scholarly journals Development of Graves' Disease After SARS-CoV-2 mRNA Vaccination: A Case Report and Literature Review

2021 ◽  
Vol 9 ◽  
Author(s):  
David Tak Wai Lui ◽  
Ka Kui Lee ◽  
Chi Ho Lee ◽  
Alan Chun Hong Lee ◽  
Ivan Fan Ngai Hung ◽  
...  
Keyword(s):  
Thyroid Dysfunction ◽  
Chinese Woman ◽  
Thyroid Peroxidase ◽  
Graves Disease ◽  
Immunoglobulin Level ◽  
Thyroglobulin Antibodies ◽  
Old Chinese ◽  
Autoimmune Thyroid ◽  
Diffuse Goiter ◽  
History Of

Background: Mounting evidence has revealed the interrelationship between thyroid and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to explain the thyroid dysfunction and autoimmune thyroid disorders observed after coronavirus disease 2019 (COVID-19). There are limited reports of thyroid dysfunction after SARS-CoV-2 vaccination.Methods: We report a case of a 40-year-old Chinese woman who developed Graves' disease after BNT162b2 mRNA vaccine. A search of PubMed and Embase databases from 1 September 2019 to 31 August 2021 was performed using the following keywords: “COVID,” “vaccine,” “thyroid,” “thyroiditis,” and “Graves.”Results: A 40-year-old Chinese woman who had 8-year history of hypothyroidism requiring thyroxine replacement. Her anti-thyroid peroxidase and anti-thyroglobulin antibodies were negative at diagnosis. She received her first and second doses of BNT162b2 mRNA vaccine on 6 April and 1 May 2021, respectively. She developed thyrotoxicosis and was diagnosed to have Graves' disease 5 weeks after the second dose of vaccine, with positive thyroid stimulating immunoglobulin level, diffuse goiter with hypervascularity on thyroid ultrasonography and diffusely increased thyroid uptake on technetium thyroid scan. Both anti-thyroid peroxidase and anti-thyroglobulin antibodies became positive. She was treated with carbimazole. Literature search revealed four cases of Graves' disease after SARS-CoV-2 vaccination, all after mRNA vaccines; and nine cases of subacute thyroiditis, after different types of SARS-CoV-2 vaccines.Conclusion: Our case represents the fifth in the literature of Graves' disease after SARS-CoV-2 vaccination, with an unusual presentation on a longstanding history of hypothyroidism. Clinicians should remain vigilant about potential thyroid dysfunction after SARS-CoV-2 vaccination in the current pandemic.

scholarly journals What Are the Common Characteristics of Pediatric Patients With Antibody Negative Primary Hypothyroidism?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A848-A848
Author(s):  
Rasha Alradadi ◽  
Erica A Eugster
Keyword(s):  
Family History ◽  
Thyroid Disease ◽  
Positive Family History ◽  
Retrospective Chart Review ◽  
Primary Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Thyroid Antibodies ◽  
Thyroglobulin Antibodies ◽  
Autoimmune Thyroid ◽  
History Of

Abstract Background: The most common cause of acquired primary hypothyroidism is autoimmune thyroiditis which is typically associated with positive anti-thyroid peroxidase and/or anti-thyroglobulin antibodies. However, some children present with primary hypothyroidism and negative antibodies. Whether there are differences between patients with acquired primary hypothyroidism who have positive vs negative anti-thyroid antibodies has not been systematically examined. Aim:To define the characteristics of patients with primary hypothyroidism and negative antibodies. Methods: A retrospective chart review of patients with hypothyroidism seen in the pediatric endocrine clinic at Riley Hospital for Children in Indianapolis, Indiana from August 2016 until December 2019 was performed. Variables examined included age at diagnosis, signs and symptoms at presentation, height, weight, BMI, TSH, FT4, T4, thyroid peroxidase and anti-thyroglobulin antibodies, family history of thyroid disease, physical exam at diagnosis, and associated diseases. Results: Of 173 patients aged 10.6 ± 3.9 years, 128 (74%) had positive antibodies and 44 (26%) had negative antibodies. Of those with positive antibodies, 80 % were female and 20% were male. Of those with negative antibodies, 53% were female and 47% were male. No differences were seen in the incidence of obesity or Down syndrome in patients with positive antibodies compared with those who had negative antibodies. A positive family history of thyroid disease was present in 45% of those with positive antibodies and in 22% of those with negative antibodies, P=0.006 Fifty-eight patients (45%) with positive antibodies reported excessive fatigue and 40 (31%) had a goiter. In contrast, 10 (22.7%) who had negative antibodies reported mild intermittent fatigue, P=0.006 and 7 (15.9 %) had a goiter, P=0.04 The average TSH in the antibody positive group was 129± 230 mcu/ml compared with 48 ± 131 mcu/ml in those with negative antibodies, p=0.04. A trend was also noted for a lower FT4 in those with positive antibodies (0.68±0.37 vs 0.85±0.27, p=0.050) No other differences in baseline characteristics were seen between patients with negative vs positive antibodies. Conclusion: Patients with positive anti-thyroid antibodies had more severe hypothyroidism and were more likely to report extreme fatigue than those with negative antibodies. It is unknown why some children with acquired primary hypothyroidism presumed due to autoimmune thyroid disease have negative antibodies. Long-term follow-up will be needed to determine whether the natural history of thyroid disease in children with primary hypothyroidism is associated with antibody status.

