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Ishay A, Oleinikov K, Chertok Shacham E. SARS-CoV-2-Vaccine-Related Endocrine Disorders: An Updated Narrative Review. Vaccines (Basel) 2024; 12:750. [PMID: 39066388 PMCID: PMC11281608 DOI: 10.3390/vaccines12070750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
The emergence of the COVID-19 pandemic has led to the rapid and worldwide development and investigation of multiple vaccines. While most side effects of these vaccines are mild and transient, potentially severe adverse events may occur and involve the endocrine system. This narrative review aimed to explore the current knowledge on potential adverse endocrine effects following COVID-19 vaccination, with thyroid disorders being the most common. Data about pituitary, adrenal, diabetes, and gonadal events are also reviewed. This review also provides a comprehensive understanding of the pathogenesis of endocrine disorders associated with SARS-CoV-2 vaccines. PubMed/MEDLINE, Embase database (Elsevier), and Google Scholar searches were performed. Case reports, case series, original studies, and reviews written in English and published online up to 31 August 2023 were selected and reviewed. Data on endocrine adverse events of SARS-CoV-2 vaccines are accumulating. However, their causal relationship with COVID-19 vaccines is not strong enough to make a definite conclusion, and further studies are needed to clarify the pathogenesis mechanisms of the endocrine disorders linked to COVID-19 vaccines.
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Affiliation(s)
- Avraham Ishay
- Endocrinology Unit, HaEmek Medical Center, Yitzhak Rabin Av. 21, Afula 18101, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel
| | - Kira Oleinikov
- Endocrinology Unit, HaEmek Medical Center, Yitzhak Rabin Av. 21, Afula 18101, Israel
| | - Elena Chertok Shacham
- Endocrinology Unit, HaEmek Medical Center, Yitzhak Rabin Av. 21, Afula 18101, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel
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2
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Mitchell MC, Shults D, Gonzalez E. Neck Pain and Symptomatic Hypothyroidism: An Atypical Presentation of Subacute Thyroiditis. Cureus 2024; 16:e58148. [PMID: 38741869 PMCID: PMC11088989 DOI: 10.7759/cureus.58148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Subacute thyroiditis (SAT) is a rare form of thyroid disease characterized by fever, neck pain, and dysregulated thyroid hormone levels. It is caused by the post-viral inflammation and destruction of thyroid follicles. Patients typically present with symptoms of hyperthyroidism, as stored thyroid hormone is released into the blood. In this case, we describe a 34-year-old female who presented to the clinic complaining of neck pain and a headache for two days. She endorsed fatigue, myalgias, dizziness, and constipation but denied any fever. She reported only minimal pain relief with ibuprofen and denied a history of recent illness. On exam, she was afebrile and normotensive. Her physical exam was notable for neck tenderness over the right lobe and isthmus of the thyroid, thyromegaly, and a palpable thyroid nodule. Her complete blood count showed no sign of infection or hematologic abnormality, but her thyroid studies showed an elevated thyroid stimulating hormone of 2.1 mIU/L and a decreased thyroxine (T4) level below 0.01 ng/dL. The laboratory results, history, and physical exam led to the diagnosis of the hypothyroid stage of subacute thyroiditis. She was initially treated with ibuprofen 600mg without resolution of her symptoms. She was then treated with prednisone 40mg with symptom relief. This case highlights an atypical presentation of subacute thyroiditis and adds a new presentation to the discussion for patients with this condition.
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Affiliation(s)
- Mary C Mitchell
- Medical School, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Daniel Shults
- Family Medicine, Christ Health Center, Birmingham, USA
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3
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Angelopoulos N, Askitis DP, Androulakis I, Valvis N, Paparodis R, Petkova V, Boniakos A, Zianni D, Perogamvros I, Toulis K, Livadas S, Iakovou I. Clinical Aspects in Subacute Thyroiditis: A Real-Life Study on 226 Cases in Greece Amid the COVID-19 Pandemic. J Clin Med 2023; 12:7171. [PMID: 38002783 PMCID: PMC10671895 DOI: 10.3390/jcm12227171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE This study aimed to evaluate various therapeutic approaches, identify potential predictive factors for the recurrence and development of hypothyroidism, and examine specific clinical and laboratory characteristics of patients with subacute thyroiditis (SAT) due to SARS-CoV-2 infection. METHODS We retrospectively analyzed the medical records of 226 patients with confirmed SAT diagnosed from January 2020 to November 2022. RESULTS The mean age was 48.01 ± 0.75 years, and the F/M ratio was 2.3/1. At the end of the follow-up period, 69 patients (32.1%) had developed hypothyroidism. Treatment duration was significantly shorter with nonsteroidal anti-inflammatory drugs (NSAIDs) (17.40 ± 2.56 days), while time-to-symptom relief was shorter with glucocorticoids (CGs). Recurrence was observed only in those treated with corticosteroid preparations (14.1%). C-reactive protein levels at treatment discontinuation were higher in patients who experienced SAT recurrence, while the coexistence of Hashimoto's thyroiditis was a significant predictive factor for the development of hypothyroidism. The TSH value at the time of treatment withdrawal >4.12 μIU/mL showed optimal sensitivity and specificity for the prediction of permanent hypothyroidism. Regarding COVID-19, 34 patients (15%) experienced related SAT, with similar clinical manifestations of the disease but a higher BMI and shorter time-to-symptom relief. CONCLUSION In conclusion, GCs administration alleviated acute symptoms earlier during the onset of SAT, whereas NSAIDs had a shorter treatment duration, and both regimens could not prevent the development of delayed hypothyroidism. The clinical characteristics of SAT due to COVID-19 infections were similar to those of typical SAT disease.
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Affiliation(s)
- Nikolaos Angelopoulos
- Academic Department of Nuclear Medicine, School of Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece;
| | - Dimitrios P. Askitis
- Athens Medical Centre, 65403 Athens, Greece; (D.P.A.); (I.A.); (N.V.); (V.P.); (A.B.); (D.Z.); (S.L.)
| | - Ioannis Androulakis
- Athens Medical Centre, 65403 Athens, Greece; (D.P.A.); (I.A.); (N.V.); (V.P.); (A.B.); (D.Z.); (S.L.)
| | - Nicolas Valvis
- Athens Medical Centre, 65403 Athens, Greece; (D.P.A.); (I.A.); (N.V.); (V.P.); (A.B.); (D.Z.); (S.L.)
| | - Rodis Paparodis
- Center for Diabetes and Endocrine Research, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43606, USA;
| | - Valentina Petkova
- Athens Medical Centre, 65403 Athens, Greece; (D.P.A.); (I.A.); (N.V.); (V.P.); (A.B.); (D.Z.); (S.L.)
| | - Anastasios Boniakos
- Athens Medical Centre, 65403 Athens, Greece; (D.P.A.); (I.A.); (N.V.); (V.P.); (A.B.); (D.Z.); (S.L.)
| | - Dimitra Zianni
- Athens Medical Centre, 65403 Athens, Greece; (D.P.A.); (I.A.); (N.V.); (V.P.); (A.B.); (D.Z.); (S.L.)
| | - Ilias Perogamvros
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester M13 9PL, UK;
| | - Konstantinos Toulis
- Diabetes Unit, Division of Endocrinology, 1st Department of Internal Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece;
| | - Sarantis Livadas
- Athens Medical Centre, 65403 Athens, Greece; (D.P.A.); (I.A.); (N.V.); (V.P.); (A.B.); (D.Z.); (S.L.)
| | - Ioannis Iakovou
- Academic Department of Nuclear Medicine, School of Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece;
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4
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Kanabaj K, Sokołowska-Wojdyło M, Wilkowska A, Nowicki RJ. Schnitzler syndrome associated with recurrent subacute thyroiditis and SARS-CoV-2 vaccine-A case review. J Eur Acad Dermatol Venereol 2023; 37:e1264-e1265. [PMID: 37415365 DOI: 10.1111/jdv.19305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Affiliation(s)
- K Kanabaj
- Dermatology, Venereology and Allergology, Gdański Uniwersytet Medyczny, Gdańsk, Poland
| | - M Sokołowska-Wojdyło
- Dermatology, Venereology and Allergology, Gdański Uniwersytet Medyczny, Gdańsk, Poland
| | - A Wilkowska
- Dermatology, Venereology and Allergology, Gdański Uniwersytet Medyczny, Gdańsk, Poland
| | - R J Nowicki
- Dermatology, Venereology and Allergology, Gdański Uniwersytet Medyczny, Gdańsk, Poland
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5
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Markus E, Bel-Ange A, Benbassat C, Steinschneider M, Koren R. Short- and long-term outcomes of patients with hyper or hypothyroidism following COVID vaccine. J Investig Med 2023; 71:700-706. [PMID: 37199279 DOI: 10.1177/10815589231173876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Since the beginning of the wide-scale anti-Coronavirus disease 2019 (COVID-19) vaccination program, sporadic cases of thyroid disease following vaccination have been reported. We describe 19 consecutive cases of COVID vaccine-related thyroid disease. Medical records were reviewed for 9 patients with Graves' disease (GD) and 10 with Thyroiditis, all of whom were diagnosed following COVID-19 vaccination. In the GD group, the median age was 45.5 years, female/male(F/M) ratio 5:4, thyroid-stimulating immunoglobulins were elevated in seven patients. The median time from vaccination to diagnosis was 3 months. Methimazole treatment was given to all but one patient. At a median follow-up of 8.5 months from vaccination, three patients were still on methimazole, five went into remission (data were missing for one). In the Thyroiditis group, the median age was 47 years, the F/M ratio 7:3. Thyroiditis was diagnosed after the first, second, and third doses in one, two, and seven patients, respectively. The median time from vaccination to diagnosis was 2 months. TPO antibodies were positive in three patients. All patients were euthyroid off medication at the last visit. Six patients were diagnosed in the hypothyroid phase at 2.5 months from vaccination. Four resolved spontaneously at 3, 6, 4, and 8 months; the other two were treated with thyroxine at 1.5 and 2 months from vaccination and remained on treatment at their last visit, at 11.5 and 8.5 months, respectively. Thyroid disease should be included among possible complications of COVID-19 vaccine and either a late onset or delayed diagnosis should be considered.
