LBSAT312 SARS-CoV-2 MRNA Vaccine Side Effects Or Something More? Case Series - Vaccine Induced Mild, Self-limiting Thyroiditis.
Authors: Arora Gunjan , Banjade Rabin , Pethe Gauri , Eshan Shayet Hossain , Qureshi Faisal 
Published: November 2022

Abstract

Introduction
- COVID-19 pandemic hit the world in 2019 and with its advent, began a race against time to curtail its destructive aftermath, which finally seemed plausible with effective vaccination. Malaise, fatigue, dizziness are the most commonly reported side effects of the vaccine. We present a series of two cases which shed light on such symptoms which often remain camouflaged under the background of expectation while indeed, may be linked to biochemical alterations in thyroid functioning causing a state of thyroid dysregulation - a syndrome of vaccine induced mild, self-limiting thyroiditis.

Case presentation
- Two healthy females presented with mild, non-specific symptoms of fatigue and dizziness days to weeks after receiving SARS-CoV-2 mRNA (severe acute respiratory syndrome coronavirus 2 messenger ribonucleic acid) vaccination. Lab work showed hyperthyroidism. They did not exhibit other clinical signs of overt hyperthyroidism. They were managed conservatively with serial hormonal measurements which stabilized over the next couple of months.

Case 1
A 44 year old female presented for an annual visit and reported fatigue and dizziness for 2-3 days. TSH (thyroid stimulating hormone) was &lt;0. 010 (normal 0.27 - 4.20 uIU/ml). She had received the SARS-CoV-2 mRNA vaccine 4 weeks earlier. TSH was repeated in 10 days and remained suppressed at &lt;0. 010 while Free T4 was elevated at 1.92 (normal 0.5-1.6 ng/dL). At Endocrinologist appointment six weeks later TSH normalized at 3.734 and free T4 was low at 0.50. She was advised conservative management. Repeat lab testing in 6 week showed a return to euthyroid state.

Case 2
A 29 year old female presented with dizziness and increased sweating. TSH was &lt;0. 005 (normal 0.27 - 4.20 uIU/ml) and freeT4 2.62 (normal 0.5-1.6 ng/dL). She had received the SARS-CoV-2 mRNA vaccine 2.5 weeks earlier. Tests after one month: TSH 0. 013 and free T4 1. 06. ESR was 1 (normal 0-20 mm/hr). Labs showed a promising trend towards euthyroid state as the TSH had become detectable and the free T4 had normalized, and thus, she was recommended conservative management with repeat laboratory testing in 4-6 weeks.

Discussion
- Post-vaccination nonspecific, often overlooked, symptoms can stem from underlying biochemical abnormalities induced by the vaccines and their interactions with the thyroid gland. Due to the covert nature of these derangements owing to their co-incidentally similar symptomatology and occurrence immediately following vaccination, there is very limited data available on this topic. There is a need to detect, report and investigate this phenomenon to formulate monitoring guidelines, identify certain populations at risk and most importantly, investigate the effects of multiple vaccinations in a series, which is likely on the horizon given the trajectory of SARS-CoV-2 illness, as it can have a huge impact on the burden of thyroid disease in the general population.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.