Table 3 Characteristics of cases presenting with new-onset GD following COVID-19 vaccination
Case no | Gender | Age (years) | Vaccine type | Dose | Onset time of symptoms (days) | Symptoms | TFTs | Thyroid antibody tests | Thyroid ultrasound | Thyroid scintigraphy | Medication | Follow up | Reference |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | F | 71 | mRNA vaccine | 2nd | 60 | Weight loss, asthenia, and atrial fibrillation | fT4 (29.6 pmol/L), TSH (< 0.005 mIU/L) | TRAb (3.6 IU/L), TPOAb (30 IU/mL), TgAb (< 0.9 IU/mL) | Enlarged thyroid and increased vascularity | Diffuse markedly increased uptake over both lobes | Methimazole | TRAb remained positive after 2 months (from 3.6 to 1.9 U/L) | [32] |
2 | F | 42 | mRNA vaccine | 1st | 10–14 | Weight loss, asthenia, and palpitations | fT4 (37.32 pmol/L), TSH (< 0.005 mIU/L) | TRAb (4.39 IU/L), TPOAb (2.5 IU/mL) | Enlarged thyroid and increased vascularity | Diffuse markedly increased uptake over both lobes | Methimazole | TRAb remained positive after 2 months (4.39 to 2.1 U/L) | |
3 | F | 54 | mRNA vaccine | 2nd | 10–14 | Weight loss, asthenia, and palpitations | fT4 (60.49 pmol/L), TSH (< 0.005 mIU/L) | TRAb (5.1 IU/L), TPOAb (30 IU/mL), TgAb (55 IU/mL) | Enlarged thyroid and increased vascularity | N/A | Methimazole | N/A | |
4 | F | 46 | mRNA vaccine | 1st | 50 | Weight loss, palpitations, and irritability | fT4 (41.18 pmol/L), TSH (< 0.005 mIU/L) | TRAb (3.1 IU/L), TPOAb (60 IU/mL), TgAb (90 IU/mL) | Enlarged thyroid and increased vascularity | N/A | Methimazole | N/A | |
5 | F | 40 | Inactivated vaccine (× 2), mRNA vaccine | After mRNA vaccination | 2 | Palpitations | fT4 (27.92 pmol/L), fT3 (8.79 pmol/L), TSH (< 0.015 mIU/L) | TRAb (10.3 IU/L), TPOAb (195.7 IU/mL), TgAb (7.1 IU/mL) | Diffuse hyperplasia and increased vascularity | Diffusely increased radiotracer uptake | Methimazole | N/A | [33] |
6 | F | 47 | mRNA vaccine | 1st | 5 | Sweating and palpitations | fT4 (42.73 pmol/L), fT3 (16.94 pmol/L), TSH (< 0.01 mIU/L) | TRAb (22.74 IU/L), TPOAb (11.2 IU/mL), TgAb (320 IU/mL) | Diffuse hyperplasia and increased vascularity | N/A | Methimazole and propranolol | The fT4 level decreased to 22.14 pmol/L and fT3 decreased to 6.44 pmol/L after one month | [34] |
7 | F | 46 | mRNA vaccine | 2nd | 21 | Weight loss, emotional lability, sweating, and palpitations | fT4 (100 pmol/L), fT3 (38.96 pmol/L), TSH (< 0.01 mIU/L) | TRAb (9.1 IU/L), TPOAb (146 IU/mL), TgAb (334 IU/mL) | Diffuse hyperplasia and increased parenchymal vascularity | N/A | Methimazole | The fT4 level decreased to 25.35 pmol/L and fT3 decreased to 10.41 pmol/L after one month | |
8 | F | 33 | mRNA vaccine | 1st | 7 | N/A | fT4 (45 pmol/L), TSH (0.01 mIU/L) | TRAb (7.3 IU/L) | N/A | N/A | Carbimazole and propranolol | The fT4 level returned to normal after 28 days | [35] |
9 | F | 37 | mRNA vaccine | 1st | 7 | N/A | fT4 (60 pmol/L), TSH (< 0.01 mIU/L) | TRAb (3.8 IU/L) | N/A | N/A | Carbimazole and propranolol | The fT4 level returned to normal after 32 days | |
10 | F | 37 | mRNA vaccine | 2nd | 21 | N/A | fT4 (72 pmol/L), TSH (< 0.01 mIU/L) | TRAb (11.2 IU/L) | N/A | N/A | Carbimazole and propranolol | The fT4 level returned to normal after 53 days | |