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Affiliation(s)
- Efrat Markus
- Endocrine Institute, Shamir medical center, Zerifin, Israel
| | - Anat Bel-Ange
- Endocrine Institute, Shamir medical center, Zerifin, Israel
| | - Carlos Benbassat
- Endocrine Institute, Shamir medical center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Steinschneider
- Endocrine Institute, Shamir medical center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Koren
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine A, Shamir Medical Center, Zerifin, Israel
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6
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Batman A, Yazıcı D, Dikbaş O, Ağbaht K, Saygılı ES, Demirci İ, Bursa N, Ayas G, Anıl C, Cesur M, Korkmaz FN, Bahçecioglu AB, Çorapçıoğlu D, Erdoğan MF, Bostan H, Calapkulu M, Hepşen S, Uçan B, Çakal E, Güler BY, Haymana C, İpekçi SH, Aydın S, Sezer H, Özışık S, Deyneli O, Alagöl F, Tanakol R, Eroğlu M, Mutlu Ü, Hacışahinoğulları H, Üzüm AK, Demir C, Koç G, Fırat SN, Omma T, İnce N, Polat ŞB, Topaloğlu O, Aydın C, Çakır B, Bahadır ÇT, Güven M, Sözen M, Selek A, Cantürk Z, Çetinarslan B, Aydemir M, Taşkaldıran I, Bozkuş Y, İyidir ÖT, Haydardedeoğlu FE, Basmaz SE, Ünal MÇ, Demir T, Oğuz A, Çelik Ö, Yilmaz M, Cimsir A, Kayıhan S, Uc ZA, Tekin S, Topaloğlu Ö, Saydam BÖ, Ünsal YA, Özer Ö, Yorulmaz G, Uğur K, Çakır SD, Aşık M, Unubol M, Genc S, Andac B, Okur M, Dogan O, Karakiliç E, Kocabas GU, Kirac CO, Cansu GB, Uygur MM, Pekkolay Z, Öztürk S, Güngüneş A, Gürkan E, Keskin L, Çağlayan K, Günay YE, İmre E, Şener SY, Kalkan AT, Gök DE, Şahin M. Subacute THYROiditis Related to SARS-CoV-2 VAccine and Covid-19 (THYROVAC Study): A Multicenter Nationwide Study. J Clin Endocrinol Metab 2023; 108:e1013-e1026. [PMID: 37186260 DOI: 10.1210/clinem/dgad235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
CONTEXT The aims of the study are to compare characteristics of subacute thyroiditis (SAT) related to different etiologies, and to identify predictors of recurrence of SAT and incident hypothyroidism. METHODS This nationwide, multicenter, retrospective cohort study included 53 endocrinology centers in Turkey. The study participants were divided into either COVID-19-related SAT (Cov-SAT), SARS-CoV-2 vaccine-related SAT (Vac-SAT), or control SAT (Cont-SAT) groups. RESULTS Of the 811 patients, 258 (31.8%) were included in the Vac-SAT group, 98 (12.1%) in the Cov-SAT group, and 455 (56.1%) in the Cont-SAT group. No difference was found between the groups with regard to laboratory and imaging findings. SAT etiology was not an independent predictor of recurrence or hypothyroidism. In the entire cohort, steroid therapy requirement and younger age were statistically significant predictors for SAT recurrence. C-reactive protein measured during SAT onset, female sex, absence of antithyroid peroxidase (TPO) positivity, and absence of steroid therapy were statistically significant predictors of incident (early) hypothyroidism, irrespective of SAT etiology. On the other hand, probable predictors of established hypothyroidism differed from that of incident hypothyroidism. CONCLUSION Since there is no difference in terms of follow-up parameters and outcomes, COVID-19- and SARS-CoV-2 vaccine-related SAT can be treated and followed up like classic SATs. Recurrence was determined by younger age and steroid therapy requirement. Steroid therapy independently predicts incident hypothyroidism that may sometimes be transient in overall SAT and is also associated with a lower risk of established hypothyroidism.
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Affiliation(s)
- Adnan Batman
- Department of Internal Medicine, Division of Endocrinology and Metabolism, School of Medicine, Koc University, 34010 Istanbul, Turkey
| | - Dilek Yazıcı
- Department of Internal Medicine, Division of Endocrinology and Metabolism, School of Medicine, Koc University, 34010 Istanbul, Turkey
| | - Oğuz Dikbaş
- Department of Endocrinology and Metabolism, Giresun University School of Medicine, 28200 Giresun, Turkey
| | - Kemal Ağbaht
- Department of Endocrinology and Metabolism, Defne Hospital, 31030 Hatay, Turkey
| | - Emre Sedar Saygılı
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Faculty of Medicine, Canakkale Onsekiz Mart University, 17020 Canakkale, Turkey
| | - İbrahim Demirci
- Department of Endocrinology and Metabolism, Gulhane Training and Research Hospital, University of Health Sciences Turkey, 06010 Ankara, Turkey
| | - Nurbanu Bursa
- Department of Statistics Beytepe, Hacettepe University, 06230 Ankara, Turkey
| | - Görkem Ayas
- School of Medicine, Koc University, 34450 Istanbul, Turkey
| | - Cüneyd Anıl
- Department of Endocrinology and Metabolic Diseases, Güven Hospital, 06540 Ankara, Turkey
| | - Mustafa Cesur
- Department of Endocrinology and Metabolic Diseases, Güven Hospital, 06540 Ankara, Turkey
| | - Fatma Nur Korkmaz
- Department of Endocrinology and Metabolism, Ankara University, School of Medicine, 06050 Ankara, Turkey
| | - Adile Begüm Bahçecioglu
- Department of Endocrinology and Metabolism, Ankara University, School of Medicine, 06050 Ankara, Turkey
| | - Demet Çorapçıoğlu
- Department of Endocrinology and Metabolism, Ankara University, School of Medicine, 06050 Ankara, Turkey
| | - Murat Faik Erdoğan
- Department of Endocrinology and Metabolism, Ankara University, School of Medicine, 06050 Ankara, Turkey
| | - Hayri Bostan
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey
| | - Murat Calapkulu
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey
| | - Sema Hepşen
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey
| | - Bekir Uçan
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey
| | - Erman Çakal
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey
| | - Bağdagül Yüksel Güler
- Department of Endocrinology and Metabolism, Gulhane Training and Research Hospital, University of Health Sciences Turkey, 06010 Ankara, Turkey
| | - Cem Haymana
- Department of Endocrinology and Metabolism, Gulhane Training and Research Hospital, University of Health Sciences Turkey, 06010 Ankara, Turkey
| | - Süleyman Hilmi İpekçi
- Department of Endocrinology, Hisar Intercontinental Hospital, 34768 Istanbul, Turkey
| | - Selami Aydın
- Department of Internal Medicine, Hisar Intercontinental Hospital, 34768 Istanbul, Turkey
| | - Havva Sezer
- Department of Internal Medicine, Division of Endocrinology and Metabolism, School of Medicine, Koc University, 34010 Istanbul, Turkey
| | - Seçil Özışık
- Department of Internal Medicine, Division of Endocrinology and Metabolism, School of Medicine, Koc University, 34010 Istanbul, Turkey
| | - Oğuzhan Deyneli
- Department of Internal Medicine, Division of Endocrinology and Metabolism, School of Medicine, Koc University, 34010 Istanbul, Turkey
| | - Faruk Alagöl
- Department of Endocrinology and Metabolism, VKV Amerikan Hospital-Koç University School of Medicine, 34365 Istanbul, Turkey
| | - Refik Tanakol
- Department of Endocrinology and Metabolism, VKV Amerikan Hospital-Koç University School of Medicine, 34365 Istanbul, Turkey
| | - Mustafa Eroğlu
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Balikesir University Faculty of Medicine, 10145 Balikesir, Turkey
| | - Ümmü Mutlu
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, Turkey
| | - Hülya Hacışahinoğulları
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, Turkey
| | - Ayşe Kubat Üzüm
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, Turkey
| | - Canan Demir
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Atilim University School of Medicine, 06830 Ankara, Turkey
| | - Gönül Koç
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Sevde Nur Fırat
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Tülay Omma
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Ankara Training and Reasearch Hospital, 06230 Ankara, Turkey
| | - Nurcan İnce
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara City Hospital, 06800 Ankara, Turkey
| | - Şefika Burçak Polat
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara City Hospital, 06800 Ankara, Turkey
| | - Oya Topaloğlu
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara City Hospital, 06800 Ankara, Turkey
| | - Cevdet Aydın
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara City Hospital, 06800 Ankara, Turkey
| | - Bekir Çakır
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara City Hospital, 06800 Ankara, Turkey
| | - Çiğdem Tura Bahadır
- Department of Endocrinology and Metabolism, Amasya University, School of Medicine, 05100 Amasya, Turkey
| | - Mehmet Güven
- Department of Endocrinology and Metabolism, Sirnak State Hospital, 73000 Sirnak, Turkey
| | - Mehmet Sözen
- Department of Endocrinology and Metabolism, Kocaeli University, School of Medicine, 41000 Kocaeli, Turkey
| | - Alev Selek
- Department of Endocrinology and Metabolism, Kocaeli University, School of Medicine, 41000 Kocaeli, Turkey
| | - Zeynep Cantürk