scholarly journals Restricted thyroglobulin antibody epitope specificities in subjects with type 1 diabetes mellitus

2009 ◽  
Vol 161 (3) ◽  
pp. 489-493 ◽  
Author(s):  
O E Okosieme ◽  
C N Wijeyaratne ◽  
J H Lazarus ◽  
L D K E Premawardhana
Keyword(s):  
Thyroid Peroxidase ◽  
Thyroglobulin Antibodies ◽  
Autoimmune Thyroid ◽  
Thyroglobulin Antibody ◽  
High Prevalence ◽  
Patients At Risk ◽  
Healthy Control ◽  
A Prospective Study ◽  
Design And Methods

ObjectivesFollowing iodisation in Sri Lanka we observed a high prevalence of thyroglobulin antibodies (TgAbs) in type 1 diabetic (T1DM) patients. The clinical significance of these TgAbs is uncertain. We sought to obtain a detailed epitope analysis of TgAbs in T1DM patients recruited from diabetes clinics and to compare these with TgAb epitope specificities in patients with autoimmune thyroid disease (AITD) and healthy individuals in that country.Design and methodsWe used a panel of 10 Tg-MAbs in competitive ELISA reactions in a prospective study of subjects recruited from Colombo, to determine the epitopes recognised by TgAb-positive patients with T1DM (n=58, 34F:24M, median age 16 years), AITD patients (n=42, 33F:9M, median age 37 years) and healthy subjects (n=50, 39F:11M, median age 27 years). The outcomes were a comparison of reactivity with six Tg clusters (I–VI) in these subjects, and the relation of epitope specificity patterns with free thyroxine and TSH.ResultsPatients with T1DM and AITD but not healthy control subjects preferentially recognised the immunodominant clusters, I, III and IV. Patients with these narrow epitope specificities had higher median TSH levels (1.60 vs 1.06;P=0.01), and were more frequently positive for antibodies to thyroid peroxidase than those with broad specificities (52.3 vs 7.1%;P=0.004).ConclusionsThe TgAb epitope specificities in euthyroid Sri Lankans with T1DM are similar to AITD patients. TgAb epitope studies may potentially identify T1DM patients at risk of thyroid dysfunction.

Normal neonatal outcome in a Chinese woman with pemphigoid gestationis, Graves? disease, and history of placental chorioangioma

2007 ◽  
Vol 46 (9) ◽  
pp. 996-997
Author(s):  
Kam-lun Ellis Hon ◽  
Lai-shan Mona Chiu ◽  
Man-ching Adrian Lam ◽  
Cheung-lung Paul Choi ◽  
Shirley Chan ◽  
...  
Keyword(s):  
Neonatal Outcome ◽  
Chinese Woman ◽  
Graves Disease ◽  
Pemphigoid Gestationis ◽  
History Of

scholarly journals A prospective study of thyroid function, morphology and autoimmunity in young patients with type 1 diabetes