11 | F | 34 | mRNA vaccine | 1st | 26 | N/A | fT4 (68 pmol/L), fT3 (23 pmol/L), TSH (0.01 mIU/L) | TRAb (32 IU/L) | N/A | N/A | Carbimazole and propranolol | The fT4 and fT3 levels returned to normal after 58 days | |
12 | F | 33 | mRNA vaccine | 2nd | 9 | N/A | fT4 (29 pmol/L), TSH (< 0.01 mIU/L) | TRAb (4.6 IU/L) | N/A | N/A | Carbimazole and propranolol | The fT4 level returned to normal after 64 days | |
13 | F | 43 | mRNA vaccine | 2nd | 13 | N/A | fT4 (70 pmol/L), fT3 (> 40 pmol/L), TSH (< 0.01 mIU/L) | TRAb (6.2 IU/L) | N/A | N/A | Carbimazole | The fT4 level returned to normal after 29 days and fT3 returned to normal after 57 days | |
14 | F | 45 | mRNA vaccine | 1st | 2 | Generalised body aches, fever (38 °C), chest tightness, and palpitation | fT4 (45.1 pmol/L), TSH (< 0.005 mIU/L) | TRAb (5.75 IU/L) | Heterogeneous thyroid gland with increased vascularity, a few sub-centimetre solid and cystic nodules | N/A | Carbimazole | N/A | [36] |
15 | M | 46 | mRNA vaccine | 1st | 15 | Asymptomatic (A routine blood test noticed hyperthyroidism.) | fT4 (20.98 pmol/L), fT3 (7.98 pmol/L) | TRAb (2.9 IU/L) | A slightly enlarged thyroid and increased vascularization | A patchy, very inhomogenous 99mtechnetium accumulation and the uptake was normal | N/A | Thyroid function rapidly returned to normal | [37] |
16 | M | 52 | mRNA vaccine | 2nd | 28 | Fever (38 °C), weight loss, and asthenia | fT4 (71.56 pmol/L), fT3 (23.1 pmol/L), TSH (< 0.004 mIU/L) | TRAb (6.48 IU/L), TPOAb (21 IU/mL), TgAb (30 IU/mL) | Enlarged thyroid and increased parenchymal vascularity | N/A | Methimazole and atenolol | The symptoms gradually improved and thyroid function returned to normal after treatment | [38] |
17 | F | 63 | mRNA vaccine | 2nd | 15 | Asymptomatic (A routine blood test noticed hyperthyroidism.) | fT4 (30.9 pmol/L), fT3 (4.6 pmol/L), TSH (0.011 mIU/L) | TRAb (positive), TgAb (positive) | A heterogeneous hypervascular gland along with 2 solid isoechoic nodules measuring 1.4 cm and 2.3 cm | N/A | No medication | The TSH level remained suppressed at 0.01 mIU/L after 6 months | [39] |
18 | M | 30 | mRNA vaccine | 2nd | 28 | Irritability, palpitations, tremors, restless sleep, and weight loss | fT4 (22.9 pmol/L), TSH (< 0.005 mIU/L) | TSI (positive) | N/A | N/A | Methimazole and atenolol | The TSH level remained fully suppressed and the fT4 level decreased to 14.9 pmol/L | |
19 | F | 28 | mRNA vaccine | 1st | 3 | Anxiety, insomnia, palpitations, and distal tremor | fT4 (23.68 pmol/L), fT3 (14.17 pmol/L), TSH (< 0.001 mIU/L) | TRAb (5.85 IU/L), TPOAb (833 IU/mL), TgAb (33 IU/mL) | N/A | N/A | Thiamazole and propranolol | N/A | [40] |
20 | F | 71 | mRNA vaccine | 2nd | 14 | Tachycardia, sweating, shortness of breath, leg swelling, dizziness, fever (37.8 °C), and subsequently developed nausea, diarrhoea, abdominal pain and hand tremors | fT4 (92.66 pmol/L), TSH (< 0.01 mIU/L) | TSI 349% (Normal reference range: < 140% baseline) | A stable multinodular disease | N/A | Methimazole and atenolol | The TSH level remained fully suppressed and the fT4 level decreased to 16.73 pmol/L after one month | [41] |