- Department of Endocrinology and Metabolism, Kocaeli University, School of Medicine, 41000 Kocaeli, Turkey
| | - Berrin Çetinarslan
- Department of Endocrinology and Metabolism, Kocaeli University, School of Medicine, 41000 Kocaeli, Turkey
| | - Mustafa Aydemir
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Akdeniz University, School of Medicine, 07050 Antalya, Turkey
| | - Işılay Taşkaldıran
- Department of Endocrinology and Metabolism, Faculty of Medicine, Baskent University, 06790 Ankara, Turkey
| | - Yusuf Bozkuş
- Department of Endocrinology and Metabolism, Faculty of Medicine, Baskent University, 06790 Ankara, Turkey
| | - Özlem Turhan İyidir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Baskent University, 06790 Ankara, Turkey
| | - Filiz Ekşi Haydardedeoğlu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Baskent University, 79097 Adana, Turkey
| | - Seda Erem Basmaz
- Department of Endocrinology and Metabolism, Kocaeli Derince Training and Research Hospital, 41900 Kocaeli, Turkey
| | - Mehmet Çağrı Ünal
- Department of Endocrinology and Metabolism, Faculty of Medicine, Dokuz Eylul University, 35330 Izmir, Turkey
| | - Tevfik Demir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Dokuz Eylul University, 35330 Izmir, Turkey
| | - Ayten Oğuz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Biruni University, 34295 Istanbul, Turkey
| | - Özlem Çelik
- Department of Endocrinology and Metabolism, Faculty of Medicine, Acıbadem University, 34752 Istanbul, Turkey
| | - Merve Yilmaz
- Department of Endocrinology and Metabolism, Samsun State Hospital, 55060 Samsun, Turkey
| | - Aykut Cimsir
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey
| | - Serdar Kayıhan
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey
| | - Ziynet Alphan Uc
- Department of Endocrinology and Metabolism, Usak University, Usak Training and Research Hospital, 64300 Usak, Turkey
| | - Sakin Tekin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Zonguldak Bulent Ecevit University, 67100 Zonguldak, Turkey
| | - Ömercan Topaloğlu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Zonguldak Bulent Ecevit University Obesity and Diabetes Practice and Research Center, 67100 Zonguldak, Turkey
| | - Başak Özgen Saydam
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Yenimahalle Training and Research Hospital, 06370 Ankara, Turkey
| | - Yasemin Aydoğan Ünsal
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Yenimahalle Training and Research Hospital, 06370 Ankara, Turkey
| | - Özge Özer
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Eskisehir Osmangazi University, 26040 Eskisehir, Turkey
| | - Göknur Yorulmaz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Eskisehir Osmangazi University, 26040 Eskisehir, Turkey
| | - Kader Uğur
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Fırat University, 23119 Elazıg, Turkey
| | - Sezin Doğan Çakır
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Istanbul Taksim Training and Research Hospital, 34433 Istanbul, Turkey
| | - Mehmet Aşık
- Endocrinologist, Private Office, Bodrum, 48400 Mugla, Turkey
| | - Mustafa Unubol
- Department of Endocrinology and Metabolism, School of Medicine, Adnan Menderes University, 09100 Aydin, Turkey
| | - Selin Genc
- Department of Endocrinology and Metabolism, School of Medicine, Inonu University, 44280 Malatya, Turkey
| | - Burak Andac
- Department of Endocrinology and Metabolism, School of Medicine, Trakya University, 22130 Edirne, Turkey
| | - Mine Okur
- Department of Endocrinology and Metabolism, School of Medicine, Trakya University, 22130 Edirne, Turkey
| | - Ozlem Dogan
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Haseki Training and Research Hospital, 34096 Istanbul, Turkey
| | - Ersen Karakiliç
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Faculty of Medicine, Canakkale Onsekiz Mart University, 17020 Canakkale, Turkey
| | - Gokcen Unal Kocabas
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ege University, 35100 Izmir, Turkey
| | - Cem Onur Kirac
- Department of Endocrinology and Metabolism, Kahramanmaras Necip Fazil City Hospital, 46050 Kahramanmaras, Turkey
| | - Güven Barış Cansu
- Department of Endocrinology and Metabolism, School of Medicine, Kutahya University of Health Sciences, 43100 Kutahya, Turkey
| | - Meliha Melin Uygur
- Department of Endocrinology and Metabolism, School of Medicine, Marmara University, Pendik Training and Research Hospital, 34899 Istanbul, Turkey
| | - Zafer Pekkolay
- Department of Endocrinology and Metabolism, School of Medicine, Dicle University, 21100 Diyarbakir, Turkey
| | - Sadettin Öztürk
- Department of Endocrinology and Metabolism, School of Medicine, Gaziantep University, 27850 Gaziantep, Turkey
| | - Aşkın Güngüneş
- Department of Endocrinology and Metabolism, School of Medicine, Kırıkkale University, 71300 Kırıkkale, Turkey
| | - Eren Gürkan
- Department of Endocrinology and Metabolism, School of Medicine, Hatay Mustafa Kemal University, 31001 Hatay, Turkey
| | - Lezzan Keskin
- Department of Endocrinology and Metabolism, School of Medicine, Malatya Turgut Ozal University, Malatya Training and Research Hospital, 44000 Malatya, Turkey
| | - Kenan Çağlayan
- Department of Endocrinology and Metabolism, School of Medicine, Baskent University Istanbul Hospital, 34662 Istanbul, Turkey
| | - Yasemin Emur Günay
- Department of Endocrinology and Metabolism, School of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Eren İmre
- Department of Endocrinology and Metabolism, Dr Ersin Arslan Education and Research Hospital, 27010 Gaziantep, Turkey
| | - Selcuk Yusuf Şener
- Department of Endocrinology and Metabolism, Pendik Medikalpark Hospital, 34899 Istanbul, Turkey
| | - Ahmet Toygar Kalkan
- Department of Endocrinology and Metabolism, Kastamonu Research and Training Hospital, 37150 Kastamonu, Turkey
| | - Deniz Engin Gök
- Department of Endocrinology and Metabolism, Lokman Hekim Hospital, 06700 Ankara, Turkey
| | - Mustafa Şahin
- Department of Endocrinology and Metabolism, Ankara University, School of Medicine, 06050 Ankara, Turkey
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7
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Abstract
At the end of 2019, the world began to fight the coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus-2. Many vaccines have quickly been developed to control the epidemic, and with the widespread use of vaccines globally, several vaccine-related adverse events have been reported. This review mainly focused on COVID-19 vaccination-associated thyroiditis and summarized the current evidence regarding vaccine-induced subacute thyroiditis, silent thyroiditis, Graves' disease, and Graves' orbitopathy. The main clinical characteristics of each specific disease were outlined, and possible pathophysiological mechanisms were discussed. Finally, areas lacking evidence were specified, and a research agenda was proposed.
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Affiliation(s)
- Süleyman Nahit Şendur
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Seda Hanife Oğuz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Uğur Ünlütürk
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
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8
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Ziaka M, Exadaktylos A. Insights into SARS-CoV-2-associated subacute thyroiditis: from infection to vaccine. Virol J 2023; 20:132. [PMID: 37344878 DOI: 10.1186/s12985-023-02103-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023] Open
Abstract
Since the COVID-19 emergence as a global pandemic in March 2020, more than 5 million SARS-CoV-2-related deaths have been globally documented. As the pandemic progressed, it became clear that, although the infection is mainly characterized as a respiratory disease, it also affects other organs and systems, including the thyroid gland. Indeed, emerging evidence suggests that SARS-CoV-2 can act as a trigger for various thyroid disorders, for example, subacute thyroiditis (SAT), Grave's disease, and non-thyroidal illness syndrome. The entry of SARS-CoV-2 into the host cells is mainly mediated by the ACE2-receptor, making organs and systems with high expression of this receptor, such as the thyroid gland, highly vulnerable to COVID-19. Accumulating data propose that SAT may be an underestimated manifestation of COVID-19 infection. Importantly, if SAT remains unrecognized, it may trigger or aggravate potential other complications of the disease, for example, respiratory insufficiency and cardiovascular complications, and thus negatively influence prognosis. Moreover, recent case reports, case series, and systematic reviews highlight SAT as a potential side effect of the vaccination against SARS-CoV-2. The present review aims to raise awareness of SARS-CoV-2-associated- and post-vaccination subacute thyroiditis, to discuss recent evidence regarding its pathophysiology, and to present useful information for this special form of SAT related to daily clinical practice.
