Covid Vaccine as a Trigger for Grave’s Hyperthyroidism: Cases and Literature Review

Abstract

Objective: Grave’s Disease is a systemic autoimmune disease directly caused by circulating auto-antibodies that bind to the thyrotropin receptor, subsequently inducing the production and release of thyroid hormone, proliferation of thyrocytes, and enlargement of the thyroid gland. Clinical practice has shown possible uncovering of Grave’s Disease following SARS-Cov-2 vaccine. The aim of this report is to shed the light on Grave’s Disease cases post SARS-Cov-2 vaccine, while reviewing the link between the vaccine and subsequent trigger of thyroid autoimmune hyperactivity. Cases: We present the case of a middle-aged woman with Grave’s disease following Hashimoto hypothyroidism manifesting 1 month post vaccine. A 36-year-old man presents with asymptomatic Grave’s disease 1 week following the vaccine. A 33-year-old woman presents with full blown Grave’s disease 9 days following vaccination. A 33-year-old man develops symptomatic Grave’s disease 3 weeks after the vaccine. Review: Cases presented above reflect different presentations of Grave’s disease. Moreso, the literature harbors similar cases of Grave’s disease recurrence, initial manifestation and exacerbation following SARS-Cov-2 vaccine. Grave’s disease etiology is autoimmune but environmental, genetic, and immunological factors contribute to its onset. The vaccine can potentially trigger autoimmune hyper-reactivity through the hyper-inflammatory response to the virus itself but also through the adjuvant found in the vaccine (Shoenfeld’s Syndrome) Conclusion: Cases of Grave’s disease manifestation or exacerbation post SARS-Cov-2 vaccines are reported. Theories are like SARS- Cov-2 -induced Grave’s Disease but also other mechanisms are uniquely mediated by vaccines. That vaccination benefit outweighs the potential risks but one should have a low threshold to test and follow patients at risk for auto-immune thyroid diseases after receiving SARS-CovV-2 vaccine.