Endocrine Abstracts

Introduction: Subacute thyroiditis due to vaccination is reported in only a few case reports. A peritoneal dialysis patient who experienced a repeating attack after a vaccination for influenzae while she was being followed and treated successfully for subacute thyroiditis is presented.

Case: A 28-year-old female patient who has been applying dialysis for nine years was seen in policlinic telling about upper respiratory tract infection 2 months ago and pain at her thyroid lodge for 3 weeks. Her thyroid was palpable and tender. She was diagnosed as subacute thyroiditis with high levels of ESR, CRP, TSH, anti-TG, TPO, and consistent ultrasonography findings. She was begun ibubrofen at 1800 mg/day in three divided doses after consulting with nephrology. She had recovered totally a week after and begun to follow up with levotyroxine 75 μg/day. She applied to hospital 3 months later with fatigue, fever, sore throat, dyspnea, pain, and swelling at her thyroid lodge again. USG showed a larger thyroid. ESR, CRP, anti-TG, and anti-TPO were much more higher. It was learnt that she had been vaccinated for influenza 3 weeks ago and began to suffer from gribal symptoms at the third day and pain and swelling of thyroid at the second week of vaccination. Her thyroid scintigraphy showed heterogenous and lower activity and her thyroid biopsy resulted as consistent with subacute thyroiditis. So the patient was diagnosed as subacute thyroiditis and ibubrofen was begun besides raising levothyroxine dose to 100 μg/day. Methyl prednisolone of 40 mg/day was added because there was no symptomatic improvement at the third day. The symptoms regressed after steroid in three days and recovered totally at the end of the first week. Steroid was stopped by gradually declining at the third week.

Discussion: Influenza like symptoms is known to develop after vaccination. This case is showing a rare condition due to vaccination to cause a subacute thyroiditis just like the virus can make.