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Affiliation(s)
- Mairi Ziaka
- Department of Internal Medicine, Hospital of Thun, Thun, Switzerland.
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
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9
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Liu Y, Qian X, Ran C, Li L, Fu T, Su D, Xie S, Tan W. Aptamer-Based Targeted Protein Degradation. ACS NANO 2023; 17:6150-6164. [PMID: 36942868 DOI: 10.1021/acsnano.2c10379] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The selective removal of misfolded, aggregated, or aberrantly overexpressed protein plays an essential role in maintaining protein-dominated biological processes. In parallel, the precise knockout of abnormal proteins is inseparable from the accurate identification of proteins within complex environments. Guided by these precepts, small molecules, or antibodies, are commonly used as protein recognition tools for developing targeted protein degradation (TPD) technology. Indeed, TPD has shown tremendous prospects in chronic diseases, rare diseases, cancer research, and other fields. Meanwhile, aptamers are short RNA or DNA oligonucleotides that can bind to target proteins with high specificity and strong affinity. Accordingly, aptamers are actively used in designing and constructing TPD technology. In this perspective, we provide a brief introduction to TPD technology in its current progress, and we summarize its application challenges. Recent advances in aptamer-based TPD technology are reviewed, together with corresponding challenges and outlooks.
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Affiliation(s)
- Yuan Liu
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
- School of Molecular Medicine, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou 310024, China
| | - Xu Qian
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Chunyan Ran
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
- School of Molecular Medicine, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou 310024, China
| | - Longjie Li
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
- School of Molecular Medicine, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou 310024, China
| | - Ting Fu
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Biology, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, Hunan 410082, China
| | - Dan Su
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
- School of Molecular Medicine, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou 310024, China
| | - Sitao Xie
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Biology, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, Hunan 410082, China
| | - Weihong Tan
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
- School of Molecular Medicine, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou 310024, China
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Biology, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, Hunan 410082, China
- Institute of Molecular Medicine (IMM), Renji Hospital, Shanghai Jiao Tong University School of Medicine, and College of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
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10
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Ie K, Ishizuka K, Sakai T, Motohashi I, Asai S, Okuse C. Subacute Thyroiditis Developing Within 2 Days of Vaccination Against COVID-19 with BNT162b2 mRNA. Eur J Case Rep Intern Med 2023; 10:003735. [PMID: 36819651 PMCID: PMC9930880 DOI: 10.12890/2023_003735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/11/2023] [Indexed: 02/24/2023] Open
Abstract
A 32-year-old woman presented to the outpatient clinic with persistent fever, anterior neck pain, and palpitations over the past week which developed 2 days after she had received the first dose of the Pfizer/BioNTech SARS-CoV-2 mRNA vaccine. On examination, the patient's heart rate was 140 beats per minute and the thyroid gland was tender on palpation. Laboratory studies showed a low serum TSH level with elevated free thyroxine. Thyroid ultrasound revealed low-echoic lesions compatible with the site of tenderness. The patient was diagnosed with subacute thyroiditis and treatment was initiated with acetaminophen and propranolol, which resulted in symptom resolution within 2 weeks. Clinicians should be aware that subacute thyroiditis may occur within a few days following COVID-19 vaccination, especially in patients with anterior cervical pain with no significant abnormal pharyngeal findings and/or severe palpitations, because differentiating them from early non-specific adverse reactions can be challenging. LEARNING POINTS Cases of subacute thyroiditis after vaccination, including against COVID-19, have been increasingly reported.Subacute thyroiditis should be considered in patients with anterior cervical pain with no significant abnormal pharyngeal findings and/or severe palpitations after COVID-19 vaccination because these can be diagnostic clues.It is important to note that this condition can occur as early as a few days after vaccination, in order to avoid diagnostic pitfalls.
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Affiliation(s)
- Kenya Ie
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Kosuke Ishizuka
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Tsubasa Sakai
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Iori Motohashi
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Shiko Asai
- Division of Metabolism and Endocrinology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Chiaki Okuse
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
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11
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Xu C, Jiang R, Liu JY. Emerging trends and hot spots in subacute thyroiditis research from 2001 to 2022: A bibliometric analysis. Front Endocrinol (Lausanne) 2023; 14:1144465. [PMID: 37008914 PMCID: PMC10064097 DOI: 10.3389/fendo.2023.1144465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Subacute thyroiditis (SAT) is the most prevalent self-limiting thyroid disease that causes pain, accounting for about 5% of all clinical thyroid disorders. Numerous clinically noteworthy results have been published in this area over the last 20 years. However, no article has comprehensively assessed the relevant literature yet. We conducted a bibliometric analysis of SAT to provide light on the dynamic nature of scientific advancement and aid researchers in gaining a global perspective while examining research core themes and hotspots. METHODS SAT-related articles and reviews from 2001 to 2022 were retrieved from the Science Citation Index-Expanded of Web of Science Core Collection (WoSCC). We analyzed current research trends and hotspots in this area using CiteSpace and Vosviewer. RESULTS A total of 568 studies associated with SAT research were published in 282 academic journals by 2,473 authors in 900 institutions from 61 countries/regions. The United States was a crucial link in inter-country/region collaboration and was the most frequently involved country in international cooperation. The University of Missouri System was the top organization, and Braley-Mullen H. was the most productive researcher. Thyroid published the most papers, with 36 publications. The most co-cited article was "Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study" (by Fatourechi V., 2003). The clustered network and timeline view of keywords showed that the prevalence, diagnosis, and treatment of SAT were the research core themes during the past 20 years. Analysis of keyword bursts indicated that the clinical characteristic and the influence of COVID-19 on SAT appeared to be the current research hotspots. CONCLUSION This bibliometric analysis conducted a thorough review of the SAT research. The clinical characteristics and the genetic background of SAT under the influence of COVID-19 are current research hotspots. However, there is still a need for further study and global collaboration. Our findings can aid researchers in understanding the current status of SAT research and immediately pinpoint new directions for further investigation.
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12
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İşgören S, Köroğlu G, Görür GD, Demir H. Evaluation of metabolic changes in FDG PET/CT imaging after mRNA-based COVID-19 vaccination. Turk J Med Sci 2022; 52:1745-1753. [PMID: 36945983 PMCID: PMC10390183 DOI: 10.55730/1300-0144.5519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It isimportant to evaluate the vaccine-related metabolic changes on FDG PET/CT to avoid confusing results. We here aimed to assess the frequency and intensity of regional and systemic metabolic PET/CT changes of patients who received the mRNAbased COVID-19 vaccine (BNT162b2-Pfizer/BioNTech) and to analyze possible factors affecting these changes. METHODS Among the patients who underwent FDG PET/CT for any indication in our department between July 2021 and December 2021, 129 volunteer patients with a history of COVID-19 vaccination were included in this prospective observational study. Bilateral axillary lymph nodes, ipsilateral deltoid muscle, bone marrow, spleen, thyroid, and liver FDG uptakes were evaluated visually and semiquantitatively for each examination. RESULTS The frequencies of positive axillary lymph nodes after vaccination were 40%, 44.4%, 32.6%, and 44.7% in all, 1st dose, 2nd dose, and heterologous vaccination regimens groups, respectively. Maximum standardized uptake values of spleen, liver, and bone marrow were statistically high in patients with positive axillary lymph nodes than with negative ones (p < 0.05). Positive deltoid muscle uptake and diffusely increased thyroid uptake findings were observed in 10 and 8 patients, respectively. The median time interval between vaccination and imaging was 9.5 days for patients with positive axillary lymph nodes and 17 days for patients with negative nodes. In our study group, only 8 patients had a positive documented history of COVID-19 infection. DISCUSSION Regional and systemic metabolic changes were occasionally found on FDG PET/CT imaging in patients who received the mRNA-based COVID-19 vaccine. To avoid these timely decreasing changes, we recommend managing the ideal timing of imaging or vaccination and taking a careful history.
