Graves Disease Following the SARS-CoV-2 Vaccine: Case Series
A 30-year-old man received the second dose of the SARS-CoV-2 vaccine (Pfizer-BioNTech) and 4 weeks later developed irritability, palpitations, tremors, and restless sleep. These symptoms were accompanied by a 15-pound weight loss over 6 weeks. Thyroid function tests revealed a suppressed TSH of <0.005 µIU/mL, fT4 minimally elevated at 22.9 pmol/L, and T3 normal at 161 pmol/L. He had an elevated TSI and negative TPO and anti-thyroglobulin antibody (ATA). He has no history of thyroid disease and had a normal TSH level 3 years prior. His mother developed Graves disease postpartum. He has no personal or family history of autoimmune disease. Medication was initiated with methimazole 5 mg and atenolol 25 mg daily. Six weeks later, the TSH remained fully suppressed and fT4 was in the normal range at 14.9 pmol/L. His irritability and restless sleep improved; however, he still endorsed occasional palpitations.