Endocrine Abstracts

Introduction: Subacute thyroiditis (SAT) has been reported after COVID-19 infection and SARS-CoV-2 vaccination. SAT has a mild and self-limiting course. This is the first reported case of thyroid storm following the SARS-CoV-2 vaccine

Case: A 32-year-old female patient had mild anterior neck pain, fatigue, tremor 2 weeks after being administered with the second dose of COVID-19 mRNA vaccine BNT162b2 (Pfizer–BioNTech). Initial biochemical investigations were consistent with thyrotoxicosis (Figure 1). The patient was prescribed a non-steroidal anti-inflammatory drug. After the following two weeks, she developed sweats, palpitations, hand tremor, dizziness, generalized numbness, fever, fatigue, headache and mild vomiting. The physical examination in the emergency department revealed a weak, anxious, agitated woman. She was tachycardic at 127 beats per minute, tachypneic (30 breaths per minute), and mildly hypertensive (140/95 mmHg). However, there was moderate tenderness on palpation of the anterior neck. The diagnosis of thyroid storm was made on a clinical basis according to the Burch and Wartofsky’ criteria. She was hospitalized and managed by intensive monitoring, giving propranolol (40 mg×4) and hydrocortisone (50 mg×4, intravenous). Graves’ disease couldn’t be excluded completely. The sedimentation rate was moderately high (ESR: 47 mm/hr), CRP (3.23 mg)/l) was normal and there were no previously measured values. Propylthiouracil 4x50 mg/day added to treatment. At the 48th hour of the treatment, increased serum liver enzymes (ALT:375 and AST:150 U/l) were detected and antithyroid drug therapy was discontinued. However, the patient responded poorly to the treatment, her thyroid free hormone levels were very high. The patient underwent two plasma exchange procedure. There was no previous history of thyroid disease, upper respiratory tract or COVID-19 infection. She reported neck pain which is typical for subacute thyroiditis developing two weeks after vaccination. Thyroid autoantibodies were negative. Thyroid ultrasound showed diffusely enlarged gland parenchyma with a heterogeneous echotexture and decreased vascular flow. The technetium 99m scintigraphy of thyroid which was performed 4 days after the antithyroid drug discontinuation has revealed a poorly visualized thyroid gland. She was discharged home on oral steroids and a beta-blocker. The changes in her thyroid functions overtime are presented in Figure 1. The patient achieved euthyroid state 1 month after being discharged from the hospital.

Conclusions: We herein present a case of thyroid storm related to SAT -reported for the first time- following SARS-CoV-2 vaccination. Clinicians should be aware of the rare post-vaccine side effects.