2003 ◽  
pp. 245-251 ◽  
Author(s):  
D Hansen ◽  
FN Bennedbaek ◽  
M Hoier-Madsen ◽  
L Hegedus ◽  
BB Jacobsen
Keyword(s):  
Type 1 Diabetes ◽  
Thyroid Dysfunction ◽  
Young Patients ◽  
Thyroid Peroxidase ◽  
Diabetic Patients ◽  
Specific Marker ◽  
Autoimmune Thyroid ◽  
High Prevalence

OBJECTIVE: Thyroid autoantibodies (TA) and thyroid ultrasonography are widely used in the diagnosis of autoimmune thyroid disease (AITD). However, we know little of the significance of having ultrasonographic abnormalities (USabn) without having any other signs of AITD. In a previous population-based study of 105 young patients with type 1 diabetes (T1DM) we found a high prevalence (42%) of USabn. In the present study we evaluate the development of both USabn and TA in a 3-Year follow-up of this cohort. DESIGN: Of the 105 previously investigated children and adolescents with T1DM (aged 5-21 Years), 101 were re-examined. Serum concentrations of tri-iodothyronine (T(3)), thyroxine (T(4)), TSH, thyroid peroxidase antibodies (TPOab) and thyroglobulin antibodies (Tgab), as well as thyroid size and morphology were determined in all patients. RESULTS: During the 3 Years follow-up period, the prevalence of thyroid dysfunction increased from 5 to 8%, the prevalence of TPOab was unchanged at 13%, while the prevalence of Tgab decreased from 14 to 7%. The prevalence of USabn increased from 42 to 49%. Most patients presented USabn at both examinations. Patients with USabn had a higher prevalence of TA than those without USabn (P=0.038) and higher serum levels of TSH (P=0.027). All patients with thyroid dysfunction presented with USabn. However, many patients with USabn had no other signs of AITD. CONCLUSIONS: A high prevalence of thyroid dysfunction, TA and thyroid USabn were found in young patients with T1DM. Thyroid USabn was a sensitive but non-specific marker of AITD and is therefore unsuitable for screening purposes. Instead, we recommend regular screening using serum TSH in the follow-up of young diabetic patients.

scholarly journals Thyroid antibody-negative euthyroid Graves’ ophthalmopathy

2016 ◽  
Vol 2016 ◽  
Author(s):  
Arshiya Tabasum ◽  
Ishrat Khan ◽  
Peter Taylor ◽  
Gautam Das ◽  
Onyebuchi E Okosieme
Keyword(s):  
Thyroid Dysfunction ◽  
Rectus Muscle ◽  
Thyroid Peroxidase ◽  
Graves Disease ◽  
List Type ◽  
Inferior Rectus ◽  
Graves Ophthalmopathy ◽  
Long Term Follow Up ◽  
Mri Scans

Summary TSH receptor antibodies (TRAbs) are the pathological hallmark of Graves’ disease, present in nearly all patients with the disease. Euthyroid Graves’ ophthalmopathy (EGO) is a well-recognized clinical entity, but its occurrence in patients with negative TRAbs is a potential source of diagnostic confusion. A 66-year-old female presented to our endocrinology clinic with right eye pain and diplopia in the absence of thyroid dysfunction. TRAbs were negative, as measured with a highly sensitive third-generation thyrotropin-binding inhibitory immunoglobulin (TBII) ELISA assay. CT and MRI scans of the orbit showed asymmetrical thickening of the inferior rectus muscles but no other inflammatory or malignant orbital pathology. Graves’ ophthalmopathy (GO) was diagnosed on the basis of the clinical and radiological features, and she underwent surgical recession of the inferior rectus muscle with complete resolution of the diplopia and orbital pain. She remained euthyroid over the course of follow-up but ultimately developed overt clinical and biochemical hyperthyroidism, 24 months after the initial presentation. By this time, she had developed positive TRAb as well as thyroid peroxidase antibodies. She responded to treatment with thionamides and remains euthyroid. This case highlights the potential for negative thyroid-specific autoantibodies in the presentation of EGO and underscores the variable temporal relationship between the clinical expression of thyroid dysfunction and orbital disease in the natural evolution of Graves’ disease. Learning points Euthyroid Graves’ ophthalmopathy can present initially with negative thyroid-specific autoantibodies. Patients with suggestive symptoms of ophthalmopathy should be carefully evaluated for GO with imaging studies even when thyroid function and autoantibodies are normal. Patients with EGO can develop thyroid dysfunction within 4 years of follow-up underpinning the need for long-term follow-up and continued patient and physician vigilance in patients who have been treated for EGO.

