ECE2023 Rapid Communications Rapid Communications 11: Late Breaking (6 abstracts)
1Rabin Medical Center, Endocrinology, Petah Tikva, Israel; 2Rabin Medical Center, Research authority, Petach Tikva, Israel; 3Rabin Medical Center, Endocrinology, Petach Tikva, Israel
Objective: Vaccination against coronavirus disease 2019 (COVID-19) an important component of coping with the pandemic. Anecdotal cases and case series reported an association between COVID-19 vaccination and the development of Graves disease. We used data from Israels largest health care organization to determine whether COVID-19 vaccination was associated with the incidence of Graves disease.
Methods: We analyzed data from Clalit Health Services (CHS), which insures 4.7 million patients. A population-based, matched, case-control study was performed. Cases were defined as adult patients diagnosed with Graves disease between December 2020 and November 2022. Each case was matched in a ratio of 1:2 with control based on age, gender, and autoimmune disease. Each control was assigned an index date which was identical to that of his/her matched case, which was defined as the date of Graves disease diagnosis. Time between vaccination date and the diagnosis of Graves disease/index date was assessed.
Results: A total of 726 patients with Graves disease were matched with 1452 controls. The median age of the cohort was 40 (interquartile range, 30-53) years, and 25.5% (555/2178) were men. Similar proportions of study patients and controls have received the first, the second and the third dosage of COVID-19 vaccine. Positive test for COVID-19 was detected in 21.2% (154/726) of Graves disease patients and 19.4% (282/1452) of controls (P=0.33). In a univariate analysis, first COVID-19 vaccine was not associated with the incidence of Graves disease [odds ratio 95% confidence interval: 1.15 (0.92-1.43)]. The mean time between first COVID-19 vaccination and the diagnosis of Graves disease for cases or index date for controls was not significantly different [275.69 days (standard deviation 144.37) for cases compared to 275.45 days (standard deviation 145.76) for controls].
Age (Years) | Gender | Medication | Prior DM | DKA | Time between exposure and presentation (months) | Underlying malignancy | Concomitant Thyroid dysfunction |
82 | M | Nivolumab | DM2 | + | 13 | HL | None |
74 | M | Avelumab | - | - | 8 | RCC | Hyperthyroidism |
58 | M | Pembrolizumab | - | + | 4 | MELANOMA | None |
70 | F | Pembrolizumab | DM2 | + | 4 | Gastric Adeno CA | None |
62 | F | Nivolumab | IFG | + | 29 | Adeno CA Lung | None |
66 | F | Pembrolizumab | - | + | 1 | Ovarian Adeno CA | None |
82 | F | Pembrolizumab | - | + | 1 | Gastric Adeno CA | None |
61 | F | Pembrolizumab | - | + | 9 | Skin SCC | Hypothyroidism |
67 | M | Durvalumab | - | + | 1 | NSCLC | Hyperthyroidism |
57 | F | Ipilimumab+Opdivo | - | + | 1 | MELANOMA | Unknown |
78 | M | ipilimumab+Nivolumab | - | + | 1 | MELANOMA | None |
76 | M | Nivolumab | IFG | - | 9 | RCC | None |
60 | M | Pembrolizumab | - | + | 4 | Head and Neck SCC | None |
This cohort emphasizes the importance of patient education and awareness for this potentially life-threatening complication. Better characterization of ICPI-induced diabetes will improve patient care and enhance our understanding of immune-mediated diabetes. |
Conclusions: We have found no association between COVID-19 vaccination and the incidence of Graves disease. Our study adds data to the thyroid safety of COVID-19 vaccine.