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Affiliation(s)
- Serkan İşgören
- Department of Nuclear Medicine Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Gizem Köroğlu
- Department of Nuclear Medicine Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Gözde Dağlıöz Görür
- Department of Nuclear Medicine Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Hakan Demir
- Department of Nuclear Medicine Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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13
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Mehta A, Andrew Awuah W, Yarlagadda R, Kalmanovich J, Huang H, Kundu M, Nansubuga EP, Lopes L, Ghosh B, Hasan MM. Investigating thyroid dysfunction in the context of COVID-19 infection. Ann Med Surg (Lond) 2022; 84:104806. [PMID: 36339111 PMCID: PMC9621589 DOI: 10.1016/j.amsu.2022.104806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/23/2022] [Indexed: 11/07/2022] Open
Abstract
COVID-19 is a contagious viral infection caused by severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2). One of the key features of COVID-19 infection is inflammation. There is increasing evidence pointing to an association between cytokine storm and autoimmunity. One autoimmune disease of interest in connection to COVID-19 is hyperthyroidism. COVID-19 has been shown to decrease TSH levels and induce thyrotoxicosis, destructive thyroiditis, and de novo Graves' disease. It has also been suggested that the immune response against SARS-CoV-2 antigens following vaccination can cross-react through a mechanism called molecular mimicry which can elicit autoimmune reactivity, potentially leading to potential thyroid disease post vaccine. However, if the COVID-19 vaccine is linked to reduced COVID-19 related serious disease, it could potentially play a protective role against post COVID-19 hyperthyroidism (de novo disease and exacerbations). Further studies investigating the complex interplay between COVID-19 or COVID-19 vaccine and thyroid dysfunction can help provide substantial evidence and potential therapeutic targets that can alter prognosis and improve COVID-19 related outcomes in individuals with or without preexisting thyroid disease.
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Affiliation(s)
- Aashna Mehta
- University of Debrecen-Faculty of Medicine, Debrecen, 4032, Hungary
| | | | - Rohan Yarlagadda
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | | | - Helen Huang
- Royal College of Surgeons in Ireland, University of Medicine and Health Science, Dublin, Ireland
| | - Mrinmoy Kundu
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
| | | | - Leilani Lopes
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, OR, USA
| | | | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
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14
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Caron P. Autoimmune and inflammatory thyroid diseases following vaccination with SARS-CoV-2 vaccines: from etiopathogenesis to clinical management. Endocrine 2022; 78:406-417. [PMID: 35763241 PMCID: PMC9243876 DOI: 10.1007/s12020-022-03118-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/14/2022] [Indexed: 01/06/2023]
Abstract
Since the Covid-19 pandemic emerged in 2019, several adenoviral-vectored, mRNA-based and inactivated whole-virus vaccines have been developed. A massive vaccination campaign has been undertaken around the world, and an increasing number of SARS-CoV-2 vaccine-induced thyroid diseases have been described in the literature. Subacute thyroiditis has been reported in 52 patients, mean age 45.5 ± 1.8 years, mainly in women (n = 39). Graves' disease is more frequent in women (n = 22) than in men (n = 10), mean age 46.2 ± 2.6 years, reported as new onset, recurrent or exacerbation of well-controlled hyperthyroidism. The mean time to symptoms onset is 9.0 ± 0.8 days in subacute thyroiditis, and 15.1 ± 2.6 days in Graves' patients. Rare patients (n = 6) present silent or painless autoimmune thyroiditis. Thyroid function and autoimmune tests, inflammatory markers, thyroid echography with colour flow Doppler, radio-activity uptake on thyroid scan, medical treatment and follow-up are described and compared in patients with SARS-CoV-2 vaccine-induced thyroid diseases. The underlying pathogenic mechanisms of vaccine-induced thyroid diseases, molecular mimicry (various SARS-CoV-2 proteins sharing a genetic homology with a large heptapeptide human protein) or autoimmune/inflammatory syndrome induced by adjuvants (ASIA) are discussed in the context of predisposition or genetic susceptibility. The benefits of SARS-CoV-2 vaccination far outweigh the potential vaccine-induced adverse effects, but clinicians should be aware of possible autoimmune and inflammatory thyroid diseases, and can advise patients to seek medical assistance when experiencing anterior neck pain, fever or palpitations following SARS-CoV-2 vaccines. Further studies are warranted to investigate the etiopathogenesis and to clarify the factors which predispose patients to SARS-CoV-2 vaccine-induced thyroid diseases.
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Affiliation(s)
- Philippe Caron
- Department of Endocrinology and Metabolic Diseases, Cardiovascular and Metabolic Unit, CHU-Larrey, Toulouse, France.
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15
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Abstract
The COVID-19 pandemic has posed a significant health threat globally. Timely and appropriate vaccination is a key step to reduce the morbidity and mortality from COVID-19. The clinical course of COVID-19 infection and the effects of COVID-19 vaccination are influenced by patients' health situations and involve a systemic physiological reaction. Just like an "endocrine phenotype" of COVID-19 infection, endocrine dysfunction after COVID-19 vaccination also acquired clinical concerns. In the present review, we briefly introduce the commonly available vaccines against SARS-CoV-2, summarize the influence of COVID-19 vaccines on the endocrine system, and explore the underlying pathogenic mechanisms.
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Affiliation(s)
- Ying Zhao
- Geriatric Medicine Center, Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Department of Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Xiaohong Wu
- Geriatric Medicine Center, Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Department of Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
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16
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Aydoğan Bİ, Ünlütürk U, Cesur M. Type 1 diabetes mellitus following SARS-CoV-2 mRNA vaccination. Endocrine 2022; 78:42-46. [PMID: 35809159 PMCID: PMC9282628 DOI: 10.1007/s12020-022-03130-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/28/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccines have been reported to trigger immune side effects. Type 1 diabetes as a manifestation of autoimmune/inflammatory syndrome induced by adjuvants has been reported in a limited number of cases after vaccinations. A few type 1 diabetes cases after SARS-CoV-2 vaccination have been reported. This study aims to report type 1 diabetes cases associated with the mRNA-based SARS-CoV-2 vaccination. METHODS We report four cases of type 1 diabetes mellitus after mRNA-based SARS-CoV-2 vaccine, BNT162b2 (Pfizer-BioNTech). In the medical history, one subject had autoimmune thyroid disease. All patients had autoantibodies against glutamate decarboxylase. RESULTS In the presented case series, type 1 diabetes developed a few weeks after BNT162b2 vaccination. After developing type 1 diabetes, the insulin dose requirements of all patients decreased rapidly, and the need for insulin therapy in three patients disappeared during follow-up. Acute deterioration of glucose regulation in a patient followed by BNT162b2 administration may be due to vaccine-induced autoimmune diabetes. CONCLUSION Vaccination with BNT162b2 may trigger type 1 diabetes.
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Affiliation(s)
- Berna İmge Aydoğan
- Department of Endocrinology and Metabolism, Ankara Güven Hospital, Ankara, Turkey.
| | - Uğur Ünlütürk
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mustafa Cesur
- Department of Endocrinology and Metabolism, Ankara Güven Hospital, Ankara, Turkey
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17
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Jafarzadeh A, Nemati M, Jafarzadeh S, Nozari P, Mortazavi SMJ. Thyroid dysfunction following vaccination with COVID-19 vaccines: a basic review of the preliminary evidence. J Endocrinol Invest 2022; 45:1835-1863. [PMID: 35347651 PMCID: PMC8960081 DOI: 10.1007/s40618-022-01786-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/13/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE The safety and efficacy of the several types of COVID-19 vaccines, including mRNA-based, viral vector-based, and inactivated vaccines, have been approved by WHO. The vaccines can confer protection against severe SARS-CoV-2 infection through induction of the anti-spike protein neutralizing antibodies. However, SARS-CoV-2 vaccines have been associated with very rare complications, such as thyroid disorders. This review was conducted to highlight main features of thyroid abnormalities following COVID-19 vaccination. METHODS A comprehensive search within electronic databases was performed to collect reports of thyroid disorders after vaccination with COVID-19 vaccines. RESULTS Among 83 reported cases including in this review, the most cases of thyroid abnormalities were observed after vaccination with mRNA-based vaccines (68.7%), followed by viral vector vaccines (15.7%) and 14.5% cases following inactivated vaccines. Subacute thyroiditis (SAT) was the most common COVID-19 vaccination-related thyroid disease, accounting for 60.2% of all cases, followed by Graves' disease (GD) with 25.3%. Moreover, some cases with focal painful thyroiditis (3.6%), silent thyroiditis (3.6%), concurrent GD and SAT (2.4%), thyroid eye disease (1.2%), overt hypothyroidism (1.2%), atypical subacute thyroiditis (1.2%), and painless thyroiditis with TPP (1.2%) were also reported. Overall, in 58.0% of SAT cases and in 61.9% of GD cases, the onset of the symptoms occurred following the first vaccine dose with a median of 10.0 days (ranged: 3-21 days) and 10.0 days (ranged: 1-60 days) after vaccination, respectively. Moreover, 40.0% of SAT patients and 38.1% of GD patients developed the symptoms after the second dose with a median of 10.5 days (ranged: 0.5-37 days) and 14.0 days (ranged: 2-35 days) after vaccination, respectively. CONCLUSION Fortunately, almost all cases with COVID-19 vaccination-associated thyroid dysfunctions had a favorable outcome following therapy. The benefits of COVID-19 vaccinations in terms of terminating the pandemic and/or reducing mortality rates can exceed any risk of infrequent complications such as a transient thyroid malfunction.
