Graves Disease Following the SARS-CoV-2 Vaccine: Case Series
A 38-year-old woman received the SARS-CoV-2 vaccine (Pfizer-BioNTech, New York, New York) and 5 days later presented to the emergency department with sudden onset left lower quadrant abdominal pain. Her presentation was consistent with thyroid storm given her fever, tachycardia to 140 beats per minute, and gastrointestinal symptoms (Burch-Wartofsky score 55).\nThyroid function tests revealed suppressed thyrotropin (TSH) of <0.008 µIU/mL, elevated free thyroxine (fT4) of 108 pmol/L, and elevated total triiodothyronine (T3) of 10.3 nmol/L. Thyrotropin receptor antibody (TSHrAb), thyroid-stimulating immunoglobulin (TSI), and anti-thyroid peroxidase (TPO) levels were all elevated. Ultrasonography revealed a diffusely enlarged thyroid gland with heterogeneous echogenicity and increased vascularity consistent with Graves. She has no personal or family history of thyroid or autoimmune disease. A computed tomography (CT) angiogram performed 1 year prior incidentally revealed thyroid gland enlargement measuring 7.3 cm in transverse diameter. She was treated with methimazole at a total daily dose of 60 mg titrated up to 80 mg along with propranolol 40 mg 3 times daily. After 2 months, fT4 decreased to 66 pmol/L, and after 3 months, it normalized to 23 pmol/L, while on methimazole, 80 mg daily in divided doses. After a discussion of the risks and benefit of administering the second vaccine, she decided to postpone the dose. She reported improved energy level and denied recurrence of palpitations or abdominal pain.