key: cord-0732731-ca9uxrtc
authors: Bennet, William M.; Elamin, Aisha; Newell‐Price, John D.
title: Subacute thyroiditis following COVID‐19 vaccination: Case report and Society for Endocrinology survey
date: 2022-03-16
journal: Clin Endocrinol (Oxf)
DOI: 10.1111/cen.14716
sha: e30749d44221af5cdaa2f36c94b631f865a8df84
doc_id: 732731
cord_uid: ca9uxrtc

We report a case of subacute thyroiditis which developed following COVID-19 vaccination and seventeen additional cases also presenting after COVID-19 vaccination This article is protected by copyright. All rights reserved.

We report a case of subacute thyroiditis which developed following COVID-19 vaccination and 17 additional cases also presenting after COVID-19 vaccination.

A 52-year-old woman developed painful anterior neck swelling 7 days after receiving the first dose of COVID-19 vaccine AstraZeneca (AZ). After 4 days, she was seen by her GP who suspected thyroiditis. Blood tests showed TSH 0.14 mIU/L, CRP 34 mg/L (0-5) and TRAb 0.3 IU/L (0-0.9). A neck Doppler ultrasound scan on Day 15 showed heterogeneous features of thyroiditis with increased Doppler flow. On Day 21, she was hyperthyroid with TSH < 0.02 mIU/L and free T4 70.3 pmol/l (12-22). In the A&E Department, a COVID-19 test was negative and she was advised to start carbimazole 40 mg daily and propranolol but took only the betablocker. Seven weeks after vaccination, she felt well and her TSH was 0.86 mIU/L, having spontaneously normalized. In the Endocrine clinic during Week 9, she remained asymptomatic but was biochemically mildly hypothyroid with TSH 11 mIU/L and free T4 9 pmol/L, and by Week 18, her TSH had spontaneously normalized again.

The diagnosis was subacute thyroiditis. She had no preceding history of thyroid disease; she was otherwise well and took no regular medication. She was concerned that COVID-19 vaccination had triggered her subacute thyroiditis. responses. An alternative explanation may be that binding and endocytosis of the vaccine-generated spike S1 protein at membrane ACE2, expressed on the surface of thyroid cells, causes direct viral injury leading to thyroiditis. 1 Third, cross-reaction has been shown between SARS-CoV-2 spike protein antibody and thyroid peroxidase (TPO), which may cause thyroiditis by viral antigenic mimicry. 2 Case reports and small case series of subacute thyroiditis following COVID-19 vaccination have recently been described. 3, 4 Endocrinologists need to be aware of potential vaccine sequalae when managing thyrotoxic patients, including the heightened risk that thyrotoxicosis following COVID-19 vaccination will result from a potentially self-limiting subacute thyroiditis. It has also been reported that Graves' disease can

Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues

Potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to an increase in autoimmune diseases

Three cases of subacute thyroiditis following SARS-CoV-2 vaccine: postvaccination ASIA syndrome

Can COVID-19 immunisation cause subacute thyroiditis?

Two cases of Graves' disease following SARS-CoV-2 vaccination: an autoimmune/inflammatory syndrome induced by adjuvants

Subacute thyroiditis following COVID-19 vaccination: case report and Society for Endocrinology survey