Title:A Case Report of Conversion from Hashimoto’s Thyroiditis to Graves’
Disease in Type 1 Diabetic Patient Following the COVID-19 Vaccination
Volume: 23
Issue: 3
Author(s): Işılay Taşkaldıran*, Feride Pınar Altay, Yusuf Bozkuş, Özlem Turhan İyidir, Aslı Nar and Neslihan Başçıl Tütüncü
Affiliation:
- Department of Endocrinology and Metabolism, Faculty of Medicine, Başkent University, Ankara, Turkey.
Keywords:
ASIA syndrome, COVID-19 vaccine, Graves’ disease, Hashimoto’s thyroiditis, SARS-CoV2, type 1 diabetes.
Abstract:
Background: A considerable number of COVID-19 vaccines became available following
the outbreak. Yet, various inflammatory and autoimmune complications have been reported
following vaccination. We aimed to report the case of a type 1 diabetic patient converting
from Hashimoto’s thyroiditis to Graves’ disease after the fourth dose of COVID-19 vaccine,
thought to trigger an autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome).
Case Presentation: A thirty-one-year-old female patient with type 1 diabetes and Hashimoto’s
thyroiditis applied to our clinic with complaints of palpitations, anxiety, and weight loss one
month after the fourth dose of COVID-19 vaccine (2 doses of CoronaVac + 2 doses of Pfizer/BioNTech).
She was receiving levothyroxine 50 mcg/day. When her thyroid function tests showed
thyrotoxicosis, we initially considered thyroxine-related exogenous thyrotoxicosis. However,
we considered Graves’ disease upon persisting thyrotoxicosis despite thyroxine withdrawal,
positive serum TSH receptor antibody titers, and other imaging findings. Therefore, various autoimmune
and inflammatory events have been reported after the COVID-19 vaccination. Adjuvants
in vaccines can trigger autoimmune events, which lead to ASIA syndrome. COVID-19
vaccines may cause increased TSH receptor antibody levels or change the balance in the activity
of blocking and stimulating antibodies, which may cause a conversion from Hashimoto’s to
Graves’ disease.
Conclusion: This was the first case report where the patient experienced a conversion from
Hashimoto’s to Graves’ disease after COVID-19 vaccination, which may ultimately be related
to ASIA syndrome. Yet, more data is needed to elucidate such a relationship, and patients should
closely be checked regularly after four doses of vaccination.