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Affiliation(s)
- A Jafarzadeh
- Department of Immunology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
- Department of Immunology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
| | - M Nemati
- Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Haematology and Laboratory Sciences, School of Para-Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - S Jafarzadeh
- Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - P Nozari
- Department of Immunology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - S M J Mortazavi
- Department of Medical Physics and Engineering, Shiraz University of Medical Sciences, Shiraz, Iran
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18
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Bostan H, Kayihan S, Calapkulu M, Hepsen S, Gul U, Ozturk Unsal I, Kizilgul M, Sencar ME, Cakal E, Ucan B. Evaluation of the diagnostic features and clinical course of COVID-19 vaccine-associated subacute thyroiditis. Hormones (Athens) 2022; 21:447-455. [PMID: 35711078 PMCID: PMC9203142 DOI: 10.1007/s42000-022-00380-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/08/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to identify cases of coronavirus disease 2019 (COVID-19) vaccine-associated subacute thyroiditis (SAT) during the active vaccination period of the pandemic, analyze the characteristics of these cases, and compare them with cases of non-vaccine associated SAT diagnosed in the same period. METHODS A total of 55 patients diagnosed with SAT in our outpatient clinic between February and October, 2021, were included in this retrospective single-center study. RESULTS Of the study population, 16 (29.1%) were diagnosed with COVID-19 vaccine-associated SAT (10 with CoronaVac® and six with Pfizer-BioNTech® vaccine), with a median time to onset of symptoms after vaccination of 6.5 (range, 2-20) days. There was no statistically significant difference between the vaccine-associated (VA) and non-vaccine associated (NVA) groups in terms of age, gender, time to diagnosis, thyroid volumes, thyroid function tests, and acute phase reactants. Seven (43.8%) and 25 (64.1%) patients were treated with methylprednisolone in the VA group and NVA group, respectively (p = 0.16). Follow-up data of 45 patients (16/16 for VA and 29/39 for NVA) were available. The mean follow-up of these patients was 47.4 ± 19.4 days, and the follow-up periods of the VA group and NVA group were comparable (p = 0.24). There was no difference between the two groups in terms of the frequency of euthyroidism at the follow-up visit (12/16 vs.14/29, p = 0.08). CONCLUSION With the increase in COVID-19 vaccination rates during the current pandemic, VA SAT cases are seen more frequently. The present study demonstrated that these cases have similar diagnostic features and clinical course to that of classic forms of SAT. In addition, most patients with VA SAT had a mild clinical course that improved with non-steroidal anti-inflammatory drugs.
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Affiliation(s)
- Hayri Bostan
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv No. 1, 06110, AltindagAnkara, Turkey.
| | - Serdar Kayihan
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv No. 1, 06110, AltindagAnkara, Turkey
| | - Murat Calapkulu
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv No. 1, 06110, AltindagAnkara, Turkey
| | - Sema Hepsen
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv No. 1, 06110, AltindagAnkara, Turkey
| | - Umran Gul
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv No. 1, 06110, AltindagAnkara, Turkey
| | - Ilknur Ozturk Unsal
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv No. 1, 06110, AltindagAnkara, Turkey
| | - Muhammed Kizilgul
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv No. 1, 06110, AltindagAnkara, Turkey
| | - Muhammed Erkam Sencar
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv No. 1, 06110, AltindagAnkara, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv No. 1, 06110, AltindagAnkara, Turkey
| | - Bekir Ucan
- Department of Endocrinology and Metabolism, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv No. 1, 06110, AltindagAnkara, Turkey
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19
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García M, Albizua-Madariaga I, Lertxundi U, Aguirre C. Subacute thyroiditis and COVID-19 vaccines: a case/non-case study. Endocrine 2022; 77:480-485. [PMID: 35678975 PMCID: PMC9178315 DOI: 10.1007/s12020-022-03101-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/27/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE Some case reports have suggested a possible association between COVID-19 vaccines and subacute thyroiditis (SAT), however, to our knowledge, no study has analyzed this possible relationship. This study aimed to analyze whether a disproportionate number of cases of SAT were reported in the EudraVigilance database for four COVID-19 vaccines (BNT162b2, mRNA-1273 ChAdOx1-S or Ad26.COV2.S). METHODS A case/non-case study was conducted to assess the association between SAT and COVID-19 vaccines, calculating the reporting odds ratios (RORs) up to December 2, 2021. Cases were selected using the preferred term 'subacute thyroiditis'. First, cases involving COVID-19 vaccines were compared with those involving all other drugs. Secondly, the RORs for COVID-19 vaccines compared with other viral vaccines (overall and influenza vaccines only) were obtained. RESULTS Until December 2, 2021, of 1,221,582 spontaneous cases of adverse reactions with the four vaccines, we found 162 SAT cases: BNT162b2 (n = 103), mRNA-1273 (n = 27), ChAdOx1-S (n = 31) and Ad26.COV2.S (n = 1). SAT cases were found to be reported more frequently in association with BNT162b2, mRNA-1273, and ChAdOx1-S vaccines than with other drugs. Moreover, we found a signal of disproportionate reporting for SAT with BNT162b2 and mRNA-1273 vaccines comparing with other viral vaccines (BNT162b2 ROR 3.58, 95% CI 1.92-6.66; mRNA-1273 ROR 3.44, 95% CI 1.71-6.94). However, this association was absent when these COVID-19 vaccines were compared with influenza vaccines. CONCLUSIONS In EudraVigilance, SAT is relatively more frequently reported in association with mRNA COVID-19 vaccines than with other viral vaccines. Well designed observational studies are needed to confirm these results.
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Affiliation(s)
- Montserrat García
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Biocruces Bizkaia Health Research Institute, Barrio Labeaga 46 A, Galdakao, 48960, Spain.
| | - Itziar Albizua-Madariaga
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Galdakao, Bizkaia, Spain
| | - Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Gasteiz, Alava, Spain
| | - Carmelo Aguirre
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Biocruces Bizkaia Health Research Institute, Barrio Labeaga 46 A, Galdakao, 48960, Spain
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country, Leioa, Spain
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20
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Kurtulmus N, Kayikci K. Subacute Thyroiditis Following SARS-CoV-2 Vaccines: Six Cases Report and Review of the Literature. Horm Metab Res 2022; 54:556-561. [PMID: 35318621 DOI: 10.1055/a-1804-9561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Subacute thyroiditis (SAT) is an inflammatory disease of the thyroid that develops following viral upper respiratory tract infections. SARS-CoV-2 virus, the cause of COVID-19, binds to the Angiotensin-Converting Enzyme-2 (ACE2) molecule expressed on the target cell surface. Thyroid gland shows high levels of ACE2 expression. The cases of SARS-CoV-2-related subacute thyroiditis and Graves' disease have been reported. It has recently been noted that vaccines for SARS-CoV-2 also induce autoimmune and inflammatory reactions. We present six (4 male, 2 female) cases of SAT that developed after mRNA and inactivated SARS-CoV-2 vaccines. And we have reviewed the literature. SAT was seen in 5 patients after mRNA vaccine, in one after inactivated vaccine. Their clinic and laboratory findings suggested to SAT. They were treated with nonsteroid anti-inflamatory drugs and/or methylprednisolone.They recovered within few weeks. Out patients did not have permanent hypothyroidism after SAT. The history of SARS-CoV-2 vaccination should be questioned in patients with subacute thyroiditis in pandemic days.
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Affiliation(s)
- Neslihan Kurtulmus
- Department of Endocrinology and Metabolism, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Kubra Kayikci
- Medical School, Bezmialem Vakif University, Istanbul, Turkey
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21
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Subacute thyroiditis after SARS-Cov2 vaccination: A review of the cases being described and personal experience. Endocr Regul 2022; 56:227-231. [DOI: 10.2478/enr-2022-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective. The present study evaluates the occurrence of subacute thyroiditis in temporal connection with SARS-Cov2 vaccinations described in the literature last year and confirmed by our clinical routine.
Methods. Systematic literature search in Medline for studies reporting diagnosis of subacute thyroiditis in temporal connection with vaccinations against Covid 19.
Results. The literature search yielded 24 relevant references out of which 22 were “case reports” and two “Letters to the Editor” and encompassed 37 patient cases, in total. They had received a SARS-Cov2 vaccination shortly before the diagnosis (median interval to vaccination six days). In none of these cases, infection of the upper respiratory tract had previously been identified as a classic trigger of the disease. Newly occurring hyperthyroidism and increased laboratory signs of inflammation were described in 78% and 74% of cases, respectively. Atypical clinical pictures (asymptomatic, euthyroid, no inflammation marks) have been observed in both the literature and our patients suspected of thyroid cancer referred to surgery.
Conclusions. In times of pandemics and the resulting vaccination, new rapidly occurring sonographic changes in the thyroid gland should be revaluated after 2–3 weeks, or recommended to undergo a fine-needle biopsy, in order to avoid unnecessary surgical interventions.
