Table 4 Characteristics of cases presenting with relapsed 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 | M | 49 | mRNA vaccine | 2nd | 30 | Palpitations, hand tremors, and sweating | fT4 (49.68 pmol/L), fT3 (20.79 pmol/L), TSH (< 0.01 mIU/L) | TRAb (3.01 IU/L), TPOAb (435 IU/mL), TgAb (236 IU/mL) | A moderate-to-severe increase in parenchymal vascularity of the thyroid gland | N/A | Methimazole and propranolol | The fT4 level decreased to 18.66 pmol/L and fT3 level decreased to 7.87 pmol/L after one month | [34] |
2 | F | 31 | mRNA vaccine | 1st | 21 | Hot flushes, weakness, and sweating | fT4 (100.00 pmol/L), fT3 (33.42 pmol/L), TSH (< 0.01 mIU/L) | TRAb (19.30 IU/L), TPOAb (325 IU/mL), TgAb (11 IU/mL) | Moderate increase in parenchymal vascularity of the thyroid gland | N/A | Methimazole and propranolol | The fT4 level decreased to 18.40 pmol/L and fT3 level decreased to 9.53 pmol/L after 5 weeks | |
3 | M | 59 | mRNA vaccine | 1st | 21 | N/A | fT4 (49 pmol/L), TSH (< 0.01 mIU/L) | TRAb (12.8 IU/L) | N/A | N/A | Carbimazole | The fT4 level was still elevated | [35] |
4 | F | 74 | mRNA vaccine | 2nd | 11 | Asymptomatic (A routine blood test indicating hyperthyroidism.) | fT4 (14 pmol/L), TSH (0.02 mIU/L) | TRAb (6.2 IU/L) | N/A | N/A | Carbimazole | N/A | |
5 | F | 25 | mRNA vaccine | 2nd | 31 | Asymptomatic (A routine blood test indicating hyperthyroidism.) | fT4 (15 pmol/L), fT3 (6.3 pmol/L), TSH (0.01 mIU/L) | TRAb (2.9 IU/L) | N/A | N/A | Carbimazole | The fT3 level returned to normal after 123 days | |
6 | F | 41 | mRNA vaccine | 2nd | 28 | NA | fT4 (50 pmol/L), TSH (< 0.01 mIU/L) | TRAb (3.9 IU/L) | N/A | N/A | Carbimazole | The fT4 level returned to normal after 31 days | |
7 | F | 24 | mRNA vaccine | 2nd | 63 | Asymptomatic (A routine blood test indicating hyperthyroidism.) | fT4 (20 pmol/L), TSH (0.01 mIU/L) | TRAb (2.4 IU/L) | N/A | N/A | NA | The fT4 level returned to normal after 42 days | |
8 | F | 22 | mRNA vaccine | 1st | 5 | N/A | fT4 (70 pmol/L), fT3 (> 40 pmol/L), TSH (0.01 mIU/L) | TRAb (5.8 IU/L) | N/A | N/A | Carbimazole and propranolol | The fT4 and fT3 levels returned to normal after 178 days | |
9 | F | 71 | mRNA vaccine | 2nd | 25 | Palpitations and sweating | fT4 (45.82 pmol/L), fT3 (17.09 pmol/L) | TRAb (4.2 IU/L) | Multiple confluent anechogenic areas and increased vascularization | Small (partly resected) left lobe and the enlarged right lobe with a patchy inhomogenous tracer distribution and uptake was only mildly increased | N/A | Thyroid function rapidly returned to normal | [37] |
10 | F | 34 | mRNA vaccine | 1st | 5 | Swelling of the eyelids, distal tremor, sweating, thermophobia, dyspnoea on exertion, and weight loss | fT4 (32.69 pmol/L), fT3 (22.01 pmol/L), TSH (< 0.01 mIU/L) | TRAb (> 40 IU/L) | N/A | N/A | Thiamazole | N/A | [62] |
11 | M | 34 | Viral vector vaccine | 1st | 14 | Weight loss | fT4 (26.61 pmol/L), TSH (< 0.008 mIU/L) | TRAb (4.24 IU/L) | Increased vascularity | N/A | N/A | N/A | [57] |
12 | F | 50 | Viral vector vaccine | 1st | 14 | Progressive dyspnoea and palpitations | fT4 (43.76 pmol/L), TSH (0.015 mIU/L) | TRAb (3.77 IU/L), TPOAb (> 1000 IU/mL) | A heterogeneous and hypoechoic thyroid with mildly increased vascularity over the right thyroid lobe | N/A | Propranolol and carbimazole | Thyroid function returned to normal after three months | [63] |
13 | F | 31 | Viral vector vaccine | 1st | 10 | palpitations | fT4 (61.39 pmol/L), TSH (0.015 mIU/L) | TRAb (4.13 IU/L), TPOAb (> 1000 IU/mL) | Heterogeneous and hypoechoic echotexture with increased vascularity | N/A | Carbimazole and propranolol | Thyroid function returned to normal after three months | |
14 | F | 30 | Inactivated vaccine (× 2) Viral vector vaccine | After Viral vector vaccination | 4 | Palpitations and weight loss | N/A | N/A | N/A | N/A | Methimazole | Symptoms of thyrotoxicity were improved. Thyroid function remained T3-toxicosis with elevated TRAb one month after methimazole dose adjustment | [64] |
15 | F | 44 | Inactivated vaccine | 1st | 7 | Sweating, palpitation, and fatigue | fT4 (34.36 pmol/L), fT3 (14.86 pmol/L), TSH (< 0.01 mIU/L) | TRAb (12.18 IU/L), TPOAb (284 IU/mL), TgAb (119 IU/mL) | Hypoechoic areas separated by fibrous septa and increased parenchymal vascularity | N/A | Methimazole and propranolol | N/A | [34] |