Subacute Thyroiditis Associated with SARS-CoV-2 Vaccines: Pandemic Hospital Experience

Yıl 2023, Cilt: 49 Sayı: 3, 313 - 318, 31.12.2023

Ayşen Akkurt Kocaeli , Sümeyye Memet

https://doi.org/10.32708/uutfd.1367704

Öz

Subacute thyroiditis (SAT) is a self-limiting inflammatory disease. This study aimed to describe the characteristics of coronavirus disease 2019 (COVID-19) vaccine-associated subacute thyroiditis cases. Forty-five patients diagnosed before the pandemic period and 19 patients diagnosed with SAT within three months after the COVID-19 vaccine were included in this retrospective study. Demographic, clinical characteristics, laboratory parameters, and ultrasonography findings of the patients were recorded. In addition, the type of vaccines they received, the time until SAT appeared after vaccination, the treatment given, and the response to treatment were evaluated. The demographics, clinical characteristics, laboratory parameters, and treatments they received were similar between the SAT group (Group-1) (n=19) associated with the COVID-19 vaccine and the SAT group (n=45) (Group-2) detected before the pandemic. Only serum C-reactive protein and mean erythrocyte sedimentation rate were higher in Group-2 than in Group-1 (p <0.05). During follow-up, euthyroid cases were detected in 15/19 (78.9%) and 15/45 (33.3%) in Group-1 and Group-2, respectively (p<0.05). There was no difference in relapse rates. SAT was observed in 7 patients after the inactive COVID-19 vaccine and 12 patients after the mRNA COVID-19 vaccine. The median time to symptom onset after vaccination was 11 (4-45) days. As COVID-19 vaccination rates increased during the pandemic, vaccine-related SAT cases became more common. This study showed that COVID-19 vaccine-associated cases have diagnostic features and clinical courses similar to classical SAT.

Anahtar Kelimeler

Subacute thyroiditis, COVID-19, SARS-CoV-2 vaccine, Pandemic.

SARS-CoV-2 Aşısıyla İlişkili Subakut Tiroidit: Pandemi Hastanesi Deneyimi

Öz

Subakut tiroidit (SAT), kendi kendini sınırlayan inflamatuar bir hastalıktır. Bu çalışma, koronavirüs hastalığı 2019 (COVID-19) aşısıyla ilişkili subakut tiroidit vakalarının özelliklerini tanımlamayı amaçlamıştır. Retrospektif yapılan çalışmaya pandemi dönemi öncesi tanı alan 45 hasta ve COVİD-19 aşısından sonraki üç ay içinde SAT tanısı alan 19 hasta dahil edildi. Hastaların demografik, klinik özellikleri, laboratuvar parametreleri ve ultrasonografi bulguları kaydedildi. Ayrıca yaptırdıkları aşıların türü, aşı sonrası SAT ortaya çıkana kadar geçen süre, verilen tedavi ve tedaviye yanıt değerlendirildi. COVID-19 aşısı ile ilişkili SAT grubu (Grup-1) (n=19) ile pandemi öncesi saptanan SAT grubunun (n=45) (Grup-2) demografik, klinik özellikleri, laboratuvar parametreleri ve aldıkları tedaviler benzerdi. Sadece serum C-reaktif protein ve ortalama eritrosit sedimantasyon hızı Grup-2’de Grup-1’e göre daha yüksekti (p <0,05). Takip sırasında Grup-1 ve Grup-2’de ötiroid saptanan vakalar sırasıyla 15/19 (%78,9), 15/45 (%33,3) saptandı (p<0.05). Nüks oranları arasında fark yoktu. İnaktif COVID-19 aşısı sonrası 7 hastada, mRNA COVID-19 aşısı sonrası ise 12 hastada SAT gözlendi. Aşılamadan sonra semptomların başlamasına kadar geçen ortanca süre 11 (4-45) gündü. Pandemi döneminde COVID-19 aşılama oranlarının artmasıyla birlikte aşı ilişkili SAT vakalarına daha sık rastlanmıştır. Bu çalışma, COVID-19 aşısı ile ilişkili vakaların pandemi dönemi öncesi görülen SAT vakaları ile benzer tanısal özelliklere ve klinik gidişata sahip olduğunu göstermiştir.