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22
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Caironi V, Pitoia F, Trimboli P. Thyroid Inconveniences With Vaccination Against SARS-CoV-2: The Size of the Matter. A Systematic Review. Front Endocrinol (Lausanne) 2022; 13:900964. [PMID: 35813627 PMCID: PMC9259875 DOI: 10.3389/fendo.2022.900964] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/20/2022] [Indexed: 12/20/2022] Open
Abstract
After the beginning of COVID-19 vaccination campaigns, several reports of thyroid disease possibly related to the COVID-19 vaccination progressively appeared in the literature, raising the question of whether the thyroid disorder might be a SARS-CoV-2 vaccine complication. The aim of this study was to analyze the data about COVID-19 vaccination and thyroid disease, evaluate the size and quality of related literature, assess the type of these events, and investigate their timing of onset with respect the vaccination. Pubmed/MEDLINE and Cochrane were systematically reviewed until February 2022 to retrieve the largest number of original papers, case reports, and case series articles reporting thyroid disease after SARS-CoV-2 vaccination. Forty-six articles were included with a total of 99 patients aged from 26 to 73 years were described, of whom 74.75% female. Regarding the vaccination received, 49.49% of patients received Comirnaty (Pfizer/BioNTech), 14.14% CoronaVac (Sinovac), 12.12% Vaxzevria (Oxford/Astrazeneca), 11.11% Spikevax (Moderna), 3.03% Ad26.COV2.S (Janssen, Johnson & Johnson), one patient Covaxin (Bharat Biotech) and one patient Convidecia (Cansino). In 7 cases the thyroid disorder developed after the third dose with a combination of different vaccines. Regarding the type of thyroid disorder, 59 were subacute thyroiditis (SAT), 29 Graves' disease (GD), 2 co-occurrence of SAT and GD, 6 painless thyroiditis (PT), and single cases of thyroid eye disease and hypothyroidism associated with mixedema. The timeline between vaccination and thyroid disorder ranged between 0.5 to 60 days, with an average of 10.96 days. Considering the limited follow-up time, a complete remission was reported in most of SAT and PT cases while a persistence was observed in GD. In conclusion, both size and quality of published data about thyroid inconveniences after COVID-19 vaccination are limited; thyroid disorders may occur within 2 months after COVID-19 vaccination; among all thyroid diseases after COVID-19 vaccination, GD and SAT seem to be more frequent.
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Affiliation(s)
- Verdiana Caironi
- Clinic for Internal Medicine, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Fabián Pitoia
- Division of Endocrinology, Hospital de Clínicas José de San Martin, University of Buenos Aires, Buenos Aires, Argentina
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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23
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Grunenwald S, Lethellier G, Imbert P, Dekeister C, Caron P. Orbital inflammatory disease following mRNA SARS‐CoV‐2 vaccine. Clin Case Rep 2022; 10:e05926. [PMID: 35685829 PMCID: PMC9172587 DOI: 10.1002/ccr3.5926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/16/2022] [Indexed: 12/13/2022] Open
Abstract
A 65‐year‐old woman reported orbital symptoms two days after her first dose and presented exacerbation of signs after the second dose of BNT162b2 mRNA vaccine. The temporal relationship between the COVID‐19 vaccination and orbital symptoms suggests a probable link between SARS‐CoV‐2 mRNA vaccine and this orbital inflammatory disease.
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Affiliation(s)
- Solange Grunenwald
- Multidisciplinary Thyroid‐Eye Outpatient Clinic Department of Endocrinology and Metabolic Disease Cardio‐Vascular and Metabolic Unit CHU Larrey (University Hospital Centre) Toulouse France
| | - Gabriel Lethellier
- Department of Ophthalmology CH intercommunal Castres‐Mazamet Castres France
| | - Philippe Imbert
- Multidisciplinary Thyroid‐Eye Outpatient Clinic Department of Endocrinology and Metabolic Disease Cardio‐Vascular and Metabolic Unit CHU Larrey (University Hospital Centre) Toulouse France
- Ophthalmologist Centre de Consultations La Croix du Sud Quint‐Fonsegrives France
| | - Céline Dekeister
- Multidisciplinary Thyroid‐Eye Outpatient Clinic Department of Endocrinology and Metabolic Disease Cardio‐Vascular and Metabolic Unit CHU Larrey (University Hospital Centre) Toulouse France
- Department of Plastic and Maxillofacial Surgery Hôpital Pierre‐Paul Riquet Toulouse France
| | - Philippe Caron
- Multidisciplinary Thyroid‐Eye Outpatient Clinic Department of Endocrinology and Metabolic Disease Cardio‐Vascular and Metabolic Unit CHU Larrey (University Hospital Centre) Toulouse France
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24
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Yasri S, Wiwanitkit V. Subacute thyroiditis after COVID-19 vaccination. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:345. [PMID: 35680353 PMCID: PMC9167940 DOI: 10.1016/j.eimce.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 06/15/2023]
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25
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Topaloğlu Ö, Tekin S, Topaloğlu SN, Bayraktaroglu T. Differences in Clinical Aspects Between Subacute Thyroiditis Associated with COVID-19 Vaccines and Classical Subacute Thyroiditis. Horm Metab Res 2022; 54:380-388. [PMID: 35491014 DOI: 10.1055/a-1840-4374] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Subacute thyroiditis (SAT) developed after SARS-CoV-2 vaccines has been less studied. We aimed to compare classical SAT and SAT developed after SARS-CoV-2 vaccines in the context of clinical aspects. Adults with SAT detected in 90 days of COVID-19 vaccination (CoronaVac or Pfizer/BioNTech) were grouped as Vac-SAT. Those with a history of SARS-CoV-2 or upper respiratory tract infection in 6 months before the vaccination, or vaccination with another antiviral vaccine after COVID-19 vaccination were excluded. Those with SAT detected before COVID-19 pandemic were grouped as Classical-SAT. Of total (n=85), female/male (54/31) ratio and age [43 (23-65)] were similar in Vac-SAT (n=23) and Classical-SAT (n=62). Duration between vaccine and SAT was 45 (7-90) days, and similar in CoronaVac-SAT (n=5) and BioNTech-SAT (n=18). SAT-duration was 28 (10-150) days, and higher in Vac-SAT than in Classical-SAT (p=0.023). SAT was developed after the 1st dose vaccine in minority in CoronaVac-SAT (n=2) and BioNTech-SAT (n=3) (p=0.263). Previous LT4 use, and TSH elevation after resolution were more frequent in Vac-SAT than in Classical-SAT (p=0.027 and p=0.041). We included a considerable number of patients with SAT occurred after COVID-19 vaccines. We cannot provide clear evidence regarding the association of COVID-19 vaccines with SAT. SAT associated with CoronaVac or BioNTech seems unlikely to be occurred after the 1st dose, and to have a longer duration, more likely to be associated with previous LT4 use and lead TSH elevation after resolution than Classical-SAT. TSH should be followed-up after the resolution of SAT detected after COVID-19 vaccination.
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Affiliation(s)
- Ömercan Topaloğlu
- Endocrinology, Zonguldak Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
- Obesity and Diabetes Practice and Research Center, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Sakin Tekin
- Endocrinology, Zonguldak Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Seda Nur Topaloğlu
- Internal Medicine, Zonguldak Bulent Ecevit Universitesi Tip Fakultesi, Zonguldak, Turkey
| | - Taner Bayraktaroglu
- Endocrinology, Zonguldak Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
- Obesity and Diabetes Practice and Research Center, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
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26
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Ippolito S, Gallo D, Rossini A, Patera B, Lanzo N, Fazzino GFM, Piantanida E, Tanda ML. SARS-CoV-2 vaccine-associated subacute thyroiditis: insights from a systematic review. J Endocrinol Invest 2022; 45:1189-1200. [PMID: 35094372 PMCID: PMC8800554 DOI: 10.1007/s40618-022-01747-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE To perform a systematic review on published cases of subacute thyroiditis (SAT) secondary to SARS-CoV-2 vaccination, to highlight main features and increase the awareness of this condition. METHODS Original reports of SAT developed after SARS-CoV-2 vaccination (mRNA, viral vector, or inactivated virus vaccines) were retrieved from a search of electronic databases. Individual patient data on demographics, medical history, type of vaccine, workup and therapies were collected. Wilcoxon rank-sum, Kruskal-Wallis and chi-squared tests were employed for comparisons. RESULTS 30 articles including 48 reports were retrieved, 3 additional cases evaluated by the Authors were described and included for analysis. Of the 51 patients, 38 (74.5%) were women, median age was 39.5 years (IQR 34-47). Patients developed SAT after a median of 10 days (IQR 4-14) after the vaccine shot. Baseline thyroid exams revealed thyrotoxicosis in 88.2% of patients, decreasing at 31.6% at follow-up. Corticosteroids were used in 56.4% of treated patients. Patients undergoing non-mRNA vaccines were most frequently Asian (p = 0.019) and reported more frequently weight loss (p = 0.021). All patients with a previous diagnosis of thyroid disease belonged to the mRNA vaccine group. CONCLUSION SARS-CoV-2 vaccine-associated SAT is a novel entity that should be acknowledged by physicians. Previous history of thyroid disease may predispose to develop SAT after mRNA vaccines, but further studies and larger cohorts are needed to verify this suggestion. SARS-CoV-2 vaccine-associated SAT is usually of mild/moderate severity and could be easily treated in most cases, thus it should not raise any concern regarding the need to be vaccinated.
