Endocrine Abstracts

A 36-year-old lady presented at 26-weeks gestation with symptoms of palpitations, anxiety, tremors, and breathlessness. She had received the 1st dose of the mRNA vaccine (Pfizer) for Covid-19 a month prior and her symptoms started a couple of weeks after the vaccine. She was a gravida 4 para 2 with gestational diabetes diagnosed during previous pregnancies and also early on in the current pregnancy requiring insulin treatment maintaining excellent antenatal glycaemic control. She also has pregnancy induced hypertension treated with Labetalol. There is no family history of thyroid disorder. She is an ex-smoker. This pregnancy has been otherwise uneventful specifically without any hyperemesis. Clinical examination demonstrated features of thyrotoxicosis with tremors of the outstretched hands, tachycardia and she did have a diffuse goitre more prominent on the right side with a bruit on auscultation. The investigations confirmed thyrotoxic state with TSH < 0.01 mU/l, free T4 59 pmol/l and free T3 > 30 pmol/l . Anti-TSH receptor antibodies were significantly elevated at 41.8 IU/l (ref <1.0) supporting the aetiology of thyrotoxicosis being Graves’ disease. After 2 weeks of Carbimazole 30 mg /day there was mild symptom relief and fT4 improving slightly to 43 pmol/l . The Carbimazole was increased to 40 mg and the Labetalol continued. There are recent literature reports of sub-acute thyroiditis and Graves’ disease that develop shortly after mRNA Covid-19 vaccination. Our case illustrates a potential association of Graves’s disease occurring after the m-RNA vaccine for Covid-19. Vaccine adjuvants have been shown to trigger a pathogenic immune response that can lead to a range of autoimmune diseases, including thyroid disorders. These are well recognised in the literature but less commonly perceived in routine clinical practice and requires a high index of suspicion especially as newer vaccines are also on the horizon for SARS-Cov-2.