Anahtar Kelimeler

Subakut tiroidit, COVİD-19, SARS-CoV-2 aşısı, Pandemi

Kaynakça

• 1. Aemaz Ur Rehman M, Farooq H, Ali MM, Ebaad Ur Rehman M, Dar QA, Hussain A. The Association of Subacute Thyroiditis with COVID-19: a Systematic Review. SN Compr Clin Med. 2021; 3(7):1515-1527.
• 2. Fatourechi V, Aniszewski JP, Fatourechi GZ, Atkinson EJ, Jacobsen SJ. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study. J Clin Endocrinol Metab. 2003; 88(5):2100-2105.
• 3. Stasiak M, Lewiński A. New aspects in the pathogenesis and management of subacute thyroiditis. Rev Endocr Metab Disord. 202; 22(4): 1027-1039.
• 4. Meftah E, Rahmati R, Zari Meidani F, Khodadadi S, Chitzan-Zadeh K, Esfahanian F, Afshar S. Subacute thyroiditis following COVID-19: A systematic review. Front Endocrinol (Lausanne). 2023; 14: 1126637.
• 5. Li M, Li L, Zhang Y, Wang X. An investigation of the expression of 2019 novel coronavirus cell receptor gene ACE2 in a wide variety of human tissues. Infect Dis Poverty. 2020; 9(1): 45.
• 6. Ippolito S, Gallo D, Rossini A, Patera B, Lanzo N, Fazzino GFM et al. SARS-CoV-2 vaccine-associated subacute thyroiditis: insights from a systematic review. J Endocrinol Invest. 2022; 45(6): 1189-1200.
• 7. İremli BG, Şendur SN, Ünlütürk U. Three Cases of Subacute Thyroiditis Following SARS-CoV-2 Vaccine: Post-vaccination ASIA Syndrome. J Clin Endocrinol Metab. 2021; 106(9): 2600-2605.
• 8. Sözen M, Topaloğlu Ö, Çetinarslan B, et al. COVID-19 mRNA vaccine may trigger subacute thyroiditis. Hum Vaccin Immunother. 2021; 17(12): 5120-5125.
• 9. Ünübol M, Erdemir Z, Çolak G, Ünsal MG, Güney E. Subacute thyroiditis associated with COVID-19 infection: two case reports. Turkish J Endocrinol Metab. 2021; 25(3): 344-348.
• 10. Jafarzadeh A, Nemati M, Jafarzadeh S, Nozari P, Mortazavi SMJ. Thyroid dysfunction following vaccination with COVID-19 vaccines: a basic review of the preliminary evidence. J Endocrinol Invest. 2022; 45(10): 1835-1863.
• 11. Saygılı ES, Karakilic E. Subacute thyroiditis after inactive SARS-CoV-2 vaccine. BMJ Case Rep. 2021; 14(10): e244711.
• 12. Topaloğlu Ö, Tekin S, Topaloğlu SN, Bayraktaroglu T. Differences in Clinical Aspects Between Subacute Thyroiditis Associated with COVID-19 Vaccines and Classical Subacute Thyroiditis. Horm Metab Res. 2022; 54(6): 380-388.
• 13. Bostan H, Kayihan S, Calapkulu M, Hepsen S, Gul U, Ozturk Unsal I et al. Evaluation of the diagnostic features and clinical course of COVID-19 vaccine-associated subacute thyroiditis. Hormones (Athens). 2022; 21(3): 447-455.
• 14. Bostan H, Unsal IO, Kizilgul M, Gul U, Sencar ME, Ucan B, Cakal E. Two cases of subacute thyroiditis after different types of SARS-CoV-2 vaccination. Arch Endocrinol Metab. 2022; 66(1): 97-103.
• 15. Şendur SN, Oğuz SH, Ünlütürk U. COVID-19 vaccination and thyroiditis. Best Pract Res Clin Endocrinol Metab. 2023; 37(4): 101759.
• 16. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016; 26(10): 1343-1421.
• 17. Jafarzadeh A, Nemati M, Jafarzadeh S, Nozari P, Mortazavi SMJ. Thyroid dysfunction following vaccination with COVID-19 vaccines: a basic review of the preliminary evidence. J Endocrinol Invest. 2022; 45(10):1835-1863.
• 18. Bahçecioğlu AB, Karahan ZC, Aydoğan BI, Kalkan IA, Azap A, Erdoğan MF. Subacute thyroiditis during the COVID-19 pandemic: a prospective study. J Endocrinol Invest. 2022; 45(4): 865-874.
• 19. Kyriacou A, Ioakim S, Syed AA. COVID-19 vaccination and a severe pain in the neck. Eur J Intern Med. 2021; 94: 95-96.
• 20. Oyibo SO. Subacute Thyroiditis After Receiving the Adenovirus-Vectored Vaccine for Coronavirus Disease (COVID-19). Cureus. 2021;13(6): e16045.
• 21. Batman A, Yazıcı D, Dikbaş O, Ağbaht K, Saygılı ES, Demirci İ et al. Subacute THYROiditis Related to SARS-CoV-2 VAccine and Covid-19 (THYROVAC Study): A Multicenter Nationwide Study. J Clin Endocrinol Metab. 2023;108(10):e1013-e1026.
• 22. Alameh MG, Tombácz I, Bettini E, Lederer K, Sittplangkoon C, Wilmore JR et al. Lipid nanoparticles enhance the efficacy of mRNA and protein subunit vaccines by inducing robust T follicular helper cell and humoral responses. Immunity. 2021;54(12):2877-2892.
• 23. Sahin Tekin M, Yorulmaz G, Yantir E, Gunduz E, Colak E. A Novel Finding of an HLA Allele's and a Haplotype's Relationship with SARS-CoV-2 Vaccine-Associated Subacute Thyroiditis. Vaccines (Basel). 2022;10(12):1986.