ocular adverse effects after COVID-19 vaccinations have emerged. This review summarizes ocular adverse effects possibly associated with COVID-19 vaccination, and discusses their clinical characteristics and management. METHODS Narrative Literature Review. RESULTS Ocular adverse effects of COVID-19 vaccinations include facial nerve palsy, abducens nerve palsy, acute macular neuroretinopathy, central serous retinopathy, thrombosis, uveitis, multiple evanescent white dot syndrome, Vogt-Koyanagi-Harada disease reactivation, and new-onset Graves' Disease. Studies in current literature are primarily retrospective case series or isolated case reports - these are inherently weak in establishing association or causality. Nevertheless, the described presentations resemble the reported ocular manifestations of the COVID-19 disease itself. Hence, we hypothesize that the human body's immune response to COVID-19 vaccinations may be involved in the pathogenesis of the ocular adverse effects post-COVID-19 vaccination. CONCLUSION Ophthalmologists and generalists should be aware of the possible, albeit rare, ocular adverse effects after COVID-19 vaccination.
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Affiliation(s)
- Xin Le Ng
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | | | - Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Su Ling Ho
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Melissa Tien
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Wei Kiong Ngo
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Manfred Zierhut
- Centre of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Soon Phaik Chee
- Department of Ocular Inflammation and Immunology, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, The Academia, Singapore
- Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Carlos E Pavesio
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Marc D. de Smet
- MicroInvasive Ocular Surgery Clinic, Lausanne, Switzerland
- Department of Ophthalmology, University of Leiden, Leiden, The Netherlands
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Ocular Inflammation and Immunology, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, The Academia, Singapore
- Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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84
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Valente DS, Zanella RK, Mulazzani CM, Valente SS. Risk Factors for Explantation of Breast Implants: A Cross-Sectional Study. Aesthet Surg J 2021; 41:923-928. [PMID: 33649754 DOI: 10.1093/asj/sjaa352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Explantation of breast implant surgery (EBIS) is an emerging surgical field. Precise information about patients undergoing EBIS is important for preoperative planning of breast, augmentation, complications management, and to address any medicolegal issues. OBJECTIVES The aim of this study was to further extend current knowledge of EBIS risk factors. METHODS An analytic cross-sectional study was conducted involving patients who had previously undergone cosmetic breast augmentation and were seeking EBIS. RESULTS The study recruited 138 patients. The average time from implant placement and decision to explantation was 59.1 months. On average, each 1-year increase in age resulted in a 4% increase in the relative risk (RR) of explantation (confidence interval (CI), 1.07-1.21). Patients who were obese or overweight present a 1.5 times higher risk of EBIS (CI 95%, 1.03-2.29). On average, this RR was 40% lower (CI 95%, 0.33-0.91) in patients who never smoked compared with those with a history of tobacco use. Women with mastalgia had a 72% higher RR for EBIS (CI 95%, 1.11-2.65). The RR of EBIS was 5.6 times higher (CI 95%, 2.42-11.47) in patients presenting major Shoenfeld's criteria for autoimmune/inflammatory syndrome induced by adjuvants (ASIA). The RR of EBIS was 4.3 times higher (CI 95%, 1.96-8.63) in patients presenting minor Shoenfeld's criteria for ASIA. CONCLUSIONS EBIS poses a higher risk to patients who are overweight/obese, have a history of tobacco use, suffer from mastalgia, or present Shoenfeld's criteria for ASIA. It is important to assess properly these individuals before performing implant surgery for breast augmentation. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | | | - Sibelie Souto Valente
- Program in Medicine and Health Sciences, School of Medicine, PUCRS, Porto Alegre, Brazil
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85
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Oyibo SO. Subacute Thyroiditis After Receiving the Adenovirus-Vectored Vaccine for Coronavirus Disease (COVID-19). Cureus 2021; 13:e16045. [PMID: 34235030 PMCID: PMC8242270 DOI: 10.7759/cureus.16045] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 02/04/2023] Open
Abstract
Since the emergence of the coronavirus disease pandemic, several effective vaccines have been introduced. These vaccines work through several different immunogenic pathways to produce effective immunity. There have been a number of reports of patients developing subacute thyroiditis and thyroid dysfunction after receiving the coronavirus (COVID-19) vaccine. This paper presents a case of a female patient who developed subacute thyroiditis soon after receiving the adenovirus-vectored COVID-19 vaccine. The patient presented with severe neck pain and her blood results demonstrated an initial thyrotoxic phase followed by a hypothyroid phase. She had no past history of thyroiditis or thyroid dysfunction. Subacute thyroiditis occurring after COVID-19 vaccination is rare but also probably underreported. We hope that this case report not only contributes to the literature but also raises awareness of subacute thyroiditis occurring after receiving the COVID-19 vaccine.
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Affiliation(s)
- Samson O Oyibo
- Diabetes and Endocrinology, Peterborough City Hospital, Peterborough, GBR
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86
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Weintraub MA, Ameer B, Sinha Gregory N. Graves Disease Following the SARS-CoV-2 Vaccine: Case Series. J Investig Med High Impact Case Rep 2021; 9:23247096211063356. [PMID: 34939881 PMCID: PMC8724979 DOI: 10.1177/23247096211063356] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/31/2021] [Accepted: 11/10/2021] [Indexed: 01/11/2023] Open
Abstract
Widespread vaccination is a principal strategy to mitigate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and lessen the global burden of coronavirus disease 2019 (COVID-19). Information is rapidly evolving about the impact of SARS-CoV-2 vaccines on the immune and endocrine systems. This case series heightens clinical awareness of possible thyroid effects and conveys knowledge of what to monitor, which are fundamental components of public health and pharmacovigilance. We present a case series of Graves disease following mRNA SARS-CoV-2 vaccination, with symptoms and altered thyroid function tests developing within 7 days of the first dose in 2 women aged 38 and 63 years, and 28 days after the second dose in a 30-year-old man. New-onset Graves disease occurred following administration of mRNA vaccines against SARS-CoV-2. Based on the timing of signs and symptoms relative to administration of the vaccine and the absence of other probable causes, we consider the vaccine as a potential contributor to the diagnosis. The viral spike protein, delivered indirectly through an encoded mRNA vaccine, may be capable of triggering an inflammatory cascade and immune response triggering thyroid dysfunction.
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Affiliation(s)
| | - Barbara Ameer
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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87
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Antonelli A, Shoenfeld Y. Autoimmunity and the endocrine system: Adrenal, Graves' disease, immune checkpoint. Best Pract Res Clin Endocrinol Metab 2020; 34:101413. [PMID: 32184057 DOI: 10.1016/j.beem.2020.101413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Russia
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