21 | F | 38 | mRNA vaccine | 1st | 12 | Nervousness, insomnia, and sweating | fT4 (25.87 pmol/L), fT3 (11.49 pmol/L), TSH (< 0.008 mIU/L) | TSI (12.54 UI/mL), TPOAb (3303.71 IU/mL), TgAb (36.57 IU/mL) | A diffuse decrease in echogenicity with some echogenic septum and increased vascularity | A diffuse goitre with hyperfunctioning | Methimazole | N/A | [42] |
22 | F | 32 | mRNA vaccine | 2nd | 38 | Palpitation | fT4 (66.6 pmol/L), fT3 (30.5 pmol/L), TSH (< 0.02 mIU/L) | TSI 420% (Normal reference range: < 140% baseline), TPOAb (239.2 IU/mL), TgAb (7.2 IU/mL) | A heterogeneous background thyroid echogenicity with increase in vascularity | Diffuse markedly increased uptake over both lobes of thyroid, with associated increased blood flow and increased blood pool | Carbimazole and propranolol | Thyroid function was improved after the treatment | [43] |
23 | F | 64 | mRNA vaccine | 1st | 4 | Shortness of breath even on a flat road, and subsequently developed palpitations, worsening respiratory distress, decreased urine output, edema of both lower legs, and fever (38.0 °C) | fT4 (42.73 pmol/L), fT3 (23.2 ng/dL), TSH (< 0.008 mIU/L) | TRAb (33.8 IU/L) | Goiter lesions and an increase in vascularization of the parenchyma | N/A | Thiamazole furosemide, and edoxaban tosilate hydrate | Thyroid function returned to normal after 80 days | [44] |
24 | F | 31 | mRNA vaccine | 2nd | 1 | Excessive sweating, diarrhea, and shortness of breath during exertion | fT4 (96.14 pmol/L), fT3 (44.2 pmol/L), TSH (< 0.005 mIU/L) | TRAb (11.9 IU/L), TPOAb (481 IU/mL), TgAb (82 IU/mL) | Diffuse hyperperfusion in the thyroid gland | Diffuse hyperaccumulation in the thyroid gland | Thiamazole | Thyroid function returned to normal after 3 months | [45] |
25 | M | 22 | mRNA vaccine | 1st | 14 | Subtle tremors in both upper extremities | fT4 (27.3 pmol/L), fT3 (10.9 pmol/L), TSH (0.02 mIU/L) | TRAb (3.76 IU/L) | Heterogeneity of the thyroid parenchyma associated with a marked, diffuse and bilateral intraparenchymal hypervascularization | An increased uptake with homogeneous distribution of the tracer | Methimazole | The patient developed a mild hypothyroidism 6 weeks later. Thyroid function then progressively improved after a thyroid hormone replacement treatment was added | [46] |
26 | F | 44 | mRNA vaccine | 1st | 0 | Asymptomatic | TSH (< 0.01 mIU/L) | TRAb (positive) | Volume was 7.4 mL with hypervascularization in both lobes | N/A | N/A | The patient had a history of Hashimoto's disease and levothyroxine had been reduced to 25 μg, with normal thyroid function | [47] |
27 | F | 43 | mRNA vaccine | 1st | 3 | Palpitations, sleep disorders, muscle weakness, and heat intolerance | fT4 (65.96 pmol/L), TSH (< 0.002 mIU/L) | TRAb (3.1 IU/L) | N/A | A normal size of the gland, with uniform increased uptake of isotope | Thiamazol and propranolol | Thyroid function returned to normal after 3 months | [48] |
28 | M | 42 | mRNA vaccine | 2nd | 2 | Nausea, significant muscle weakness, shortness of breath on exertion, excessive sweating, headache, and difficulty sleeping at night | fT4 (76.71 pmol/L), TSH (0.015 mIU/L) | TRAb (16.1 IU/L) | A prominent heterogeneous and hyperemic gland | Bilateral avid symmetric radionuclide uptake consistent with a hyperfunctioning gland | Methimazole and propranolol | N/A | [49] |