scholarly journals Pandora’s Box: Autoimmune Hypothyroidism Treatment During Pregnancy

2021 ◽  
Vol 28 (4) ◽  
pp. 401-405
Author(s):  
Florina-Paula PAULET ◽  
◽  
Claudia MEHEDINTU ◽  
Marina ANTONOVICI ◽  
Monica Mihaela CIRSTOIU ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Autoimmune Thyroid Disease ◽  
Descriptive Study ◽  
Thyroid Stimulating Hormone ◽  
Obstetrics And Gynecology ◽  
Thyroid Peroxidase ◽  
Thyroglobulin Antibodies ◽  
Autoimmune Thyroid ◽  
Autoimmune Hypothyroidism ◽  
Immunological Markers

There are international protocols for the management of hypothyroidism induced by autoimmune thyroid disease during pregnancy. In this descriptive study, we analyzed the implementation of international protocols regarding these pathologies, in local clinical practice. Analyzing the cases admitted to the Obstetrics and Gynecology department of Bucharest University Emergency Hospital on a period of 55 months, we identified the pregnancies with autoimmune hypothyroidism treated with Levothyroxine (LT4). We determined the prevalence of specific immunological markers for autoimmune hypothyroidism in pregnant women, we analyzed whether they are associated with distinct clinical phenotypes and ultrasound characteristics, and also, we evaluated the treatment of choice. Measurement of thyroglobulin antibodies, thyroid peroxidase antibodies, Thyroid-Stimulating Hormone, free fractions of Triiodothyronine and Thyroxine with substitute treatment instituted early (in the first 2 weeks postnatal) determine the normalization of cognitive development, especially in areas known for iodine deficiency, including Romania.

scholarly journals Prevalence of thyroid dysfunction and anti-thyroid peroxidase antibodies in vitiligo patients

2017 ◽  
Vol 3 (1) ◽  
pp. 140 ◽  
Author(s):  
Jishna P. ◽  
M. P. Binitha ◽  
Abdul Latheef E. N. ◽  
V. P. Anilakumari
Keyword(s):  
Autoimmune Diseases ◽  
Thyroid Dysfunction ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Peroxidase ◽  
Cross Sectional ◽  
Autoimmune Thyroid ◽  
Thyroid Peroxidase Antibodies ◽  
Thyroid Peroxidase Antibody ◽  
Antibody Positivity ◽  
Antibody Levels

<p class="abstract"><strong>Background:</strong> Vitiligo is associated with various autoimmune diseases, including autoimmune thyroid disease. The objectives of the present study was to determine the prevalence of thyroid dysfunction and anti-thyroid peroxidase antibodies in patients with vitiligo, and to compare the clinical profile of anti-thyroid peroxidase positive and anti-thyroid peroxidase negative patients<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> A cross-sectional comparative study was conducted in 100 patients with vitiligo and 100 controls. After dermatologic and systemic evaluation, serum thyroid hormones and anti-thyroid peroxidase antibody levels were measured in all the subjects.<strong></strong></p><p class="abstract"><strong>Results:</strong> Thyroid dysfunction was more common in the vitiligo group (27%) than in the controls. Serum thyroid stimulating hormone abnormalities were more common in the vitiligo group (27%) than in the controls (6%). The most common thyroid dysfunction was subclinical hypothyroidism. Anti-thyroid peroxidase antibody positivity was higher in the vitiligo group (36%) when compared to the controls (24%), and the most common type of vitiligo was vitiligo vulgaris (18%) in this group. Thyroid dysfunction and anti-thyroid peroxidase positivity were more common in women (58%) when compared to men (42%). There was a significantly higher prevalence of other autoimmune diseases in the vitiligo group (20%) compared to the controls (6%)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> This study shows a significant association between vitiligo and thyroid dysfunction, anti-thyroid peroxidase antibodies and other autoimmune diseases. We recommend that thyroid evaluation and regular follow-up should be done in patients with vitiligo for prompt detection of thyroid dysfunction<span lang="EN-IN">.</span></p>

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