Endocrine Abstracts

Introduction: The occurrence or worsening of thyroid eye disease (TED) after SARS-CoV-2 mRNA vaccines is extremely rare whereas has not been reported following viral vector vaccination. In the region of South-West Greece during the COVID-19 pandemic, a case of de novo appearance of TED referred to the Endocrinology Department of our hospital, following viral vector SARS-COV-2 vaccine.

Case report: The patient was a 62-year-old woman, heavy smoker (40 pack-years) with no known history of Graves’ disease. Five days after vaccination for the 1st time with Vaxzevria (COVID-19 Vaccine (ChAdOx1-S[recombinant]- Previously known as COVID-19 Vaccine AstraZeneca), she presented with diplopia and at the same time she was diagnosed with hyperthyroidism due to Graves’ disease. She was administered antithyroid drugs, selenium (100 mgx2/day) and intravenous glucocorticoid boosts (500 mg solumedrol/week for 6 weeks and then 250 mg solumedrol/week) by a private endocrinologist. She also stopped smoking. However, diplopia did not improve, and she was referred to our hospital. Upon presentation, she had active disease, exophthalmos, periocular edema and permanent diplopia. She received 2 doses of rituximab (1gr/week for 2 weeks). Two months later, permanent diplopia and strabismus remained with a slight remission of the activity of the disease and thus she was referred for surgical correction of her strabismus. The patient did not suffer from COVID-19 disease at the time of diagnosis.

Conclusion: We reported a case of de novo moderate-to-severe TED resistant to drug therapy, following viral vector vaccine, in a middle-aged heavy smoker woman. To the best of our knowledge, this is the first report of TED after this type of vaccine against SARS-COV-2.