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Endocrine Abstracts (2022) 84 PS1-01-08 | DOI: 10.1530/endoabs.84.PS1-01-08

ETA2022 Poster Presentations COVID & Thyroid Disease (9 abstracts)

Graves’ orbitopathy and subacute thyroiditis related to SARS-CoV-2 infection or vaccination: the experience of a single centre in milan, italy

Ilaria Muller 1 , Erica Crivicich 2 , Francesco Di Marco 2 , Nicola Currò 3 , Maura Arosio 4 & Mario Salvi 5


1University of Milan; Fondazione Irccs Ca’ Granda Policlinico Hospital of Milan, Clinical Sciences and Community Health; Endocrinology; Graves’ Orbitopathy Centre, Milan, Italy; 2Graves Orbitopathy Centre, Endocrine; Fondazione Irccs Ca’ Granda, University of Milan, University of Milan, Milan, Italy; 3Ophthalmology, Fondazione Irccs Cà Granda, Ospedale Maggiore Policlinico, Italy; 4Graves’ Orbitopathy Centre, Endocrinology Department, Fondazione Irccs Ca’ Granda, University of Milan, University of Milan, Clinical Sciences and Community Health, Milan, Italy, Milan, Italy; 5Graves Orbitopathy Centre, Endocrine, Fondazione Irccs Ca’ Granda, University of Milan, Milan, Italy

Background: The Covid-19 pandemic caused by the severe-acute-respiratory-syndrome-coronavirus-2 (SARS-CoV-2) determined millions of deaths worldwide, thus at the end of 2020 a massive vaccination campaign has been launched. SARS-CoV-2 infection and vaccines have been associated with several thyroid disorders, especially subacute thyroiditis (SAT), Graves’ disease (GD) and orbitopathy (GO). We studied the occurrence of SAT and GO following SARS-CoV-2 infection or vaccination in our Centre.

Methods: We recorded all consecutive cases of SAT (new diagnosis) from February 2020 and GO (new diagnosis or sudden worsening) from June 2021 onwards, noting if occurred within 1 month after SARS-CoV-2 infection or vaccines.

Results: Up to March 2022 we have recorded 25 SAT and 28 GO. The onset of SAT occurred within 1 month from SARS-CoV-2 vaccination in 8/25 (32%) and from SARS-CoV2 infection in 4/25 (16%). Among the 28 GO, 11 (39%) occurred within 1 month from SARS-CoV2-vaccination (9 new diagnosis and 2 worsening) and 1 from SARS-CoV2-infection (new diagnosis). Interestingly, 5 (18%) had a GO onset apparently unrelated to SARS-CoV2-vaccination, however had developed GD hyperthyroidism within one month from it. The 19 patients developing SAT or GO after SARS-CoV-2 vaccination had received Pfizer (n = 12), Moderna (n = 3) or AstraZeneca (n = 4); symptoms developed following the first, second or third dose in 8 (42%, mean +13 days), 5 (26%, mean +17 days) and 6 (31% mean +10 days) cases, respectively. A previous documented SARS-CoV-2 infection several months before the vaccination had occurred in 1/19 patients (5%). The mean age of patients was 54±18.17 years (range 21-83 years) and females were 14/19 (73%). A previous history of thyroid disease was present in 3/19 (16%): one subclinical hypothyroidism, one euthyroid nodular goitre, one euthyroid Hashimoto’s thyroiditis. A family history of thyroid disorders was present in 10/19 (52%) patients.

Conclusions: SARS-CoV-2 vaccines seem to be associated with the onset of SAT and the onset or worsening of GO. Possible mechanisms involve the interaction of the spike protein with the ACE-II receptor expressed in thyroid tissue, a cross-reactivity of the spike protein with thyroid self-proteins or an immune reaction induced by adjuvants (ASIA syndrome). Many patients had a positive family history for thyroid disorders, thus a genetic predisposition is likely involved. Until more safety data about SARS-CoV-2 vaccines will be available, caution and strict monitoring of injected individuals is suggested, especially those predisposed to thyroid disorders or autoimmunity.

Volume 84

44th Annual Meeting of the European Thyroid Association (ETA) 2022

Brussels, Belgium
10 Sep 2022 - 13 Sep 2022

European Thyroid Association 

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