Endocrine Abstracts

Several reports of Graves’ disease (GD) onset after COVID-19 vaccination were recently published. The mechanism underlying GD occurrence in these cases could be related to the autoimmune syndrome induced by adjuvants (ASIA), a condition triggered by several vaccine adjuvants and excipients leading to dysfunctional immune response causing different conditions and endocrinopathies in genetically predisposed subjects. In Italy, population campaign for COVID-19 vaccination started in December 2020 and by the end of December 2021 more than 80% of citizens were vaccinated. The aim of our study was to evaluate for the first time the impact of COVID-19 vaccine on incidence of GD in 2021. Of the 33 first-diagnosis of GD in our Center in 2021, in 16 (48.5%) patients, 2 males (12.5%) and 14 (87.5%) females, GD temporally occurred before the vaccination and in 17 patients (51.5%), 5 males (29%) and 12 females (71%), after the first or second vaccine dose. In 14 (83%) patients, GD occurred in the first four weeks after vaccination, in 1 (6%) after 8 weeks and in 2 (11%) after 12 weeks. All 5 male patients with GD after vaccine injection presented symptoms and signs onset and subsequent GD diagnosis in the first four weeks after vaccination. All 33 patients started anti-thyroid treatment. After three months of therapy, TSH was normalized in 7 out of 14 (50%) patients in whom GD occurs after vaccine administration, whereas fT4 and fT3 levels were available in 13 and 12 and within the normal reference range in 11 and 11 patients (85% and 92%), respectively. Anti TSH-receptor antibodies were negative in 2 out of 6 patients (33.3%) with post-vaccine GD. Possibly COVID-19 vaccine-related GD (within 4 weeks after vaccine administration) accounted for more than 50% of the cases observed in our 2021 monocentric experience. Moreover, since one third of post-vaccine GD were males, our observation strengthens the hypothesis of a causal vaccine-GD relationship since males are usually less affected by GD. In conclusion, for the first time we report a remarkable impact of COVID-19 vaccination in GD diagnosis in a single-center experience. Our report can improve awareness of thyrotoxicosis diagnosis by primary-care physicians and endocrinologists, particularly in patients with marked and persistent symptoms, such as fever, palpitations and asthenia, occurring after vaccination.