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Affiliation(s)
- S Ippolito
- Endocrine Unit, ASST dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy.
| | - D Gallo
- Endocrine Unit, ASST dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
| | - A Rossini
- Endocrine and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - B Patera
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - N Lanzo
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - G F M Fazzino
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - E Piantanida
- Endocrine Unit, ASST dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - M L Tanda
- Endocrine Unit, ASST dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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27
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Chee YJ, Liew H, Hoi WH, Lee Y, Lim B, Chin HX, Lai RTR, Koh Y, Tham M, Seow CJ, Quek ZH, Chen AW, Lim Quek TP, Tan AWK, Dalan R. SARS-CoV-2 mRNA Vaccination and Graves' Disease: A Report of 12 Cases and Review of the Literature. J Clin Endocrinol Metab 2022; 107:e2324-e2330. [PMID: 35235663 PMCID: PMC8903505 DOI: 10.1210/clinem/dgac119] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Indexed: 12/31/2022]
Abstract
CONTEXT AND OBJECTIVE Thyroid autoimmunity has been reported to be associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the SARS-CoV-2 vaccination recently. We report a series of patients who presented with new onset or relapse of Graves' disease-related hyperthyroidism shortly after receiving the SARS-CoV-2 messenger RNA (mRNA) vaccine at a single tertiary institution in Singapore. METHODS AND RESULTS We describe 12 patients who developed hyperthyroidism within a relatively short interval (median onset, 17 [range, 5-63] days) after receiving the SARS-CoV-2 mRNA vaccine. The majority were females (11/12) with median age of 35.5 (range, 22-74) years. Six patients had new-onset hyperthyroidism, whereas the other 6 had relapse of previously well-controlled Graves' disease. TSH receptor antibody concentrations ranged from 2.4 to 32 IU/L. The majority of the patients were able to go for the second dose of the vaccine without any further exacerbations. Literature review revealed 21 other similar cases reported from across the world. CONCLUSION Our case series provides insight into the characteristics of individuals in whom Graves' disease was triggered by the SARS-CoV-2 vaccination. Clinicians need to be vigilant of precipitation or exacerbation of autoimmune thyroid disorders in predisposed individuals after exposure to the SARS-CoV-2 vaccination. Further epidemiological and mechanistic studies are required to elucidate the possible associations between the SARS-CoV-2 vaccines and the development of thyroid autoimmunity.
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Affiliation(s)
| | - Huiling Liew
- Department of Endocrinology, Tan Tock Seng Hospital
| | - Wai Han Hoi
- Department of Endocrinology, Tan Tock Seng Hospital
| | - Yingshan Lee
- Department of Endocrinology, Tan Tock Seng Hospital
| | - Brenda Lim
- Department of Endocrinology, Tan Tock Seng Hospital
| | - Han Xin Chin
- Department of Endocrinology, Tan Tock Seng Hospital
| | | | - Yunqing Koh
- Department of Endocrinology, Tan Tock Seng Hospital
| | | | | | - Zhi Han Quek
- Department of Endocrinology, Tan Tock Seng Hospital
| | | | | | | | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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28
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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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Popescu M, Ghemigian A, Vasile CM, Costache A, Carsote M, Ghenea AE. The New Entity of Subacute Thyroiditis amid the COVID-19 Pandemic: From Infection to Vaccine. Diagnostics (Basel) 2022; 12:960. [PMID: 35454008 PMCID: PMC9030970 DOI: 10.3390/diagnostics12040960] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 02/04/2023] Open
Abstract
This is a review of full-length articles strictly concerning subacute thyroiditis (SAT) in relation to the SARS-CoV-2 virus infection (SVI) and COVID-19 vaccine (COV) that were published between the 1st of March 2020 and the 21st of March 2022 in PubMed-indexed journals. A total of 161 cases were reported as follows: 81 cases of SAT-SVI (2 retrospective studies, 5 case series, and 29 case reports), 80 respective cases of SAT-COV (1 longitudinal study, 14 case series, 17 case reports; also, 1 prospective study included 12 patients, with 6 patients in each category). To our knowledge, this represents the largest cohort of reported cases until the present time. SAT-SVI was detected in adults aged between 18 and 85 years, mostly in middle-aged females. SAT-COVID-19 timing classifies SAT as viral (synchronous with infection, which is an original feature of SATs that usually follow a viral infection) and post-viral (during the recovery period or after infection, usually within 6 to 8 weeks, up to a maximum 24 weeks). The clinical spectrum has two patterns: either that accompanying a severe COVID-19 infection with multi-organ spreading (most frequent with lung involvement) or as an asymptomatic infection, with SAT being the single manifestation or the first presentation. Either way, SAT may remain unrecognized. Some data suggest that more intense neck pain, more frequent fever, and more frequent hypothyroidism at 3 months are identified when compared with non-SAT-SVI, but other authors have identified similar presentations and outcomes. Post-COVID-19 fatigue may be due to residual post-SAT hypothyroidism. The practical importance of SAT-SVI derives from the fact that thyroid hormone anomalies aggravate the general status of severe infections (particular concerns being tachycardia/arrhythmias, cardiac insufficiency, and ischemic events). If misdiagnosed, SAT results in unnecessary treatment with anti-thyroid drugs or even antibiotics for fever of unknown cause. Once recognized, SAT does not seem to require a particular approach when compared with non-COVID-19 cases, including the need for glucocorticoid therapy and the rate of permanent hypothyroidism. A complete resolution of thyroid hormone anomalies and inflammation is expected, except for cases with persistent hypothyroidism. SAT-COV follows within a few hours to a few weeks, with an average of 2 weeks (no particular pattern is related to the first or second vaccine dose). Pathogenesis includes molecular mimicry and immunoinflammatory anomalies, and some have suggested that this is part of ASIA syndrome (autoimmune/inflammatory syndrome induced by adjuvants). An alternative hypothesis to vaccine-related increased autoimmunity is vaccine-induced hyperviscosity; however, this is supported by incomplete evidence. From what we know so far concerning the risk factors, a prior episode of non-SVI-SAT is not associated with a higher risk of SAT-COV, nor is a previous history of coronavirus infection by itself. Post-vaccine SAT usually has a less severe presentation and a good outcome. Generally, the female sex is prone to developing any type of SAT. HLA susceptibility is probably related to both new types of SATs. The current low level of statistical evidence is expected to change in the future. Practitioners should be aware of SAT-COV, which does not restrict immunization protocols in any case.
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Affiliation(s)
- Mihaela Popescu
- Department of Endocrinology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Adina Ghemigian
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Endocrinology, C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Corina Maria Vasile
- Department of Paediatrics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Andrei Costache
- Department of Biophysics, University of Medicine and Pharmacy of Craiova, 2003349 Craiova, Romania;
| | - Mara Carsote
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Endocrinology, C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Alice Elena Ghenea
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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Tozinameran. REACTIONS WEEKLY 2022. [PMCID: PMC8948054 DOI: 10.1007/s40278-022-12342-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pezzaioli LC, Gatta E, Bambini F, Facondo P, Gava M, Cavadini M, Buoso C, Di Lodovico E, Rotondi M, Ferlin A, Cappelli C. Endocrine system after 2 years of COVID-19 vaccines: A narrative review of the literature. Front Endocrinol (Lausanne) 2022; 13:1027047. [PMID: 36440218 PMCID: PMC9685624 DOI: 10.3389/fendo.2022.1027047] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to describe the current knowledge on the potential endocrine adverse effects post-COVID-19 vaccines. METHODS A PubMed/MEDLINE, Web of Science, and Scopus research was performed. Case reports, case series, original studies, and reviews written in English and published online up to 31 July 2022 were selected and reviewed. The final reference list was defined based on the relevance of each paper to the scope of this review. RESULTS The available data showed that endocrine side effects are generally rare and with favorable outcome, being thyroid disorders the most common. Conversely, data on type 1 diabetes mellitus are rare; adrenal and pituitary events are even anecdotal. Finally, the available clinical studies suggest no impact on female reproductive system and on male and couple fertility. CONCLUSION Overall, these data show that, after 2 years of COVID-19 vaccines, the endocrine system is not heavily threatened.
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Affiliation(s)
- Letizia Chiara Pezzaioli
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Brescia, Italy
| | - Elisa Gatta
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Brescia, Italy
| | - Francesca Bambini
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Brescia, Italy
| | - Paolo Facondo
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Brescia, Italy
| | - Maria Gava
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Brescia, Italy
| | - Maria Cavadini
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Brescia, Italy
| | - Caterina Buoso
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Brescia, Italy
| | - Elena Di Lodovico
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Brescia, Italy
| | - Mario Rotondi
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Alberto Ferlin
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Brescia, Italy
- *Correspondence: Carlo Cappelli,
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