Graves Disease Following the SARS-CoV-2 Vaccine: Case Series
A 63-year-old woman received the first dose of the SARS-CoV-2 vaccine (Moderna, Cambridge, Massachusetts) and 1 week later developed a pruritic rash on her neck and upper chest. She had no palpitations, heat intolerance, distal tremor, or diarrhea. She received her second vaccine dose 31 days after the first dose. Four days after receiving the second vaccine dose, thyroid function tests were drawn, which revealed a suppressed TSH of 0.011 µIU/mL and elevated fT4 of 30.9 pmol/L and T3 of 4.6 nmol/L. She had elevated TSHrAb, TSI, and TPO antibody levels. Thyroid ultrasound demonstrated a heterogeneous hypervascular gland along with 2 solid isoechoic nodules measuring 1.4 and 2.3 cm. She has no personal or family history of thyroid disease. Except for a sister and aunt with lupus, there is no other family history of autoimmune disease. She received no recent intravenous contrast. No antithyroid medication or bet-blocker was initiated as the patient was asymptomatic. After 6 months, the TSH remained suppressed at 0.01 µIU/mL with a high-normal fT4 of 21 pmol/L. On thyroid scintigraphy, radiotracer activity was high throughout both thyroid lobes with an elevated 24-hour uptake of 41%, consistent with Graves. The patient remained asymptomatic and no antithyroid medication was initiated.