COVID-19 vaccination might be associated with asymmetric thyroid eye disease

Abstract

The influence of COVID-19 vaccination on thyroid eye disease (TED) is unknown. We investigated the characteristics of COVID-19-vaccinated TED. Sixty-two consecutive patients diagnosed with active TED were divided as follows. Patients from 2014 to 2019 were defined as pre-COVID-19 (n = 32). Patients during the COVID-19 pandemic (2020–2023) were divided into patients with (n = 16) or without (n = 14) COVID-19 vaccination before TED onset. Magnetic resonance images were evaluated using number of involved extraocular muscles (n-EOM), maximum signal intensity ratio (SIR max) and the inferior rectus (IR) muscle area. Additionally, the ratio of the more enlarged IR muscle area and SIR max divided by that on the other side was calculated (IR ratio, SIR max ratio). TED symmetry was also evaluated based on IR ratios. Although, in more affected orbit, n-EOM were no significant difference, vaccinated showed fewer n-EOM in the less affected orbit. SIR max and IR ratio were significantly higher in vaccinated than others (SIR max ratio; 1.07, 1.16, 1.42, IR ratio; 1.52, 1.38, 2.12, pre-COVID-19, non-vaccinated, vaccinated, respectively). When asymmetric TED was defined as IR ratio of 2 or greater, the proportion of asymmetric were significantly higher in vaccinated (50 %) than others (pre-COVID-19; 13 %, non-vaccinated; 14 %). In less affected IR, the regression line between SIR max and Thyroid-stimulating antibody was located lower in vaccinated than in those without vaccination. After treatment, the vaccinated IR ratio improved and the difference between groups disappeared. COVID-19 vaccinated showed asymmetry. Importantly, asymmetric involvement of vaccinated was reversible by treatment.