Sex: F
Vaccine: COVID19
Symptoms: Investigation, Thyroid stimulating immunoglobulin, Thyroxine free, Ultrasound thyroid
Clinical narrative: Graves' disease; This is a literature report from the Thyroid, "A case of graves' disease after the sars-cov-2 vaccine".  The authors present a case of new-onset Graves disease and thyroid storm within one week of SARS-CoV-2 vaccine administration. A 38-year-old woman received the SARS-CoV-2 vaccine (Pfizer- BioNTech) and 5 days later presented to the emergency department with sudden onset left lower quadrant abdominal pain. Her presentation was diagnostic of thyroid storm given her fever, tachycardia to 150 bpm and gastrointestinal symptoms (Burch-Wartofsky score 55). Thyroid function tests revealed TSH 0.008 uIU/mL (reference range 0.55-4.78 uIU/mL) and FT4 8.4 ng/dL (reference range 0.9-1.8 ng/ dL). Additional testing showed TSHrAb 31 IU/L (reference range <1.75 IU/L), TSI >40 (reference range <0.1IU/L) and TPO 1730 IU/mL (reference range <9 IU/mL). Thyroid ultrasound revealed a diffusely enlarged thyroid gland with heterogeneous echogenicity and increased vascularity. She has no personal history or family history of thyroid or autoimmune disease. A CT angiogram performed one year prior incidentally revealed thyroid gland enlargement measuring 7.3cm in transverse diameter. Beta blocker therapy was begun along with methimazole at a total daily dose of 60mg. It was titrated to 80 mg, due to persistent elevation of (free T4 5.1 ng/dL 5 weeks after initiation), with good response 2 weeks later (free T4 2.1 ng/dL). It is difficult to confirm a causal relationship between the SARSCoV- 2 vaccine and Graves disease. However, there have been other cases published of Graves disease occurring after SARS-CoV-2 vaccination. Potential mechanisms by which SARS-CoV-2 vaccines could trigger autoimmune disease are proposed. Adjuvants incorporated in the formulation stimulate autoimmunity in genetically susceptible individuals, a syndrome known as Autoimmune Syndrome Induced by Adjuvants. Molecular mimicry between the spike protein and host antigens could trigger a cross-reaction, inducing autoimmunity. Human antibodies developed against the SARS-CoV-2 spike protein cross-react with many endogenous tissues and substances, including thyroperoxidase. This cross-reactivity could be related to sequence homology between the spike protein and thyroperoxidase.  No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender's Comments: Based on the current limited available information and the drug-event temporal association, a possible contributory role of the suspect product BNT162B2 to the development of event Basedow's disease cannot be excluded. The case will be reassessed if additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.