Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2023; 11(5): 1122-1128
Published online Feb 16, 2023. doi: 10.12998/wjcc.v11.i5.1122
Thyrotoxicosis in patients with a history of Graves’ disease after SARS-CoV-2 vaccination (adenovirus vector vaccine): Two case reports
Bo-Chang Yan, Rong-Rong Luo
Bo-Chang Yan, Rong-Rong Luo, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
Author contributions: Luo RR conceived of the presented idea; both Luo RR and Yan BC verified the analytical methods; Luo RR encouraged Yan BC to investigate thyrotoxicosis after SARS-CoV-2 vaccination and supervised the findings of this work; Both authors discussed the results and contributed to the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rong-Rong Luo, MD, Doctor, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21 Section 2, Nanya S Road Banqiao Dist, New Taipei City 220, Taiwan. agelinro@gmail.com
Received: November 1, 2022
Peer-review started: November 1, 2022
First decision: December 19, 2022
Revised: December 31, 2022
Accepted: January 19, 2023
Article in press: January 19, 2023
Published online: February 16, 2023
Abstract
BACKGROUND

Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which were approved for emergency use have been administered on a large scale globally to contain the pandemic coronavirus disease 2019 (COVID-19) and to save lives. Vaccine safety is one of the issues under surveillance and a possible correlation between vaccines and thyroid function has been reported. However, reports of the impact of coronavirus vaccines on those with Graves’ disease (GD) are rare.

CASE SUMMARY

This paper presents two patients with underlying GD in remission, both developed thyrotoxicosis and one developed thyroid storm following the adenovirus-vectored vaccine (Oxford-AstraZeneca, United Kingdom). The objective of this article is to raise awareness regarding a possible association between COVID-19 vaccination and the onset of thyroid dysfunction in patients with underlying GD in remission.

CONCLUSION

Receiving either the mRNA or an adenovirus-vectored vaccine for SARS-CoV-2 could be safe under effective treatment. Vaccine induced thyroid dysfunction has been reported, but the pathophysiology still not well understood. Further investigation is required to evaluate the possible predisposing factors for developing thyrotoxicosis especially in patients with underlying GD. However, early awareness of thyroid dysfunction following vaccination could avoid a life-threatening event.

Keywords: SARS-CoV-2 vaccine, Graves’ disease, Hyperthyroidism, Thyroid storm, Vaccine and thyroid disease, Case report

Core Tip: Thyroid storm is potentially life-threatening. If the diagnosis of thyroid storm is suspected, treatment should be initiated without delay. We report two cases with underlying Graves’ disease who experienced thyrotoxicosis and thyroid storm after receiving an adenovirus-vectored vaccine for coronavirus disease (COVID-19). Both had achieved disease remission before the vaccination. The pathophysiology of COVID-19 vaccine induced thyroid dysfunction still not well understood. However, early awareness of thyroid dysfunction following the vaccination could avoid the life-threatening events.