29 | M | 50 | mRNA vaccine | 1st | 14 | Fatigue, palpitations, distal tremor, insomnia, anxiety, nervousness, and irritability | fT4 (25.74 pmol/L), fT3 (16.12 pmol/L), TSH (0.001 mIU/L) | TRAb (5 IU/L) | A diffuse enlargement of the thyroid, associated with hypoechogenicity and increased vascularity | An enlarged gland with diffuse uptake of the radioactive | Methimazole | The signs and symptoms of hyperthyroidism gradually improved and FT3 and FT4 levels returned to normal | [50] |
30 | M | 45 | mRNA vaccine | 1st | 14 | Palpitations, hand tremors, and weight loss | fT4 (82.63 pmol/L), fT3 (42.35 pmol/L), TSH (< 0.01 mIU/L) | TRAb (17.5 IU/L) | A diffuse swelling of the thyroid gland and an uneven internal hypoechoic image | N/A | Thiamazole and bisoprolol | Thyroid function returned to normal and TRAb decreased to 6.3 IU/L after one year | [51] |
31 | M | 29 | mRNA vaccine | 2nd | 120 | Palpitations and mild heat intolerance | fT4 (24.45 pmol/L), fT3 (7.81 pmol/L), TSH (0.008 mIU/L) | TSI (2.9 IU/L) | Heterogeneous echotexture with diffuse hypervascularity and without nodules | A diffuse increased uptake, slightly more intense by the inferior left lobe | Thiamazole | The patient became asymptomatic after three days. The TSH level was still low and fT3 and fT4 levels returned to normal after six months | [52] |
32 | F | 36 | mRNA vaccine | 2nd | 2 | Fever (38.9 °C), headache and palpitations, and cervical pain | fT4 (66.02 pmol/L), fT3 (27.57 pmol/L), TSH (< 0.01 mIU/L) | TRAb (26.6 IU/L) | Slight swelling and a focal hypoechoic area with decreased blood flow | Uptake increased to 2.21% | Thiamazole | Subsequently, the patient became euthyroid | [53] |
33 | F | 31 | mRNA vaccine | 2nd | 2 | Palpitations, anxiety, and weight loss | fT4 (27.8 pmol/L), TSH (< 0.003 mIU/L) | TRAb (2.21 IU/L) | An enlarged thyroid gland with increased parenchymal Vascularization, and numerous isoechoic nodules on both lobes | Diffusely increased uptake in the thyroid gland and hypoactive nodules on both lobes | Methimazole and propranolol | The patient’s symptoms improved with treatment | [54] |
34 | F | 59 | Viral vector vaccine | 1st | 14 | Dyspnea, dizziness, and palpitations | fT4 (29.34 pmol/L), TSH (< 0.0038 mIU/L) | TRAb (positive), TPOAb (< 3.0 IU/mL), TgAb (1494.78 IU/mL) | N/A | N/A | Carbimazole | N/A | [55] |
35 | F | 44 | Viral vector vaccine | 1st | 4 | Tremor, heat intolerance, and weight loss | fT4 (35.26 pmol/L), TSH (< 0.0038 mIU/L) | TRAb (positive), TPOAb (206.64 IU/mL), TgAb (2904.39 IU/mL) | N/A | N/A | Carbimazole | N/A | |
36 | M | 70 | Viral vector vaccine | 2nd | 3 | Exertional dyspnea, myalgia, palpitation, and weight loss | fT4 (41.06 pmol/L), fT3 (> 30.8 pmol/L), TSH (< 0.0036 mIU/L) | TRAb (3.23 IU/L) | N/A | N/A | Methimazole | N/A | [56] |
37 | F | 46 | Viral vector vaccine | 1st | 1 | Chest pain and dyspnea | fT4 (33.92 pmol/L), TSH (0.001 mIU/L) | TRAb (6.42 IU/L), TPOAb (77.72 IU/mL), TgAb (137.5 IU/mL) | Increased vascularity | N/A | N/A | N/A | [57] |
