Table 1.
Reported cases of thyroid eye disease after COVID-19 vaccination
| Country | Age / Sex | Smoking status | Type of vaccine/dose | Post-vaccination symptoms onset | History of GD / TED | Pre-vaccination thyroid status | History of RAI | History of total thyroidectomy | Laboratory test results at diagnosis | CAS | Severity of TED | Rx for TED | Symptoms improvement | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TSH (RR) | fT4 (RR) | fT3 (RR) | TRAb (RR) | TSI (RR) | ||||||||||||||
| Our case | Malaysia | 54 / male | N | mRNA Pfizer / 2nd | 3 weeks | Y / N | Euthyroid with LT | Y (1 year ago) | N | 0.46 (0.35-4.94 mIU/L) |
16.47 (9-19.05 pmol/L) |
4.5 (2.6-5.7 pmol/L) |
3.6 (<1.75 IU/L) |
NA | 4/7 | Moderate-to-severe | MTP | Yes (after 3rd infusion) |
| Case 110 | United States | 51 / female | N | mRNA Pfizer / 2nd | 4 days | N / N | Euthyroid | N | N | <0.01 (0.27-4.2 mIU/L) |
3.72 (0.93-1.7 ng/dL) |
12.6 (2-4.4 ng/dL) |
5.04 (<1.5 IU/L) |
NA | 3/7 | Mild | Thyroidectomy | Yes |
| Case 215 | United States | 50 / female | N | mRNA Pfizer / 2nd | 3 days | Y / N | Euthyroid with LT | Y (12 years ago) | N | Normal | Normal | Normal | NA | 2.29 (<0.55 IU/L) |
5/7 | Moderate-to-severe | Teprotumumab | Yes (after 2nd infusion) |
| Case 316 | United States | 66 / female | N | mRNA Moderna / 2nd | 3 weeks | Y / Y* | Euthyroid with LT | Y (15 years ago) | N | 0.04 (0.3-5.0 uIU/mL |
1.7 (0.7-1.7 ng/dL) |
NA | 5.51 (<1.5 IU/L) |
3.91 (<0.55 IU/L) |
6/10 | Moderate-to-severe | Teprotumumab | Yes (at 5 months) |
| Case 416 | United States | 53 / female | N | mRNA Pfizer / 1st | 1 day | N / N | Euthyroid | N | N | 0.99 uIU/mL (0.3-5.0 uIU/mL |
0.9 (0.7-1.7 ng/dL) |
NA | NA | 3.21 (<0.55 IU/L) |
NA | Moderate-to-severe | Teprotumumab | Yes (at 8 months) |
| Case 516 | United States | 45 / female | N | mRNA Moderna / 1st | 3 weeks | Hashimoto / Y* | Euthyroid with LT | N | N | Abnormal | Abnormal | NA | NA | NA | NA | Mild-to-moderate | No Rx | Yes |
| Case 617 | Italy | 58 / female | NA | mRNA Pfizer / 2nd | 3 days | Y / Y* | Euthyroid with LT | Y (2 years ago) | N | 1.17 (0.4-4.00 mIU/L) |
1.26 (0.7-1.7 ng/dL) |
3.54 (2.7-5.7 ng/dL) |
6.82 (<1.5 IU/L) |
NA | 6/10 | Moderate-to-severe | Teprotumumab | NA |
| Case 717 | Italy | 43 / male | NA | mRNA Pfizer / 1st | 2 weeks | Y / Y* | Euthyroid with MMI | N | N | 2.316 (0.4-4.00 mIU/L) |
0.96 (0.7-1.7 ng/dL) |
3.4 (2.7-5.7 ng/dL) |
20.7 (<1.5 IU/L) |
NA | NA | Sight-threatening disease | NA | NA |
| Case 818 | United States | 51 / female | Former smoker | mRNA Moderna / 2nd | 2 weeks | Y / Y* | NA | NA | NA | NA | NA | NA | NA | NA | 9/10 | NA | Prednisolone, teprotumumab, orbital decompression | Yes (13 months after teprotumumab, 2 months after surgery) |
| Case 919 | United States | 50 / male | N | mRNA Pfizer / 2nd | 3 weeks | Y / Y* | Euthyroid with LT | N | Y | 2.3 mIU/L | NA | NA | NA | 4.46 (<1.75 IU/L) |
7/10 | Moderate-to-severe | MTP, tocilizumab and teprotumumab | Yes (after 3rd teprotumumab infusion) |
| Case 1019 | United States | 71 / female | N | mRNA Moderna / 2nd | 3 days | Hypothyroidism / N | Euthyroid with LT | N | N | Undetectable | 1.4 (0.93-1.70 ng/dL) |
3.9 (2.3-4.2 ng/dL) |
NA | 5.5 (≤1.3) | 4/7 | Moderate-to-severe, progressed to sight-threatening disease | MTP followed by teprotumumab | Yes (after 3rd teprotumumab infusion) |
| Case 1120 | France | 70 / female | NA | mRNA Pfizer / 2nd | 60 days | Y / Y* | Euthyroid with LT | N | Y | 1.65 mIU/L | 20 pmol/l | NA | >40 IU/L | NA | 4/7 | Moderate-to-severe | Prednisolone, tocilizumab | Yes (after 2 weeks of tocilizumab infusion) |
| Case 1220 | France | 43 / male | NA | mRNA Moderna / 1st | 1 day | Y / Y* | Mild hypothyroid with CBZ | N | N | 4.04 mIU/L | 6.2 pmol/l | NA | Absent | NA | 7/7 | Sight-threatening disease | Tocilizumab | Yes (after 1st infusion) |
| Case 1320 | France | 73 / male | NA | mRNA Pfizer / 1st | 21 days | Y / N | Euthyroid with CBZ | N | N | 2.4 mIU/L | NA | NA | Normal | NA | 3/7 | Mild | Selenium,MTP | Yes (after 1st infusion |
| Case 1420 | France | 45 / female | NA | mRNA Moderna / 2nd | NR | Y / Y* | Euthyroid with LT | N | Y | 0.76 mIU/L | NA | NA | 151 IU/L | NA | 4/7 | Moderate-to-severe | Lubricants | Yes (at 5 months) |
| Case 1520 | France | 48 / male | NA | mRNA Moderna / 2nd | 30 days | Y / Y* | NR | N | Y | <0.01 mIU/L | 21 pmol/l | NA | 28 IU/L | NA | 5/7 | Sight-threatening disease | MTP, orbital decompression, teprotumumab | Yes (after 1st infusion) |
| Case 1620 | France | 39 / female | NA | mRNA Pfizer / 1st | 7 days | N / N | Euthyroid | N | N | 0.3 mIU/L | NA | NA | 5 IU/L | NA | 2/7 | Mild | Selenium | Unchanged |
GD: Graves’ disease; TED: thyroid eye disease; TSH: thyroid-stimulating hormone; fT4: free thyroxine; fT3: free triiodothyronine; TRAb: TSH receptor antibody; TSI: thyroid stimulating immunoglobulin; CAS: Clinical activity score; MMI: methimazole; CBZ: carbimazole; LT: levothyroxine; MTP: Methylprednisolone; NA: not available; Y: yes; N: no; RR: reference range.
*
Stable disease after receiving Rx for TED