|Ahead of print publication
Subacute thyroiditis after COVID-19 vaccination
Bashir Ahmad Laway, Atul Sharma
Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
|Date of Submission||29-Nov-2021|
|Date of Acceptance||12-Jan-2022|
|Date of Web Publication||21-Mar-2022|
Bashir Ahmad Laway,
Professor and head, department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar
Source of Support: None, Conflict of Interest: None
Thyroid dysfunction during COVID-19 infection has been described. Few cases of thyroiditis following COVID-19 vaccination have also been described. We describe the clinical details of a woman who developed subacute thyroiditis after the COVID-19 vaccination.
Keywords: COVID-19, covishield vaccine, thyroiditis
| Introduction|| |
In current pandemic of COVID-19, the role of vaccine cannot be understated. COVID Vaccines have been developed more rapidly than ever and nearly 1,21,94,71,134 people have been vaccinated in India so far. Initial safety profile of COVID-19 vaccines have been acceptable. However, like new drugs, side effects of vaccine need to be monitored as well. Thyroid dysfunction is not uncommon during and after the COVID-19 infection., Here we describe the course of a woman who developed sub-acute thyroiditis (SAT) after AstraZeneca Covishield vaccine.
| Case Report|| |
A 36-year-old woman, with no previous comorbidity presented in the endocrine clinic with complaints of anterior neck pain and generalized malaise of 2 months. The patient had received the Covishield vaccine on May 2 and felt the above symptoms 6 days after. There was no history of weight loss, palpitations, and sweating, examination revealed tachycardia (heart rate of 110 beats per min) and diffusely enlarged tender thyroid gland. COVID-19 reverse transcription-polymerase chain reaction test was negative.
Investigations revealed erythrocyte sedimentation rate (ESR) of 44 mm/hour, total thyroxine (T4) of 15.2 ug/dl (normal value of 4–13), total triiodothyronine (T3) of 1.2 ng/ml (normal value of 0.7–2.5), thyrotropin thyroid-stimulating hormone of 0.02 uiU/ml (normal value of 0.5–6.5), and anti-thyroid peroxidase (TPO) antibody titter negative. Routine thyroid function tests 6 months before were within the normal limits. Ultrasonography (USG) of the neck revealed an enlarged gland with heterogeneous echotexture consistent with thyroiditis with inferior thyroid artery peak systolic velocity of 22.2 cm/s suggestive of thyroiditis [Figure 1]. 99mTc scan for thyroid revealed uptake of 0.2% also suggestive of thyroiditis. With this history, physical findings, and thyroid function tests, a diagnosis of thyrotoxicosis was made and with high ESR, 99mTc uptake, USG evidence of heterogeneous gland echo texture and low peak systolic velocity of inferior thyroid artery, a diagnosis of subacute thyroiditis (SAT) was entertained. In view of TPO negative and the temporal correlation with Covishield vaccine, a diagnosis of SAT as a part of autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome) is highly probable. The patient is being managed conservatively on beta-blockers and analgesics for neck pain and she continues to do well.
|Figure 1: Ultrasonography thyroid gland showing (a) heterogeneous echotexture of gland and (b) Doppler pattern showing low peak systolic velocity of Inferior thyroid artery|
Click here to view
| Discussion|| |
Subacute thyroiditis has been associated with many viruses with patients often reporting a preceding respiratory tract infection. It has also been reported with COVID-19 infection.
Indian vaccination program began on January 16, 2021, with Covishield the vaccination drive has been intensified since its inception. Although the Covishield appears safe in the clinical trials, it is well known that many adverse effects appear late in the postmarketing surveillance. Covishield is an inactivated vaccine prepared with the methods used for decades. After injecting the vaccine, an immune response that can neutralize the virus is generated against the S protein (a part of the SARS-Cov-2 spike). Recently to our knowledge only one case report describing three cases of SAT after the COVID-19 vaccine has been published. In the above report, signs and symptoms of thyroiditis developed after 6 days of vaccine administration. In the present case also, SAT developed 6 days after injection of the vaccine. The pathogenetic mechanisms leading to SAT may involve the use of adjuvants to boost the efficacy of the vaccine. These adjuvants can trigger ASIA syndrome, leading to thyroiditis as seen with our patient. We therefore conclude and emphasize that thyroid gland dysfunction may be a complication of the COVID-19 vaccine, and large population and long-term follow-up may unfold the association of COVID-19 vaccine and SAT.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Garg MK, Gopalakrishnan M, Yadav P, Misra S. Endocrine involvement in COVID-19: Mechanisms, clinical features, and implications for care. Indian J Endocrinol Metab 2020;24:381-6.
Brancatella A, Ricci D, Cappellani D, Viola N, Sgrò D, Santini F, et al.
Is subacute thyroiditis an underestimated manifestation of SARS-CoV-2 Infection? Insights from a case series. J Clin Endocrinol Metab 2020;105:doi: 10.1210/clinem/dgaa537.
Malik SA, Choh NA, Misgar RA, Khan SH, Shah ZA, Rather TA, et al.
Comparison between peak systolic velocity of the inferior thyroid artery and technetium-99m pertechnetate thyroid uptake in differentiating Graves' disease from thyroiditis. Arch Endocrinol Metab 2019;63:495-500.
Desailloud R, Hober D. Viruses and thyroiditis: An update. Virol J 2009;6:5.
İremli BG, Şendur SN, Ünlütürk U. Three cases of subacute thyroiditis following SARS-CoV-2 vaccine: Post vaccination ASIA Syndrome. J Clin Endocrinol Metab 2021;106:2600-5.
Vera-Lastra O, Medina G, Cruz-Dominguez Mdel P, Jara LJ, Shoenfeld Y. Autoimmune/inflammatory syndrome induced by adjuvants (Shoenfeld's syndrome): Clinical and immunological spectrum. Expert Rev Clin Immunol 2013;9:361-73.