38 | F | 73 | Viral vector vaccine | 2nd | 14 | Weight loss and dyspnea | fT4 (73.8 pmol/L), TSH (< 0.008 mIU/L) | TRAb (6.30 IU/L), TgAb (137.5 IU/mL) | Increased vascularity | N/A | N/A | N/A | |
39 | M | 32 | Viral vector vaccine | 2nd | 4 | Anxiety, tachycardia, and palpitations | fT4 (38.1 pmol/L), fT3 (12.17 pmol/L), TSH (0.005 mIU/L) | TRAb (7.98 IU/L) | Gland enlargement with pseudonodules and hypervascularization | N/A | Propylthiouracil | Thyroid function returned to normal and TRAb level halved on 100 mg/d dose of propylthiouracil after three months | [58] |
40 | M | 35 | Viral vector vaccine | 1st | 5 | Headache, nausea, asthenia, palpitations, tachycardia, mild eyes-redness, and superior palpebral retraction | fT4 (63.84 pmol/L), TSH (< 0.004 mIU/L) | TRAb (3.2 IU/L) | Gland enlargement and hypervascularization | N/A | Propranolol and thiamazole | Thyroid function and TRAb level returned to normal on 5 mg/day dose of thiamazole after three months | |
41 | F | 35 | Viral vector vaccine | 1st | 5 | Palpitations, hyperphagia, heat intolerance, and tremor | fT4 (64 pmol/L), fT3 (> 30 pmol/L), TSH (< 0.02 mIU/L) | TSI (24 IU/L), TPOAb (> 1300 IU/mL), TgAb (33 IU/mL) | A diffusely heterogeneous thyroid, with a marked increase in vascularity | N/A | Carbimazole | N/A | [59] |
42 | M | 20 | Viral vector vaccine | 1st | 7 | Weight loss, tremors, and bulging of the left eyeball | T4 (18.69 μg/dL), T3 (2.5 ng/mL), TSH (0.002 mIU/L) | TRAb (2.6 IU/L) | N/A | N/A | Carbimazol and propranolol | Thyroid function returned to normal after four months and TED remained stable | [60] |
43 | F | 46 | Viral vector vaccine | 1st | 10 | Weight loss and heaviness of both eyes | T4 (21.1 μg/dL), T3 (2.7 ng/mL), TSH (< 0.01 mIU/L) | TRAb (> 40 IU/L), TPOAb (417 IU/mL) | N/A | N/A | Carbimazole and propranolol | Thyroid function returned to normal after two months and TED remained stable | |
44 | F | 19 | Viral vector vaccine | 1st | 28 | Hair loss, palpitation, and weight loss | T4 (14.59 μg/dL), T3 (1.62 ng/mL), TSH (< 0.01 mIU/L) | TRAb (7.32 IU/L), TPOAb (703 IU/mL) | N/A | N/A | Carbimazole and propranolol | Symptoms improved and thyroid function returned to normal after two months | |
45 | F | 37 | Viral vector vaccine | 1st | 14 | Weight loss, palpitation, and increased frequency of defecation | T4 (17.28 μg/dL), T3 (2.1 ng/mL), TSH (< 0.01 mIU/L) | TRAb (4.37 IU/L), TPOAb (116 IU/mL) | N/A | N/A | Carbimazole and propranolol | Thyroid function returned to normal after three months | |
46 | M | 57 | Viral vector vaccine | 1st | 21 | Tremor, palpitations, weight loss, and fatigue | fT4 (51.48 pmol/L), TSH (< 0.005 mIU/L) | TPOAb (positive), TgAb (positive) | A diffusely enlarged gland with increased vascularity | A diffuse goitre with increased uptake | Thiamazole and propranolol | Thyroid function returned to normal after six months | [61] |
47 | F | 68 | Viral vector vaccine | 1st | 30 | Asymptomatic | fT4 (46.33 pmol/L), TSH (< 0.01 mIU/L) | TRAb (14.3 IU/L) | Subcentimeter thyroid nodules in the right and left thyroid lobe | Inappropriately normal uptake bilaterally with a region of relative photon deficiency in the right and left thyroid lobes due to nodules | Methimazole, beta-blocker, and apixaban | N/A | [49] |