Sex: F
Vaccine: COVID19
Symptoms: Angiotensin converting enzyme, Antineutrophil cytoplasmic antibody, Antinuclear antibody increased, Basedow's disease, Blood immunoglobulin G
Clinical narrative: GD relapse; GD relapse; This is a literature report.  A 50 year-old female patient received bnt162b2 (BNT162B2) (Batch/Lot number: unknown) as dose 2, single for covid-19 immunisation. Relevant medical history included: "GD", start date: 2010, stop date: 2010, notes: cured since 2010; "nonsmoking" (unspecified if ongoing); "hypertension" (ongoing); "anxiety" (ongoing); "hypothyroidism" (ongoing); "radioactive iodine" (unspecified if ongoing). The patient's concomitant medications were not reported. Past drug history included: Levothyroxine for hypertension. Vaccination history included: Bnt162b2 (DOSE 1, SINGLE).  The following information was reported: BASEDOW'S DISEASE (medically significant), DISEASE RECURRENCE (medically significant), outcome "unknown" and all described as "GD relapse". The patient underwent the following laboratory tests and procedures: blood thyroid stimulating hormone: normal, notes: T4, and free T3; computerised tomogram: left more than right enlarged, notes: inferior and medial recti muscles without tendon involvement or sinus disease; laboratory test: quantiferon gold for tuberculosis, notes: RPR, RF, ACE, anti-proteinase3 antibody, anti-myeloperodixase antibody, and serum IgG4. She had an elevated ANA; ophthalmological examination: 20.5, notes: OD; 22.5, notes: OS; 5, notes: mm right; 6-7, notes: left; 3, notes: left reduced; 20/25, notes: OD; 20/20-2, notes: OS; thyroid stimulating immunoglobulin (0-0.55): 2.29, notes: elevated. Therapeutic measures were taken as a result of basedow's disease, disease recurrence.  Clinical course: It has been hypothesized that SARS-CoV-2 might cause a wide range of autoimmune/autoinflammatory diseases via molecular mimicry, dysregulated immunity in response to COVID-19, or other as-yet-undiscovered pathways. Antibodies against the SARS-CoV-2 spike protein have been shown to cross-react with various human tissue proteins, including thyroid peroxidase. It has been postulated that vaccines against SARS-CoV-2 may also induce autoimmune reactions. mRNA and adenovirus-vectored vaccines encode, and the inactivated SARS-CoV-2 vaccines contain the SARS-CoV-2 spike protein, the primary target of neutralizing antibodies generated during natural infection. Therefore, cross-reactivity of the spike protein with thyroid antigens following vaccinations seems possible.  Materials and method: Patients diagnosed with SAT or Graves' disease between January and October 2021 who developed symptoms within 4 weeks of receiving the SARS-CoV-2 vaccinations were included in the study. Patients with <4 weeks of follow-up and positive for the polymerase chain reaction test for COVID-19 were excluded. Patients with a history of an upper respiratory infection in the previous 3 months were also precluded. 50 year old female took 1st vaccine of BNT162b2 3 days after she had GD relapse. she is taking Teprotumumab as treatment . previously her GD, cured since 2010. Patient dont have any family history of autoimmune diseases. Discussion: We evaluated the clinical characteristics, management, and follow-up of patients with SARS-COV-2 vaccine-induced SAT and Grave disease. We were able to determine the time to remission with longer follow-up and, at least in part, evaluate whether additional vaccine doses are safe in these patients. BNT162b2 was the type of vaccination that precipitated thyroiditis in all patients with Graves disease and more than half of the patients with SAT. Cases 16 and 18 developed Graves disease after a BNT162b2 booster dose administered 6 months after 2 doses of CoronaVac. Given that prior CoronaVac vaccinations had not induced thyroiditis in either patient and that all reported cases of SARS-CoV-2 vaccine-induced Graves disease in the literature were associated with either mRNA or adenovirus-vectored type vaccines, inactivated SARS-CoV-2 vaccines seem to be safe in terms of inducing Graves disease.  Follow-up (11Feb2022): This is a literature report.This is a follow-up report based on the receipt of the publication; the case has been updated to include additional information identified in the publication..; Sender's Comments: Based on the currently available information the possibility of causal association between the event Graves' disease relapse and the suspect drug BNT162B2  cannot be ruled out. 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.