FRI462 Incidence Of Graves Hyperthyroidism Before And After The Implementation Of COVID-19 mRNA Vaccination

Abstract

Abstract Disclosure: J.O. Pinto: None. M.Y. Roth: None. A.N. Hoofnagle: None. R.A. Failor: None. T.S. Tylee: None. M. Endo: None. Background: There have been several case reports of post COVID-19 vaccination early-onset Graves’ disease (PVGD) and their distinct clinical features documented. The purpose of this study was to investigate whether the incidence of Graves’ disease (GD) increased after the administration of the COVID-19 vaccine or after COVID-19 infection. Methods: This is a single academic center retrospective study. This study compared the incidence of new-onset GD during two separate time periods. Periods were defined as December 2017-October 2019 and December 2020-October 2022 to assess for differences in new-onset GD before and after COVID-19 vaccine administration. PVGD was defined as laboratory-confirmed hyperthyroidism and GD within 4 weeks of vaccination/infection or reporting of symptoms of thyrotoxicosis within 4 weeks of vaccination/infection and laboratory evidence within 3 months. Results: There was a total of 803 patients in the pre-vaccination period that carried the diagnosis of GD, 131 (16.4%) of which were new diagnoses. There was a total of 901 patients in the post-vaccination period that carried the diagnosis of GD, 138 (15.3%) of which were new. There was no statistically significant difference in the incidence of new onset GD between the pre- and post-vaccination groups (p=0.52). Twenty-four (17.4%) out of the 138 newly diagnosed patients in the post-COVID group met criteria for PVGD. There was a higher median free T4 (3.9 vs 2.5; p=0.05), higher TRAb titer (7.5 vs 6.9; p=0.94), and higher TSI titer (3.61 vs 3.60, p=0.82) in the PVGD group when compared to the control although none were statistically significant. There was no statistically significant difference in age, gender, race, or vaccine type. Twenty patients (87%) from the PVGD group were started on methimazole and all cases achieved a euthyroid state with a relatively low median methimazole dose of 12.5 mg. Hyperthyroidism resolved spontaneously in three patients (13%) without any anti-thyroid medication. Conclusion: This study did not demonstrate statistically significant evidence that COVID-19 vaccines increase the incidence of GD. In addition, all patients with PVGD had a good clinical response and achieved a euthyroid state at follow-up. This evidence may be beneficial in reassuring patients on vaccine administration. Presentation: Friday, June 16, 2023